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Sample records for chronic low-back pain

  1. Low back pain - chronic

    Science.gov (United States)

    ... as scoliosis or kyphosis Medical problems, such as fibromyalgia or rheumatoid arthritis Piriformis syndrome, a pain disorder ... used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed ...

  2. Nordic walking and chronic low back pain

    DEFF Research Database (Denmark)

    Morsø, Lars; Hartvigsen, Jan; Puggaard, Lis;

    2006-01-01

    Low Back Pain is a major public health problem all over the western world. Active approaches including exercise in the treatment of low back pain results in better outcomes for patients, but it is not known exactly which types of back exercises are most beneficial or whether general physical....... Until now no studies have been performed to investigate whether Nordic Walking has beneficial effects in relation to low back pain. The primary aim of this study is to investigate whether supervised Nordic Walking can reduce pain and improve function in a population of chronic low back pain patients...

  3. Acute and chronic low back pain.

    Science.gov (United States)

    Patrick, Nathan; Emanski, Eric; Knaub, Mark A

    2014-07-01

    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.

  4. Chronic low back pain in housewives

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    Mehmet Bulut

    2011-09-01

    Full Text Available Objectives: The aim of this study is to investigate low back pain of housewives and to deteremine relationships between psychological status, education and physical health in housewives.Materials and methods: Thirty premenopausal housewives aged 33-45 years with chronic low back pain were included and the control group consisted of 30 healthy premenopausal housewives. Physical examinations were performed. Age, height, weight, educational level, number of children, consumption of cigarettes and alcohol were recorded. The body mass index (BDI was measured. The severity of back pain was measured by the Oswestry Disability Index (ODI, psychological status was evaluated by the Beck Depression Inventory (BDI and muscle strength by manual technique.Results: There was no difference between demographic data of patients and controls. BDI scores of patients were significantly higher than the controls (p<0,01. Abdominal and dorsal muscle strength were higher in the control group but different was not significant. OBAS values in the patient group, were positively correlated with BDI and BMI (p= 0.011; p= 0.001, respectively, and negatively correlated with abdominal and dorsal muscle strength (p= 0.006 and p= 0.001. Significant correlations were found between abdominal and dorsal muscle strength and the BMI, ODI and BDI scores and high educational level positively affected the ODI and the BDI scores in patients.Conclusion: The housewives with chronic back pain and do not exercise regularly limit activities of daily living. Because of higher BDI scores of patients with chronic low back pain, these patients should also undergo psychiatric examination. J Clin Exp Invest 2011; 2 (3: 295-298.

  5. Central sensitization in chronic low back pain: A narrative review.

    Science.gov (United States)

    Sanzarello, Ilaria; Merlini, Luciano; Rosa, Michele Attilio; Perrone, Mariada; Frugiuele, Jacopo; Borghi, Raffaele; Faldini, Cesare

    2016-11-21

    Low back pain is one of the four most common disorders in all regions, and the greatest contributor to disability worldwide, adding 10.7% of total years lost due to this health state. The etiology of chronic low back pain is, in most of the cases (up to 85%), unknown or nonspecific, while the specific causes (specific spinal pathology and neuropathic/radicular disorders) are uncommon. Central sensitization has been recently recognized as a potential pathophysiological mechanism underlying a group of chronic pain conditions, and may be a contributory factor for a sub-group of patients with chronic low back pain. The purposes of this narrative review are twofold. First, to describe central sensitization and its symptoms and signs in patients with chronic pain disorders in order to allow its recognition in patients with nonspecific low back pain. Second, to provide general treatment principles of chronic low back pain with particular emphasis on pharmacotherapy targeting central sensitization.

  6. Do illness perceptions of people with chronic low back pain differ from people without chronic low back pain?

    NARCIS (Netherlands)

    van Wilgen, C. Paul; van Ittersum, Miriam W.; Kaptein, Ad A.

    2013-01-01

    Objectives To determine why some people develop chronic low back pain, and whether illness perceptions are an important risk factor in the transition from acute to chronic low back pain. Design Cross-sectional study. Participants Four hundred and two members of the general Dutch population, with and

  7. Core strength training for patients with chronic low back pain.

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    Chang, Wen-Dien; Lin, Hung-Yu; Lai, Ping-Tung

    2015-03-01

    [Purpose] Through core strength training, patients with chronic low back pain can strengthen their deep trunk muscles. However, independent training remains challenging, despite the existence of numerous core strength training strategies. Currently, no standardized system has been established analyzing and comparing the results of core strength training and typical resistance training. Therefore, we conducted a systematic review of the results of previous studies to explore the effectiveness of various core strength training strategies for patients with chronic low back pain. [Methods] We searched for relevant studies using electronic databases. Subsequently, we evaluated their quality by analyzing the reported data. [Results] We compared four methods of evaluating core strength training: trunk balance, stabilization, segmental stabilization, and motor control exercises. According to the results of various scales and evaluation instruments, core strength training is more effective than typical resistance training for alleviating chronic low back pain. [Conclusion] All of the core strength training strategies examined in this study assist in the alleviation of chronic low back pain; however, we recommend focusing on training the deep trunk muscles to alleviate chronic low back pain.

  8. Effect of Iyengar yoga therapy for chronic low back pain.

    Science.gov (United States)

    Williams, Kimberly Anne; Petronis, John; Smith, David; Goodrich, David; Wu, Juan; Ravi, Neelima; Doyle, Edward J; Gregory Juckett, R; Munoz Kolar, Maria; Gross, Richard; Steinberg, Lois

    2005-05-01

    Low back pain is a significant public health problem and one of the most commonly reported reasons for the use of Complementary Alternative Medicine. A randomized control trial was conducted in subjects with non-specific chronic low back pain comparing Iyengar yoga therapy to an educational control group. Both programs were 16 weeks long. Subjects were primarily self-referred and screened by primary care physicians for study of inclusion/exclusion criteria. The primary outcome for the study was functional disability. Secondary outcomes including present pain intensity, pain medication usage, pain-related attitudes and behaviors, and spinal range of motion were measured before and after the interventions. Subjects had low back pain for 11.2+/-1.54 years and 48% used pain medication. Overall, subjects presented with less pain and lower functional disability than subjects in other published intervention studies for chronic low back pain. Of the 60 subjects enrolled, 42 (70%) completed the study. Multivariate analyses of outcomes in the categories of medical, functional, psychological and behavioral factors indicated that significant differences between groups existed in functional and medical outcomes but not for the psychological or behavioral outcomes. Univariate analyses of medical and functional outcomes revealed significant reductions in pain intensity (64%), functional disability (77%) and pain medication usage (88%) in the yoga group at the post and 3-month follow-up assessments. These preliminary data indicate that the majority of self-referred persons with mild chronic low back pain will comply to and report improvement on medical and functional pain-related outcomes from Iyengar yoga therapy.

  9. Lumbar motion changes in chronic low back pain patients

    DEFF Research Database (Denmark)

    Mieritz, Rune M; Hartvigsen, Jan; Boyle, Eleanor;

    2014-01-01

    BACKGROUND CONTEXT: Several therapies have been used in the treatment of chronic low back pain, including various exercise strategies and spinal manipulative therapy. A common belief is that spinal motion changes in particular ways in direct response to specific interventions, such as exercise....../SETTING: Secondary analysis of a subset of participants from a randomized clinical trial. PATIENT SAMPLE: 199 study participants with low back pain of more than six weeks' duration who had spinal motion measures obtained before and after the period of intervention. OUTCOME MEASURES: Lumbar region spinal kinematics......, the motion parameters included in the analysis. The spinal manipulation group changed to a smoother motion pattern (reduced jerk index) while the exercise groups did not. CONCLUSION: This study provides evidence that spinal motion changes can occur in chronic low back pain patients over a 12-week period...

  10. Low back pain.

    Science.gov (United States)

    Delitto, Anthony; George, Steven Z; Van Dillen, Linda R; Whitman, Julie M; Sowa, Gwendolyn; Shekelle, Paul; Denninger, Thomas R; Godges, Joseph J

    2012-04-01

    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.

  11. Chronic Low Back Pain due to Retroperitoneal Cystic Lymphangioma

    Directory of Open Access Journals (Sweden)

    Asieh Sadat Fattahi

    2014-03-01

    Full Text Available Abdominal cystic lymphangioma is a rare benign neoplasm. Less than 1% of lymphangiomas is in the retroperitoneum. Lymphangioma is mostly asymptomatic. Chronic symptoms were reported in retroperitoneal type more than others. Acute symptoms due to complications like infection, cyst rupture or hemorrhage may occur. We report an 18-years-old girl with low back pain from 6 months ago with huge pelvic mass and diagnosis of retroperitoneal cystic lymphangioma.

  12. Chronic Low Back Pain due to Retroperitoneal Cystic Lymphangioma

    Directory of Open Access Journals (Sweden)

    Asieh Sadat Fattahi

    2014-03-01

    Full Text Available   Abdominal cystic lymphangioma is a rare benign neoplasm. Less than 1% of lymphangiomas is in the retroperitoneum. Lymphangioma is mostly asymptomatic. Chronic symptoms were reported in retroperitoneal type more than others. Acute symptoms due to complications like infection, cyst rupture or hemorrhage may occur. We report an 18-years-old girl with low back pain from 6 months ago with huge pelvic mass and diagnosis of retroperitoneal cystic lymphangioma.

  13. Naturopathic care for chronic low back pain: a randomized trial.

    Directory of Open Access Journals (Sweden)

    Orest Szczurko

    Full Text Available OBJECTIVE: Chronic low back pain represents a substantial cost to employers through benefits coverage and days missed due to incapacity. We sought to explore the effectiveness of Naturopathic care on chronic low back pain. METHODS: This study was a randomized clinical trial. We randomized 75 postal employees with low back pain of longer than six weeks duration to receive Naturopathic care (n = 39 or standardized physiotherapy (n = 36 over a period of 12 weeks. The study was conducted in clinics on-site in postal outlets. Participants in the Naturopathic care group received dietary counseling, deep breathing relaxation techniques and acupuncture. The control intervention received education and instruction on physiotherapy exercises using an approved education booklet. We measured low back pain using the Oswestry disability questionnaire as the primary outcome measure, and quality of life using the SF-36 in addition to low back range of motion, weight loss, and Body Mass Index as secondary outcomes. RESULTS: Sixty-nine participants (92% completed eight weeks or greater of the trial. Participants in the Naturopathic care group reported significantly lower back pain (-6.89, 95% CI. -9.23 to -3.54, p = <0.0001 as measured by the Oswestry questionnaire. Quality of life was also significantly improved in the group receiving Naturopathic care in all domains except for vitality. Differences for the aggregate physical component of the SF-36 was 8.47 (95% CI, 5.05 to 11.87, p = <0.0001 and for the aggregate mental component was 7.0 (95% CI, 2.25 to 11.75, p = 0.0045. All secondary outcomes were also significantly improved in the group receiving Naturopathic care: spinal flexion (p<0.0001, weight-loss (p = 0.0052 and Body Mass Index (-0.52, 95% CI, -0.96 to -0.08, p = 0.01. CONCLUSIONS: Naturopathic care provided significantly greater improvement than physiotherapy advice for patients with chronic low back pain. TRIAL REGISTRATION: Controlled

  14. DNA methylation of SPARC and chronic low back pain

    Directory of Open Access Journals (Sweden)

    Dashwood Thomas

    2011-08-01

    Full Text Available Abstract Background The extracellular matrix protein SPARC (Secreted Protein, Acidic, Rich in Cysteine has been linked to degeneration of the intervertebral discs and chronic low back pain (LBP. In humans, SPARC protein expression is decreased as a function of age and disc degeneration. In mice, inactivation of the SPARC gene results in the development of accelerated age-dependent disc degeneration concurrent with age-dependent behavioral signs of chronic LBP. DNA methylation is the covalent modification of DNA by addition of methyl moieties to cytosines in DNA. DNA methylation plays an important role in programming of gene expression, including in the dynamic regulation of changes in gene expression in response to aging and environmental signals. We tested the hypothesis that DNA methylation down-regulates SPARC expression in chronic LBP in pre-clinical models and in patients with chronic LBP. Results Our data shows that aging mice develop anatomical and behavioral signs of disc degeneration and back pain, decreased SPARC expression and increased methylation of the SPARC promoter. In parallel, we show that human subjects with back pain exhibit signs of disc degeneration and increased methylation of the SPARC promoter. Methylation of either the human or mouse SPARC promoter silences its activity in transient transfection assays. Conclusions This study provides the first evidence that DNA methylation of a single gene plays a role in chronic pain in humans and animal models. This has important implications for understanding the mechanisms involved in chronic pain and for pain therapy.

  15. Diagnostic uncertainty and recall bias in chronic low back pain.

    Science.gov (United States)

    Serbic, Danijela; Pincus, Tamar

    2014-08-01

    Patients' beliefs about the origin of their pain and their cognitive processing of pain-related information have both been shown to be associated with poorer prognosis in low back pain (LBP), but the relationship between specific beliefs and specific cognitive processes is not known. The aim of this study was to examine the relationship between diagnostic uncertainty and recall bias in 2 groups of chronic LBP patients, those who were certain about their diagnosis and those who believed that their pain was due to an undiagnosed problem. Patients (N=68) endorsed and subsequently recalled pain, illness, depression, and neutral stimuli. They also provided measures of pain, diagnostic status, mood, and disability. Both groups exhibited a recall bias for pain stimuli, but only the group with diagnostic uncertainty also displayed a recall bias for illness-related stimuli. This bias remained after controlling for depression and disability. Sensitivity analyses using grouping by diagnosis/explanation received supported these findings. Higher levels of depression and disability were found in the group with diagnostic uncertainty, but levels of pain intensity did not differ between the groups. Although the methodology does not provide information on causality, the results provide evidence for a relationship between diagnostic uncertainty and recall bias for negative health-related stimuli in chronic LBP patients.

  16. Low back pain - acute

    Science.gov (United States)

    Backache; Low back pain; Lumbar pain; Pain - back; Acute back pain; Back pain - new; Back pain - short-term; Back ... lower back supports most of your body's weight. Low back pain is the number two reason that ...

  17. Perspectives on physiotherapy guidelines for chronic low back pain

    Directory of Open Access Journals (Sweden)

    P. Berger

    2007-02-01

    Full Text Available The prevalence of chronic low back pain presents a world widedilemma to patients, physiotherapists and clinicians. There is scant evidence for prevention and treatment however it is now acknowledged that the use of  physiotherapy in a multidimensional context has proved the more appropriate model as a vital component of the collaborative approach required for effective pain management. The following article reviews the current literature, evaluates and combines the guidelines that have been proposed from various international studies to provide a practical approach to the management of chronic back pain. This approach recognizes a broad biopsychosocial model of health and the positive role of activity in health and healing with emphasis on function, rather than impairment. Therefore the development of a patient-centred rehabilitative approach has emerged that emphasizes the restoration of normal movement and function with the addition of physical modalities where appropriate. Recent advances in neurophysiology, the modulation of pain and its perception and the fact that biological systems are known to be greatly affected by electrical treatment provide a clearer rationale for the use of physical agents for rehabilitation of patients with pain and relateddisability. The modalities used in conjunction with active exercises include thermal, massage, electrical stimulation, traction, transcutaneous electrical nerve stimulation (Tens, myofascial release, dry needling, mobilization and acupuncture. An algorithm is provided with the intention of developing protocols for breaking the pain cycle in both nociceptive and neuropathic pain states and in reducing inflammation which is a component of both peripheral and central sensitization. Pain rehabilitation is a useful and cost-effective approach to chronic pain management and makes patients’ responsible partners in their own progress. It encourages planning, pacing of activities and activity related

  18. Hypovitaminosis D in female patients with chronic low back pain.

    Science.gov (United States)

    Lotfi, Ahmed; Abdel-Nasser, Ahmed M; Hamdy, Ahmed; Omran, Ahmed A; El-Rehany, Mahmoud A

    2007-11-01

    Chronic low back pain (LBP) is an extremely common problem in practice, where it is often labeled idiopathic. No sufficient studies have been conducted to analyze the contribution of hypovitaminosis D to the etiology of chronic LBP in populations wherein vitamin D deficiency is endemic. The present study was, therefore, carried out to examine hypovitaminosis D and its determinants in female patients with chronic LBP during the childbearing period. Sixty female patients complaining of LBP lasting more than 3 months were clinically studied rheumatologically and neurologically. Questionnaires and indices quantifying risk factors associated with vitamin D deficiency were utilized. Biochemical assays of serum calcium, phosphorus, alkaline phosphatase (ALP), parathormone (PTH), and 25-hydroxyvitamin D (25 OHD) were performed and compared to those of 20 matched healthy controls. The determinants of vitamin D levels in patients were examined by stepwise regression. Patients with LBP had significantly lower 25 OHD levels (p vitamin D levels in patients, only limited duration of sun exposure, contributing 55% to the variance of 25 OHD, limited areas of skin exposed (13%), and increased number of pregnancies (2%), were significant determinants of vitamin D levels in patients. Despite the sunny climate, hypovitaminosis D is prevalent among Egyptian women in the childbearing period, especially those presenting with chronic LBP, where it is associated with hyperphosphatasia and hyperparathyroidism, without alterations in serum calcium. The major determinant of hypovitaminosis D in our patients is limited sun exposure.

  19. Disability predictors in chronic low back pain after aquatic exercise.

    Science.gov (United States)

    Baena-Beato, Pedro Ángel; Delgado-Fernández, Manuel; Artero, Enrique G; Robles-Fuentes, Alejandro; Gatto-Cardia, María Claudia; Arroyo-Morales, Manuel

    2014-07-01

    The physical and psychological factors associated with reduction of disability after aquatic exercise are not well understood. Sixty participants (30 men and 30 women; age, 50.60 [9.69] yrs; body mass index, 27.21 [5.20] kg/m²) with chronic low back pain were prospectively recruited. The 8-wk aquatic therapy program was carried out in an indoor pool sized 25 × 6 m, with 140-cm water depth and 30°C (1°C) of water temperature, where patients exercised for 2-5 days a week. Each aquatic exercise session lasted 55-60 mins (10 mins of warm-up, 20-25 mins of aerobic exercise, 15-20 mins of resistance exercise, and 10 mins of cooldown). Demographic information, disability (Oswestry Disability Index), back pain (visual analog scale), quality-of-life (Short Form 36), abdominal muscular endurance (curl-up), handgrip strength, trunk flexion and hamstring length (sit and reach), resting heart rate, and body mass index were outcomes variables. Significant correlations between change in disability and visual analog scale (at rest, flexion, and extension), curl-up and handgrip (r ranged between -0.353 and 0.582, all Ps < 0.01) were found. Changes in pain and abdominal muscular endurance were significant predictors of change in disability after therapy.

  20. Minimally invasive spine surgery in chronic low back pain patients

    NARCIS (Netherlands)

    Spoor, A. B.; Oner, F. C.

    2013-01-01

    Low back pain (LBP) is a common disorder with a lifetime prevalence of 85%. The pathophysiology of LBP can be various depending on the underlying problem. Only in about 10% of the patients specific underlying disease processes can be identified. Patients with scoliosis, spondylolisthesis, herniated

  1. Profile of sexuality in Moroccan chronic low back pain patients

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    Bahouq Hanane

    2013-02-01

    Full Text Available Abstract Background Sexual life had an important role in preserving the good quality of life for patients and for their partner. Chronic Low Back Pain (CLBP as other musculoskeletal diseases may affect all aspects of life including sexual functioning. The purpose of this study is to describe the impact of CLBP on the sexual life of patients and to identify the factors that affect their Sexual Quality of Life (SQOL. Methods One hundred CLBP sexually active patients were included. Patients and disease Characteristics were collected. Impact on sexual life (sexual intercourse and SQOL was also assessed. Univariate and multivariate analysis were performed to analyze significant determinants associated with the SQOL disturbance. Results Eighty one percent of our patients complained about sexual difficulties related to CLBP. Libido decrease and painful intercourse position were reported respectively in 14.8 and 97.5% of cases. The most pain generating position was supine. Mean of sexual intercourse frequency decrease was at −10.4 ± 4.8 per month. SQOL score mean was at 44.6 ± 17.4%. Men suffered more than women from sexual problems (respectively 90% vs. 72%; p = 0.02. Men had worse SQOL than women (respectively 38.9 ± 17.2 vs. 50.3 ± 15.7%; p = 0.001. Univariate and multivariate analysis showed that advanced age (p = 0.009, poor functional status (p = 0.03, male gender (p = 0.03 and sexual intercourse frequency decrease (p = 0.005 were the independent variables associated with the SQOL disturbance. Conclusion Our study suggests that sexuality is profoundly disturbed in CLBP patients; both their sexual intercourse and SQOL were affected. This disturbance seems to be associated with patient and disease characteristics. Sexuality should be taken into account in managing CLBP patients.

  2. Mediators of Yoga and Stretching for Chronic Low Back Pain

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    Karen J. Sherman

    2013-01-01

    Full Text Available Although yoga is an effective treatment for chronic low back pain, little is known about the mechanisms responsible for its benefits. In a trial comparing yoga to intensive stretching and self-care, we explored whether physical (hours of back exercise/week, cognitive (fear avoidance, body awareness, and self-efficacy, affective (psychological distress, perceived stress, positive states of mind, and sleep, and physiological factors (cortisol, DHEA mediated the effects of yoga or stretching on back-related dysfunction (Roland-Morris Disability Scale (RDQ. For yoga, 36% of the effect on 12-week RDQ was mediated by increased self-efficacy, 18% by sleep disturbance, 9% by hours of back exercise, and 61% by the best combination of all possible mediators (6 mediators. For stretching, 23% of the effect was mediated by increased self-efficacy, 14% by days of back exercise, and 50% by the best combination of all possible mediators (7 mediators. In open-ended questions, ≥20% of participants noted the following treatment benefits: learning new exercises (both groups, relaxation, increased awareness, and the benefits of breathing (yoga, benefits of regular practice (stretching. Although both self-efficacy and hours of back exercise were the strongest mediators for each intervention, compared to self-care, qualitative data suggest that they may exert their benefits through partially distinct mechanisms.

  3. Mediators of yoga and stretching for chronic low back pain.

    Science.gov (United States)

    Sherman, Karen J; Wellman, Robert D; Cook, Andrea J; Cherkin, Daniel C; Ceballos, Rachel M

    2013-01-01

    Although yoga is an effective treatment for chronic low back pain, little is known about the mechanisms responsible for its benefits. In a trial comparing yoga to intensive stretching and self-care, we explored whether physical (hours of back exercise/week), cognitive (fear avoidance, body awareness, and self-efficacy), affective (psychological distress, perceived stress, positive states of mind, and sleep), and physiological factors (cortisol, DHEA) mediated the effects of yoga or stretching on back-related dysfunction (Roland-Morris Disability Scale (RDQ)). For yoga, 36% of the effect on 12-week RDQ was mediated by increased self-efficacy, 18% by sleep disturbance, 9% by hours of back exercise, and 61% by the best combination of all possible mediators (6 mediators). For stretching, 23% of the effect was mediated by increased self-efficacy, 14% by days of back exercise, and 50% by the best combination of all possible mediators (7 mediators). In open-ended questions, ≥20% of participants noted the following treatment benefits: learning new exercises (both groups), relaxation, increased awareness, and the benefits of breathing (yoga), benefits of regular practice (stretching). Although both self-efficacy and hours of back exercise were the strongest mediators for each intervention, compared to self-care, qualitative data suggest that they may exert their benefits through partially distinct mechanisms.

  4. Effects of obesity and chronic low back pain on gait

    Directory of Open Access Journals (Sweden)

    Galli Manuela

    2011-09-01

    Full Text Available Abstract Background Obesity is often associated with low back pain (LBP. Despite empirical evidence that LBP induces gait abnormalities, there is a lack of quantitative analysis of the combined effect of obesity and LBP on gait. The aim of our study was to quantify the gait pattern of obese subjects with and without LBP and normal-mass controls by using Gait Analysis (GA, in order to investigate the cumulative effects of obesity and LBP on gait. Methods Eight obese females with chronic LBP (OLG; age: 40.5 ± 10.1 years; BMI: 42.39 ± 5.47 Kg/m2, 10 obese females (OG; age: 33.6 ± 5.2 years; BMI: 39.26 ± 2.39 Kg/m2 and 10 healthy female subjects (CG; age: 33.4 ± 9.6 years; BMI: 22.8 ± 3.2 Kg/m2, were enrolled in this study and assessed with video recording and GA. Results and Discussion OLG showed longer stance duration and shorter step length when compared to OG and CG. They also had a low pelvis and hip ROM on the frontal plane, a low knee flexion in the swing phase and knee range of motion, a low dorsiflexion in stance and swing as compared to OG. No statistically significant differences were found in ankle power generation at push-off between OLG and OG, which appeared lower if compared to CG. At hip level, both OLG and OG exhibited high power generation levels during stance, with OLG showing the highest values. Conclusions Our results demonstrated that the association of obesity and LBP affects more the gait pattern than obesity alone. OLG were in fact characterised by an altered knee and ankle strategy during gait as compared to OG and CG. These elements may help optimizing rehabilitation planning and treatment in these patients.

  5. Discriminative ability of reflex receptive fields to distinguish patients with acute and chronic low back pain.

    Science.gov (United States)

    Müller, Monika; Biurrun Manresa, José A; Treichel, Fabienne; Agten, Christoph A; Heini, Paul; Andersen, Ole K; Curatolo, Michele; Jüni, Peter

    2016-12-01

    Low back pain has a life time prevalence of 70% to 85%. Approximately 10% to 20% of all patients experience recurrent episodes or develop chronic low back pain. Sociodemographic, clinical, and psychological characteristics explain the transition from acute to chronic low back pain only to a limited extent. Altered central pain processing may be a contributing mechanism. The measurement of reflex receptive fields (RRF) is a novel method to assess altered central pain processing. The RRF area denotes the area of the foot sole from which spinal nociceptive reflexes can be elicited. It was shown to be enlarged in patients with acute and chronic low back pain compared with pain-free individuals. The aim of the study was to explore the discriminative ability of the RRF to distinguish patients with acute and chronic low back pain with the hypothesis that enlarged RRF are associated with chronic low back pain. We included 214 patients with either acute or chronic low back pain and compared RRF between groups in both univariable and multivariable analyses adjusted for different sociodemographic and clinical characteristics possibly associated with the transition to chronic pain. We found a mean difference between patients with acute and chronic low back pain of -0.01 (95% confidence interval [CI], -0.06 to 0.04) in the crude, -0.02 (95% CI, -0.08 to 0.04) in the age and sex adjusted, and -0.02 (95% CI, -0.09 to 0.05) in the fully adjusted model. Our results suggest that the enlargement of RRF area may not be associated with the transition from acute to chronic low back pain.

  6. Electronic diary assessment of pain-related fear, attention to pain, and pain intensity in chronic low back pain patients.

    NARCIS (Netherlands)

    Roelofs, J.; Peters, M.L.; Patijn, J.; Schouten, E.G.; Vlaeyen, J.W.

    2004-01-01

    The present study investigated the relationships between pain-related fear, attention to pain, and pain intensity in daily life in patients with chronic low back pain. An experience sampling methodology was used in which electronic diary data were collected by means of palmtop computers from 40 chro

  7. Effects of Pilates and Classical Kinesiotherapy on chronic low back pain: a case study

    OpenAIRE

    Ribeiro,Ivanna Avila; Oliveira,Tiago Damé de; Blois,Cleci Redin

    2015-01-01

    Abstract Introduction : Chronic low back pain (LBP) is characterized by daily lower back pain lasting more than three consecutive months. It may lead to functional disability and can be treated by several physical therapy techniques, including therapeutic exercise. The aim of this study was to investigate the effects of pilates and classical kinesiotherapy on the treatment of pain and functional disability in patients with chronic low back pain. Materials and methods : The study sample cons...

  8. Core Stability Exercise Versus General Exercise for Chronic Low Back Pain.

    Science.gov (United States)

    Coulombe, Brian J; Games, Kenneth E; Neil, Elizabeth R; Eberman, Lindsey E

    2017-01-01

    Reference: Wang XQ, Zheng JJ, Yu ZW, et al. A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PLoS One. 2012;7(12):e52082. Clinical Questions: Is core stability exercise more effective than general exercise in the treatment of patients with nonspecific low back pain (LBP)?

  9. Non-steroidal anti-inflammatory drugs for chronic low back pain

    NARCIS (Netherlands)

    W.T.M. Enthoven (Wendy); P.D.D.M. Roelofs; R.A. Deyo (Richard); M.W. van Tulder (Maurits); B.W. Koes (Bart)

    2016-01-01

    textabstractBackground: Chronic back pain is an important health problem. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat people with low back pain, especially people with acute back pain. Short term NSAID use is also recommended for pain relief in people with chronic back pa

  10. McKenzie treatment versus mulligan sustained natural apophyseal glides for chronic mechanical low back pain

    OpenAIRE

    Waqqar, Saira; Shakil-ur-Rehman, Syed; Ahmad, Shakeel

    2016-01-01

    Background and Objective: Chronic mechanical low back pain is common among different age groups and genders. Different manual therapy techniques combined with exercise therapy and electrotherapy modalities play an important role in its management. Our objective was to compare the effects of McKenzie extension exercisesprogram (EEP) versus Mulligan Sustained Natural Apophyseal Glides (SNAGs) for chronic mechanical low back pain (CMLBP). Methods: This randomized control trial (RCT) was conducte...

  11. Standardized versus Individualized Acupuncture for Chronic Low Back Pain: A Randomized Controlled Trial

    OpenAIRE

    Daniel Pach; Xiaoli Yang-Strobel; Rainer Lüdtke; Stephanie Roll; Katja Icke; Benno Brinkhaus; Witt, Claudia M.

    2013-01-01

    We aimed to compare the effectiveness of standardized and individualized acupuncture treatment in patients with chronic low back pain. A single-center randomized controlled single-blind trial was performed in a general medical practice in Germany run by a Chinese-born medical doctor trained in western and Chinese medicine. One hundred and fifty outpatients with chronic low back pain were randomly allocated to two groups (78 standardized and 72 individualized acupuncture). Patients received ei...

  12. Effective physical treatment for chronic low back pain.

    Science.gov (United States)

    Maher, C G

    2004-01-01

    It is now feasible to adopt an evidence-based approach when providing physical treatment for patients with chronic LBP. A summary of the efficacy of a range of physical treatments is provided in Table 1. The evidence-based primary care options are exercise, laser, massage, and spinal manipulation; however, the latter three have small or transient effects that limit their value as therapies for chronic LBP. In contrast, exercise produces large reductions in pain and disability, a feature that suggests that exercise should play a major role in the management of chronic LBP. Physical treatments, such as acupuncture, backschool, hydrotherapy, lumbar supports, magnets, TENS, traction, ultrasound, Pilates therapy, Feldenkrais therapy, Alexander technique, and craniosacral therapy are either of unknown value or ineffective and so should not be considered. Outside of primary care, multidisciplinary treatment or functional restoration is effective; however, the high cost probably means that these programs should be reserved for patients who do not respond to cheaper treatment options for chronic LBP. Although there are now effective treatment options for chronic LBP, it needs to be acknowledged that the problem of chronic LBP is far from solved. Though treatments can provide marked improvements in the patient's condition, the available evidence suggests that the typical chronic LBP patient is left with some residual pain and disability. Developing new, more powerful treatments and refining the current group of known effective treatments is the challenge for the future.

  13. Training frequency and intensity in the rehabilitation of chronic nonspecific low back pain: an exploratory review

    OpenAIRE

    Verbrugghe, Jonas; Agten, Anouk; Smeets, Wout; Eijnde, Bert O.; Vandenabeele, Frank; Timmermans, Annick

    2016-01-01

    Introduction Low back pain is one of the most frequently occurring musculoskeletal disorders1 and it causes the highest global disability rates compared to any other condition1. Exercise therapy can improve pain and disability in persons with nonspecific chronic low back pain (CNSLBP), however optimal training frequency and intensity for rehabilitation settings are not known2. Purpose/Aim The purpose of this review is 1) to inventory training frequencies and intensities that are us...

  14. Effects of long-term corset wearing on chronic low back pain.

    Science.gov (United States)

    Sato, Naoto; Sekiguchi, Miho; Kikuchi, Shinichi; Shishido, Hiroaki; Sato, Katsuhiko; Konno, Shinichi

    2012-01-01

    There are few studies of the therapeutic effects of long-term corset wearing in patients with chronic low back pain. The aim of this study was to evaluate the effects of long-term corset wearing on chronic low back pain and to examine the myoelectrical activities of the paravertebral muscles. Forty subjects with chronic low back pain were enrolled and randomly divided into two groups: a group wearing corsets for 6 months (CW) group and a group not wearing corsets (NW). The treatment effects were measured using the Japanese Orthopaedic Association (JOA) score. Muscle endurance was evaluated during the Biering-Sorensen test (S-test), and the degree of muscle fatigue was evaluated by the change in percent mean power frequency (%MPF) of the paravertebral muscles. Corset treatment for chronic low back pain improved low back pain and increased muscle endurance for a short period of time. Paravertebral muscle fatigue was not increased by long-term corset wearing for chronic low back pain, and weakening of the paravertebral muscles was not observed up to 6 months after the start of corset wearing.

  15. Case Study: The Use of Massage Therapy to Relieve Chronic Low-Back Pain

    OpenAIRE

    Allen, Laura

    2016-01-01

    Objectives To study the effects of massage on chronic low-back pain in a patient with four different diagnoses: osteoarthritis, scoliosis, spinal stenosis, and degenerative disc disease. The patient’s goal was to cut down on the amount of pain medication he takes. Methods A 63-year-old man with chronic back pain received four massages across a twenty-day period. Progress was recorded using the Oswestry Low Back Pain Scale, as he self-reported on levels of pain and interference with his activi...

  16. Myofascial low back pain.

    Science.gov (United States)

    Ramsook, Ryan R; Malanga, Gerard A

    2012-10-01

    Low back pain is a common condition that is encountered by both primary care physicians as well as various specialists, which include: orthopedic surgeons, physical medicine and rehabilitation specialists, neurologists, rheumatologists, and pain management specialists. Associated muscular pain is very common and often a reactive response from nociception from other structures. Myofascial pain may arise, which is characterized by the presence of myofascial trigger points (MTrPs) that are located in fascia, tendons, and/or muscle. This article reviews the current evidence regarding the pathophysiology, assessment, and recommended treatment options for myofascial low back pain.

  17. Effectiveness of mindfulness meditation on pain and quality of life of patients with chronic low back pain

    OpenAIRE

    Sudha Banth; Maryam Didehdar Ardebil

    2015-01-01

    Background and Aim: Recovery of patients with chronic low back pain (LBP) is depended on several physical and psychological factors. Therefore, the authors aimed to examine the efficacy of mindfulness based stress reduction (MBSR) as a mind-body intervention on quality of life and pain severity of female patients with nonspecific chronic LBP (NSCLBP). Effectiveness of mindfulness meditation on pain and quality of life of patients with chronic low back pain Eighty-eight patients diagnosed a...

  18. Effectiveness of mindfulness meditation (Vipassana) in the management of chronic low back pain

    OpenAIRE

    Sangram G Patil

    2009-01-01

    Summary Chronic low back pain (CLBP) is challenging to treat with its significant psychological and cognitive behavioural element involved. Mindfulness meditation helps alter the behavioural response in chronic pain situations. Significant body of research in the filed of mindfulness meditation comes from the work of Dr Kabat-Zinn. The current evidence in the field, though not grade one, shows that there is a place for mindfulness meditation in managing chronic pain conditions including CLBP....

  19. Treatment of degenerative chronic low back pain with fluoroscopically guided epidural procaine-corticosteroid injection

    Directory of Open Access Journals (Sweden)

    Ćulafić Slobodan

    2008-01-01

    Full Text Available Background/Aim. Low back pain is one of the most common painful conditions in the modern age. Therefore, it is very important to establish the most effective protocol for the treatment of this condition. The aim of this study was to find out if fluoroscopically, guided epidural procainecorticosteroid injection is effective in the treatment of degenerative chronic low back pain. Methods. This prospective cohort study was performed in the Military Medical Academy from September 2005 to June 2006 and included 60 patients of both sexes, 34-85 years of age. Degenerative changes of lumbosacral spine were determined by magnetic resonance imaging. The intensity of low back pain was evaluated by subjective (Roland's scale and objective parameter (Lazarevic sign. Epidural procaine-corticosteroid injection was applied in the patients with low back pain not responding to conservative therapy. After the application of injection, effects of the therapy were followed up. Results. In 92% of the patients there was a reduction of pain intensity for three months, in 4.8% a reduction for a month, but after another injection they felt pain reduction for the next three months. One patient (2.3% had pain reduction for one month. Conclusion. In the treatment of degenerative chronic low back pain, not responding to conservative therapy with nonsteroidal anti-inflammatory drugs, epidural procaine-corticosteroid injection have a satisfactory short-term as well as a long-term analgesic effect.

  20. The effects of lumbar stabilization exercise with thoracic extension exercise on lumbosacral alignment and the low back pain disability index in patients with chronic low back pain.

    Science.gov (United States)

    Woo, Seong-Dae; Kim, Tae-Ho

    2016-01-01

    [Purpose] To determine the effects of lumbar stabilization exercise with thoracic extension exercise on chronic low back pain patients. [Subjects and Methods] Thirty patients with chronic low back pain were randomly divided into a lumbar stabilization exercise group (group A) and a lumbar stabilization exercise with thoracic extension exercise group (group B). Group B did 15 min of lumbar stabilization exercises and 15 min of thoracic extension exercises, while group A did 30 min of lumbar stabilization exercises five times a week for 4 weeks. For assessing lumbosacral alignment, the lordotic angle, lumbosacral angle, and sacral angle were evaluated. The Oswestry disability index was used for assessment of disability due to low back pain. [Results] Both groups showed improvement in lumbosacral alignment and in the disability index. Group B showed greater changes in the lordotic angle and in the Oswestry disability index than group A, although the differences were not statistically significant. [Conclusion] Lumbar stabilization exercise with thoracic extension exercise can be recommended for improvement of chronic low back pain, although the improvements seen in lumbosacral alignment and low back pain disability index in this study did not achieve statistical significance.

  1. Ignoring the sacroiliac joint in chronic low back pain is costly

    Directory of Open Access Journals (Sweden)

    Polly DW

    2016-01-01

    Full Text Available David W Polly,1,2 Daniel Cher3 1Department of Orthopedic Surgery, 2Department of Neurosurgery, University of Minnesota, Minneapolis, MN, 3SI-BONE, Inc., San Jose, CA, USA Background: Increasing evidence supports minimally invasive sacroiliac joint (SIJ fusion as a safe and effective treatment for SIJ dysfunction. Failure to include the SIJ in the diagnostic evaluation of low back pain could result in unnecessary health care expenses. Design: Decision analytic cost model. Methods: A decision analytic model calculating 2-year direct health care costs in patients with chronic low back pain considering lumbar fusion surgery was used. Results: The strategy of including the SIJ in the preoperative diagnostic workup of chronic low back pain saves an expected US$3,100 per patient over 2 years. Cost savings were robust to reasonable ranges for costs and probabilities, such as the probability of diagnosis and the probability of successful surgical treatment. Conclusion: Including the SIJ as part of the diagnostic strategy in preoperative patients with chronic low back pain is likely to be cost saving in the short term. Keywords: chronic low back pain, lumbar fusion, sacroiliac joint pain, sacroiliac joint fusion, healthcare costs, decision modeling

  2. The effect of chronic low back pain on tactile suppression during back movements.

    Science.gov (United States)

    Van Damme, Stefaan; Van Hulle, Lore; Danneels, Lieven; Spence, Charles; Crombez, Geert

    2014-10-01

    The aim of the present study was to examine whether tactile suppression, the phenomenon whereby tactile perception is suppressed during movement, would occur in the context of back movements. Of particular interest, it was investigated if tactile suppression in the back would be attenuated in those suffering from chronic low back pain. Individuals with chronic low back pain (N = 30) and a matched control group (N = 24) detected tactile stimuli on three possible locations (back, arm, chest) while performing a back or arm movement, or no movement. We hypothesized that the movements would induce tactile suppression, and that this effect would be largest for low-intense stimuli on the moving body part. We further hypothesized that, during back movements, tactile suppression on the back would be less pronounced in the chronic low back pain group than in the control group. The results showed the expected general tactile suppression effects. The hypothesis of back-specific attenuation of tactile suppression in the chronic low back pain group was not supported. However, back-specific tactile suppression in the chronic low back pain group was less pronounced in those who performed the back movements more slowly.

  3. Acupuncture for Chronic Non-Specific Low Back Pain: A Case Series Study

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To evaluate the efficacy of acupuncture in treating chronic non-specific low back pain. Methods: Ten patients with chronic low back pain were selected to receive 9 acupuncture treatments over a three-week period with point selection based on syndrome differentiation in Chinese medicine. The BROM Instrument for assessment of back range of motion; subjective evaluation with Visual Analog Scale of Pain (VASP) ratings, Oswestry Disability ratings, objective measurements including Algometry, and Flexion and Extension ratings to investigate the range of motion were used for comparing the large, medium and small effect sizes of baseline, treatment and follow-up phases. Results: Clinical significance of pain relief was shown in all parameters assessed. A large effect size was detected in VASP, Oswestry and Algometry. A small effect size was demonstrated in Flexion/Extension. Needling over short period time (3 weeks) could relieve the pain, but the muscular-skeletal function measured by BROM persists. To treat patients exclusively by needling for statistical purposes can not be justified, because by merely relieving pain, permanent improvement in function may not be achieved. Conclusion: Acupuncture offers an effective alternative for the clinical management of chronic low back pain, significant improvement in most of the parameters evaluated, but the functional improvement was not as satisfactory as pain relieving. Further study with larger sample size focuses on long-term efficacy and functional improvement for chronic low back pain is recommended.

  4. Acupuncture for chronic low back pain: protocol for a multicenter, randomized, sham-controlled trial

    Directory of Open Access Journals (Sweden)

    Shin Im

    2010-06-01

    Full Text Available Abstract Background Use of acupuncture has widely increased in patients with chronic low back pain. However, the evidence supporting its efficacy remains unclear. In this article, we report the design and the protocol of a multi-center randomized sham-controlled trial to treat chronic low back pain. Our goal is to verify the effect of acupuncture on chronic low back pain. Methods/Design This study is a multi-center randomized sham-controlled trial with 2 parallel arms. Participants included in the study met the following criteria: 1 low back pain lasting for at least the last 3 months, 2 a documented ≥ 5 points on a 10 cm visual analog scale for bothersomeness of low back pain at the time of screening and 3 between 18 and 65 years of age. Participants were blinded to the real and sham acupuncture treatments. The real acupuncture treatment group received real acupuncture 2 times a week, during a total of 12 sessions over 6 weeks. The control group received sham acupuncture during the same period. In order to assess the primary and secondary outcome measures, the participants were asked to fill out a questionnaire at the baseline and 6, 8, 12 and 24 weeks after starting the treatments. The primary outcome was measured using the visual analog scale for bothersomeness of low back pain at 8 weeks after the initiation of treatments. Discussion The result of this trial (which will be available in 2010 will demonstrate the efficacy of using acupuncture to treat chronic low back pain. Trial registration This study is registered with the U.S. National Institutes of Health Clinical Trials registry: NCT00815529

  5. Yoga attitudes in chronic low back pain: Roles of catastrophizing and fear of movement.

    Science.gov (United States)

    Combs, Martha A; Thorn, Beverly E

    2015-08-01

    Chronic low back pain is a significant public health problem and, although underused, yoga may be an effective complementary treatment. The current study examined associations of pain catastrophizing and fear of movement with attitudes toward yoga in adults with chronic low back pain. Participants completed three quantitative questionnaires assessing specific constructs: beliefs about yoga, fear of movement, and pain catastrophizing. A semi-structured in-person interview was then conducted to obtain specific pain-related information. Hierarchical regression and mediational analyses were used to test hypotheses. Consistent with the fear-avoidance model of chronic pain, catastrophizing and fear of movement were negatively associated with yoga attitudes. Specifically, fear of movement was a mediator between catastrophizing and attitudes toward yoga. Individuals with higher levels of catastrophizing and fear of movement may be less likely to consider a pain treatment involving physical movement.

  6. Effectiveness of Behavioral Therapy for Chronic Low Back Pain: A Component Analysis.

    Science.gov (United States)

    Turner, Judith A.; And Others

    1990-01-01

    Evaluated effects of group behavioral therapy including aerobic exercise, behavioral therapy alone, and aerobic exercise alone on pain and physical and psychological disability among mildly disabled chronic low-back-pain patients (n=96). The combined behavioral therapy and exercise group improved significantly more pretreatment to posttreatment…

  7. Prognostic Factors for Recovery in Chronic Nonspecific Low Back Pain: A Systematic Review

    NARCIS (Netherlands)

    Verkerk, K.; Luijsterburg, P.A.J.; Miedema, H.S.; Pool - Goudzwaard, A.; Koes, B.W.

    2011-01-01

    Background. Few data are available on predictors for a favorable outcome in patients with chronic nonspecific low back pain (CNLBP). Purpose. The aim of this study was to assess prognostic factors for pain intensity, disability, return to work, quality of life, and global perceived effect in patient

  8. Yoga for Chronic Low Back Pain: A Meta-Analysis of Randomized Controlled Trials

    Directory of Open Access Journals (Sweden)

    Susan Holtzman

    2013-01-01

    Full Text Available OBJECTIVES: To evaluate the efficacy of yoga as an intervention for chronic low back pain (CLBP using a meta-analytical approach. Randomized controlled trials (RCTs that examined pain and/or functional disability as treatment outcomes were included. Post-treatment and follow-up outcomes were assessed.

  9. Physiotherapy for sleep disturbance in chronic low back pain: a feasibility randomised controlled trial.

    LENUS (Irish Health Repository)

    Hurley, Deirdre A

    2010-01-01

    Sleep disturbance is becoming increasingly recognised as a clinically important symptom in people with chronic low back pain (CLBP, low back pain >12 weeks), associated with physical inactivity and depression. Current research and international clinical guidelines recommend people with CLBP assume a physically active role in their recovery to prevent chronicity, but the high prevalence of sleep disturbance in this population may be unknowingly limiting their ability to participate in exercise-based rehabilitation programmes and contributing to poor outcomes. There is currently no knowledge concerning the effectiveness of physiotherapy on sleep disturbance in people with chronic low back pain and no evidence of the feasibility of conducting randomized controlled trials that comprehensively evaluate sleep as an outcome measure in this population.

  10. Low back pain and yoga.

    Science.gov (United States)

    Singh, Supreet

    2014-12-01

    ABSTRACT Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. The topic addressed in this issue is chronic low back pain, one of the most common reasons to visit one's primary care doctor. Complementary approaches, including yoga, will be addressed.

  11. Experimentally induced pain perception is acutely reduced by aerobic exercise in people with chronic low back pain.

    Science.gov (United States)

    Hoffman, Martin D; Shepanski, Melissa A; Mackenzie, Sean P; Clifford, Philip S

    2005-01-01

    This study examined whether subjects with chronic low back pain demonstrate exercise-induced analgesia to experimentally induced pressure pain. We employed a repeated measures design to study eight subjects with chronic low back pain (mean +/- standard deviation age = 40 +/- 10, duration of pain = 7 +/- 4 years). Pain ratings were measured immediately before and 2 minutes and 32 minutes after 25 minutes of cycle ergometry (5 minutes at 50% peak oxygen uptake, then 20 minutes at 70% peak oxygen uptake). We based the pain ratings on subject input on a visual analog scale at 10-second intervals during the 2-minute pressure pain stimulus to the nondominant index finger. Compared with preexercise values, pain ratings were significantly (p exercise at both 2 and 32 minutes postexercise. We conclude that pressure pain perception can be reduced for more than 30 minutes following aerobic exercise from leg cycling among people with chronic low back pain.

  12. Living with chronic low back pain: a metasynthesis of qualitative research.

    Science.gov (United States)

    Snelgrove, Sherrill; Liossi, Christina

    2013-12-01

    OBJECTIVES The purpose of this qualitative metasynthesis is to articulate the knowledge gained from a review of qualitative studies of patients' experiences of chronic low back pain. METHODS Meta-ethnographic methodology guided the review of 33 articles representing 28 studies published in English in peer-reviewed journals between 2000 and 2012. A systematic comparison of the main themes from each study was conducted and 'synthesised' to create superordinate themes. RESULTS Three overarching interrelated themes were identified: the impact of chronic low back pain on self; relationships with significant others that incorporated two streams - health professionals and the organisation of care and relationships with family and friends; coping with chronic low back pain. Coping strategies were predominantly physical therapies, medication and avoidance behaviours with very few successful strategies reported. Professional and family support, self-efficacy, motivation, work conditions and exercise opportunities influenced pain experiences. Review authors' recommendations included psychological therapies, education, the facilitation of self-management strategies and support groups. DISCUSSION The review substantiates chronic low back pain as complex, dynamic and multidimensional, underpinned by experiences of persistent distressing pain, loss, and lowered self-worth, stigma, depression, premature aging, fear of the future. Future research should address the paucity of longitudinal studies, loss and issues of ethnicity, gender, ageing.

  13. Biospectral analysis of the bladder channel point in chronic low back pain patients

    Science.gov (United States)

    Vidal, Alberto Espinosa; Nava, Juan José Godina; Segura, Miguel Ángel Rodriguez; Bastida, Albino Villegas

    2012-10-01

    Chronic pain is the main cause of disability in the productive age people and is a public health problem that affects both the patient and society. On the other hand, there isn't any instrument to measure it; this is only estimated using subjective variables. The healthy cells generate a known membrane potential which is part of a network of biologically closed electric circuits still unstudied. It is proposed a biospectral analysis of a bladder channel point as a diagnosis method for chronic low back pain patients. Materials and methods: We employed a study group with chronic low back pain patients and a control group without low back pain patients. The visual analog scale (VAS) to determine the level of pain was applied. Bioelectric variables were measured for 10 seconds and the respective biostatistical analyses were made. Results: Biospectral analysis on frequency domain shows a depression in the 60-300 Hz frequency range proportional to the chronicity of low back pain compared against healthy patients.

  14. Does anterior trunk pain predict a different course of recovery in chronic low back pain?

    Science.gov (United States)

    Panagopoulos, John; Hancock, Mark J; Kongsted, Alice; Hush, Julia; Kent, Peter

    2014-05-01

    Patient characteristics associated with the course and severity of low back pain (LBP) and disability have been the focus of extensive research, however, known characteristics do not explain much of the variance in outcomes. The relationship between anterior trunk pain (ATP) and LBP has not been explored, though mechanisms for visceral referred pain have been described. Study objectives were: (1) determine prevalence of ATP in chronic LBP patients, (2) determine whether ATP is associated with increased pain and disability in these patients, and (3) evaluate whether ATP predicts the course of pain and disability in these patients. In this study, spinal outpatient department patients mapped the distribution of their pain and patients describing pain in their chest, abdomen or groin were classified with ATP. Generalized estimating equations were performed to investigate the relationship between ATP and LBP outcomes. A total of 2974 patients were included and 19.6% of patients reported ATP. At all time points, there were significant differences in absolute pain intensity and disability in those with ATP compared with those without. The presence of ATP did not affect the clinical course of LBP outcomes. The results of this study suggest that patients who present with LBP and ATP have higher pain and disability levels than patients with localised LBP. Visceral referred pain mechanisms may help to explain some of this difference.

  15. The Efficacy of a Perceptive Rehabilitation on Postural Control in Patients with Chronic Nonspecific Low Back Pain

    Science.gov (United States)

    Paolucci, Teresa; Fusco, Augusto; Iosa, Marco; Grasso, Maria R.; Spadini, Ennio; Paolucci, Stefano; Saraceni, Vincenzo M.; Morone, Giovanni

    2012-01-01

    Patients with chronic low back pain have a worse posture, probably related to poor control of the back muscles and altered perception of the trunk midline. The aim of this study was to evaluate the efficacy of a perceptive rehabilitation in terms of stability and pain relief in patients with chronic nonspecific low back pain. Thirty patients were…

  16. Short-term outcomes of a back school program for chronic low back pain

    NARCIS (Netherlands)

    Hodselmans, AP; Jaegers, SM; Goeken, LN; Göeken, L.N.

    2001-01-01

    Objective: To assess the short-term outcome of a back school program for patients suffering from chronic, nonspecific low back pain (LBP). Design: Quasi-experimental cohort study with a waiting list control group. Setting: Dutch rehabilitation department. Participants: Experimental group (n = 14) pa

  17. Multidisciplinary Rehabilitation Treatment of Patients With Chronic Low Back Pain: A Prognostic Model for Its Outcome

    NARCIS (Netherlands)

    Hulst, van der Marije; Vollenbroek-Hutten, Miriam M.R.; Groothuis-Oudshoorn, Karin G.M.; Hermens, Hermie J.

    2008-01-01

    Objectives: (1) To determine if treatment outcome in chronic low back pain can be predicted by a predefined multivariate prognostic model based on consistent predictors from the literature and (2) to explore the value of potentially prognostic factors further. Methods: Data were derived from a rand

  18. Group Outpatient Physical and Behavioral Therapy for Chronic Low Back Pain.

    Science.gov (United States)

    Cohen, Michael J.; And Others

    1983-01-01

    Compared the effectiveness of behavioral (BT) or physical therapy (PT) for treating chronic low back pain (CLBP), for 13 BT patients and 12 PT patients. Treatments were conducted in a group outpatient setting. Posttreatment results showed general improvement for patients in both groups, but few treatment-specific differences in outcome measures.…

  19. Injection therapy for subacute and chronic low back pain: an updated Cochrane review.

    NARCIS (Netherlands)

    Staal, J.B.; Bie, R.A. de; Vet, H.C. de; Hildebrandt, J.; Nelemans, P.

    2009-01-01

    STUDY DESIGN: A systematic review of randomized controlled trials (RCTs). OBJECTIVE: To determine if injection therapy is more effective than placebo or other treatments for patients with subacute or chronic low back pain. SUMMARY OF BACKGROUND DATA: The effectiveness of injection therapy for low ba

  20. Measuring disability in patients with chronic low back pain : the usefulness of different instruments

    NARCIS (Netherlands)

    Kuijer, Wietske

    2006-01-01

    Measuring disability is an important topic in rehabilitation research in patients with chronic low back pain (CLBP). Due to the major impact of CLBP on functioning in both daily living and work, measuring disability in patients with CLBP is best described in terms of limitations in activities and re

  1. Nonspecific Chronic Low Back Pain Patients Are Deconditioned and Have An Increased Body Fat Percentage

    Science.gov (United States)

    Hodselmans, Audy P.

    2010-01-01

    The aim of this cross-sectional study was to compare data on the level of aerobic capacity and body composition of nonspecific chronic low back pain (CLBP) patients with normative data matched for sex, age and level of sporting activity. The study population consisted of 101 outpatients with nonspecific CLBP who had entered a rehabilitation…

  2. Nonspecific chronic low back pain patients are deconditioned and have an increased body fat percentage

    NARCIS (Netherlands)

    Hodselmans, Audy P.; Dijkstra, Pieter U.; Geertzen, Jan H. B.; van der Schans, Cees P.

    2010-01-01

    The aim of this cross-sectional study was to compare data on the level of aerobic capacity and body composition of nonspecific chronic low back pain (CLBP) patients with normative data matched for sex, age and level of sporting activity. The study population consisted of 101 outpatients with nonspec

  3. Standardized versus Individualized Acupuncture for Chronic Low Back Pain: A Randomized Controlled Trial.

    Science.gov (United States)

    Pach, Daniel; Yang-Strobel, Xiaoli; Lüdtke, Rainer; Roll, Stephanie; Icke, Katja; Brinkhaus, Benno; Witt, Claudia M

    2013-01-01

    We aimed to compare the effectiveness of standardized and individualized acupuncture treatment in patients with chronic low back pain. A single-center randomized controlled single-blind trial was performed in a general medical practice in Germany run by a Chinese-born medical doctor trained in western and Chinese medicine. One hundred and fifty outpatients with chronic low back pain were randomly allocated to two groups (78 standardized and 72 individualized acupuncture). Patients received either standardized acupuncture or individualized acupuncture. Treatment encompassed between 10 and 15 treatments based on individual symptoms with two treatments per week. The main outcome measure was the area under the curve (AUC) summarizing eight weeks of daily rated pain severity measured with a visual analogue scale (0 mm = no pain, 100 mm = worst imaginable pain). No significant differences between groups were observed for the AUC (individualized acupuncture mean: 1768.7 (95% CI, 1460.4; 2077.1); standardized acupuncture 1482.9 (1177.2; 1788.7); group difference, 285.8 (-33.9; 605.5) P = 0.080). In this single-center trial, individualized acupuncture was not superior to standardized acupuncture for patients suffering from chronic pain. As a next step, a multicenter noninferiority study should be performed to investigate whether standardised acupuncture treatment for chronic low back pain might be applicable in a broader usual care setting. This trial is registered with ClinicalTrials.gov NCT00758017.

  4. Standardized versus Individualized Acupuncture for Chronic Low Back Pain: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Daniel Pach

    2013-01-01

    Full Text Available We aimed to compare the effectiveness of standardized and individualized acupuncture treatment in patients with chronic low back pain. A single-center randomized controlled single-blind trial was performed in a general medical practice in Germany run by a Chinese-born medical doctor trained in western and Chinese medicine. One hundred and fifty outpatients with chronic low back pain were randomly allocated to two groups (78 standardized and 72 individualized acupuncture. Patients received either standardized acupuncture or individualized acupuncture. Treatment encompassed between 10 and 15 treatments based on individual symptoms with two treatments per week. The main outcome measure was the area under the curve (AUC summarizing eight weeks of daily rated pain severity measured with a visual analogue scale (0 mm = no pain, 100 mm = worst imaginable pain. No significant differences between groups were observed for the AUC (individualized acupuncture mean: 1768.7 (95% CI, 1460.4; 2077.1; standardized acupuncture 1482.9 (1177.2; 1788.7; group difference, 285.8 (−33.9; 605.5 P=0.080. In this single-center trial, individualized acupuncture was not superior to standardized acupuncture for patients suffering from chronic pain. As a next step, a multicenter noninferiority study should be performed to investigate whether standardised acupuncture treatment for chronic low back pain might be applicable in a broader usual care setting. This trial is registered with ClinicalTrials.gov NCT00758017.

  5. Assessment of Vitamin D status In Patients of Chronic Low Back Pain of Unknown Etiology.

    Science.gov (United States)

    Lodh, Moushumi; Goswami, Binita; Mahajan, Rajni Dawar; Sen, Dipankar; Jajodia, Nirmal; Roy, Abhishek

    2015-04-01

    Low back pain is very disabling and dispiriting because of the physical impediment it causes and its psychological effects. Innumerable factors have been implicated in its etiology. In spite of improvements in diagnostic modalities, a considerable number of such cases fall in the ambiguous zone of unknown etiology or 'idiopathic.'Early diagnosis of low back pain will allow effective prevention and treatment to be offered. This study was conducted to assess the contribution of vitamin D levels and other biochemical factors to chronic low back pain in such cases. All patients attending the orthopedics OPD for low back pain in whom a precise anatomical cause could not be localized, were prospectively enrolled in this study. We measured serum levels of glucose, calcium, phosphorus, uric acid, rheumatoid factor, C reactive protein, alkaline phosphatase, total protein, albumin and 25 (OH) D concentrations in 200 cases and 200 control samples. The patients showed significantly lower vitamin D levels compared to controls with p value back pain patients were in the age group of 31-50 years (42 %).The average BMI was 23.27 ± 5.17 kg/sq m, 73 % of total patient population were females and 27 % were known case of type 2 diabetes mellitus. Calcium, alkaline phosphatase, was positively correlated with vitamin D and glucose showed a negative correlation with vitamin D in the patient population. The problem of low back pain provides a challenge to health care providers. The problem in developing countries is compounded by ignorance to report for early treatment and occupational compulsions in rural areas and sedentary lifestyle in urban youth. The authors strongly recommend early frequent screening for vitamin D along with glucose, protein, albumin, calcium, phosphorus, CRP as part of general health checkup for non-specific body pain, especially low back pain.

  6. Discriminative ability of reflex receptive fields to distinguish patients with acute and chronic low back pain

    DEFF Research Database (Denmark)

    Müller, Monika; Biurrun Manresa, José; Treichel, Fabienne;

    2016-01-01

    central pain processing may be a contributing mechanism. The measurement of Reflex Receptive Fields (RRF) is a novel method to assess altered central pain processing. The RRF area denotes the area of the foot sole from which spinal nociceptive reflexes can be elicited. It was shown to be enlarged...... included 214 patients with either acute or chronic low back pain and compared RRF between groups in both uni- and multivariable analyses adjusted for different socio-demographic and clinical characteristics possibly associated with the transition to chronic pain. We found a mean difference between patients...

  7. Effectiveness of mindfulness meditation (Vipassana in the management of chronic low back pain

    Directory of Open Access Journals (Sweden)

    Sangram G Patil

    2009-01-01

    Full Text Available Chronic low back pain (CLBP is challenging to treat with its significant psychological and cognitive behavioural element involved. Mindfulness meditation helps alter the behavioural response in chronic pain situations. Significant body of research in the filed of mindfulness meditation comes from the work of Dr Kabat-Zinn. The current evidence in the field, though not grade one, shows that there is a place for mindfulness meditation in managing chronic pain conditions including CLBP. Further research to test the usefulness of mindfulness in CLBP should involve good quality randomized controlled trials of pure mindfulness based technique in matched subjects.

  8. Low Back Pain Fact Sheet

    Science.gov (United States)

    ... day in a chair with inadequate back support. Mental health factors : Pre-existing mental health issues such as anxiety and depression can influence ... is particularly important for persons with skeletal irregularities. Health care ... benefits of yoga to ease chronic low back pain. Physical therapy ...

  9. Are chronic low back pain outcomes improved with co-management of concurrent depression?

    OpenAIRE

    Pollard Henry; Middleton Peter

    2005-01-01

    Abstract Objective To discuss the role of depression in chronic lower back pain and comment on appropriate methods of screening and co-management. Data Sources The current scientific literature was investigated using the online web databases CINAHL, Medline/PUBMED, Proquest, Meditext and from manual library searches. Data Extraction Databases were searched from 1980 to the present (2005). Articles were searched with the key words "depression" and "low back pain". Over three hundred articles w...

  10. Yoga as a treatment for chronic low back pain: A systematic review of the literature

    OpenAIRE

    Chang, Douglas G.; Holt, Jacquelyn A.; Sklar, Marisa; Groessl, Erik J.

    2016-01-01

    Objectives Chronic low back pain (CLBP) affects millions of people worldwide, and appears to be increasing in prevalence. It is associated not only with pain, but also with increased disability, psychological symptoms, and reduced quality of life. There are various treatment options for CLBP, but no single therapy stands out as being the most effective. In the past 10 years, yoga interventions have been studied as a CLBP treatment approach. The objective of this paper is to review the current...

  11. Chronic non-specific low back pain; has cognitive behavioural therapy effect and

    OpenAIRE

    Hjermann, Mette Kristine

    2005-01-01

    Low back pain (LBP) presents a major public health problem. Half of the population will report acute LBP during the last year; approximately 80-90% is non-specific. Many will develop chronic / intermittent LBP and a part of these patients will become unable to maintain daily function and working life. Although non-specific chronic LBP is common, there is little knowledge of its cause and right treatment. In this paper the cognitive chronification process is seen together with newer neurobiolo...

  12. Daily Practice Clinic of Scientific Evidence in the Physiotherapy Management of Chronic Nonspecific Low Back Pain

    Directory of Open Access Journals (Sweden)

    María Constanza Trillos Chacón

    2015-05-01

    Full Text Available Introduction: 80 % of adults experience back pain at least once in their life. Back pain is the third leading cause of consultation in the emergency room, the fourth in general practice, the second of disability pension and the first job relocation. Objective: To compare the criteria that guide decision making of a group of physiotherapists in Bogota Colombia for the management of chronic nonspecific low back pain management criteria contained in the guide COST B13 (European Guidelines For The Management Of Chronic Non- specific Low Back Pain, 2004. Material and methods: This was a descriptive study, for which clinical practice guideline COST B13 for the management of chronic nonspecific low back pain through the AGREE tool is selected and a survey was applied to 50 physiotherapists through a convenience sample with to compare the clinical practices that are performed with the recommendations given guidance. Results: 56 % of respondents had some type of training for the management of chronic nonspecific low back pain (DLCI. 94 % of patients with DLCI served range in age from 40 to 59, with female predominance. In 80 % of respondents stated that physiotherapists diagnostic help with counting for the management of patients is the radiological image. 80 % of physiotherapists evaluated variable lumbar pain experienced by the patient and 54 % stance. Other aspects were reported in lower percentage. In the treatment of DLCI, physiotherapists reported use of stretching in 80 % of cases, the superficial thermotherapy in 70 % and isometric muscle strength in 70 %, all with favorable results.Conclusion: There are differences between clinical practice of physiotherapists and guidelines contained in the recommendations of the guide in the cost DLCI B13. Mainly in the processes of physiotherapy assessment of the surveyed population as they are often focused on observation and not always in the rigorous measurement, which makes it difficult to establish

  13. Fear of movement/(re)injury and muscular reactivity in chronic low back pain patients : an experimental investigation

    NARCIS (Netherlands)

    Vlaeyen, Johan W.S.; Seelen, HAM; Peters, Madelon L.; de Jong, Peter; Aretz, E; Beisiegel, E; Weber, WEJ

    1999-01-01

    This experiment was set up to test the hypothesis that confrontation with feared movements would lead to symptom-specific muscular reactivity in chronic low back pain patients who report high fear of movement/(re)injury. Thirty-one chronic low back pain patients were asked to watch a neutral nature

  14. Enhanced sensitivity to punctate painful stimuli in female patients with chronic low back pain

    Directory of Open Access Journals (Sweden)

    Puta Christian

    2012-09-01

    Full Text Available Abstract Background Chronic low back pain (CLBP has been shown to be associated with various pathophysiological changes at several level of the sensorimotor system, pointing to a general hypersensitivity in CLBP patients. The aim of the present study was to investigate signs of generalized mechanical pain hypersensitivity in CLBP patients on the hand and on the painful site of the back. Methods Pinprick stimulation according to a validated standardized quantitative sensory testing protocol was used in 14 female CLBP patients and 14 healthy controls (HC matched for sex and age. Stimulus response functions to pinprick stimulation on the skin were examined at the affected back and reference sites (hand palmar and hand dorsum. Data from CLBP patients were compared with HC and with reference data from the German Research Network on Neuropathic Pain. Results We found significant differences in the stimulus response functions between CLBP patients and HC. Pain ratings to the pinpricks were increased for low and moderate pinprick stimuli in CLBP patients. Importantly, this kind of specific pinprick hyperalgesia was found not only for the affected body site (back, but also for the remote reference sites (hand dorsum and hand palmar. Conclusions We interpret our results as pointing to changes in the nociceptive processing in CLBP at higher levels of the neuraxis, possibly thalamus and/or attentional control, rather than changes of spinal processing. Alternatively, there might be a higher vulnerability to noxious stimulation in CLBP patients.

  15. Are chronic low back pain outcomes improved with co-management of concurrent depression?

    Directory of Open Access Journals (Sweden)

    Pollard Henry

    2005-06-01

    Full Text Available Abstract Objective To discuss the role of depression in chronic lower back pain and comment on appropriate methods of screening and co-management. Data Sources The current scientific literature was investigated using the online web databases CINAHL, Medline/PUBMED, Proquest, Meditext and from manual library searches. Data Extraction Databases were searched from 1980 to the present (2005. Articles were searched with the key words "depression" and "low back pain". Over three hundred articles were sourced and articles were then selected on their relevance to the chronic spinal pain states that present to manual therapy practitioners. Data synthesis Pain is a subjective awareness of peripheral nociceptive stimulation, projected from the thalamus to the cerebral cortex with each individual's pain experience being mediated by his or her psychological state. Thus a psychological component will often be associated with any painful experience. A number of studies suggest (among other things that the incidence of depression predicts chronicity in lower back pain syndromes but that chronic lower back pain does not have the reciprocal action to predict depression. Conclusion The aetiology of chronic pain is multifactorial. There is sufficient evidence in the literature to demonstrate a requirement to draw treatment options from many sources in order to achieve a favourable pain relief outcome. The treatment should be multimodal, including mental and emotional support, counseling and herbal advice. While a strong correlation between depression and chronic low back pain can be demonstrated, an apparent paucity of literature that specifically addresses the patient response to chiropractic treatment and concurrent psychotherapy identifies the need for prospective studies of this nature to be undertaken. It is likely that multimodal/multidisciplinary treatment approaches should be encouraged to deal with these chronic lower back pain syndromes.

  16. Effects of the CORE Exercise Program on Pain and Active Range of Motion in Patients with Chronic Low Back Pain.

    Science.gov (United States)

    Cho, Hwi-Young; Kim, Eun-Hye; Kim, Junesun

    2014-08-01

    [Purpose] This study aimed to identify the effects of the CORE exercise program on pain and active range of motion (AROM) in patients with chronic low back pain. [Subjects and Methods] Thirty subjects with chronic low back pain were randomly allocated to two groups: the CORE group (n = 15) and the control group (n = 15). The CORE group performed the CORE exercise program for 30 minutes a day, 3 times a week, for 4 weeks, while the control group did not perform any exercise. The visual analog scale (VAS) and an algometer were used to measure pain, and pain-free AROM in the trunk was measured before and after the intervention. [Results] The CORE group showed significantly decreased VAS scores at rest and during movement and had a significantly increased pressure pain threshold in the quadratus lumborum and AROM in the trunk compared with those in the control group. [Conclusion] This study demonstrated that the CORE exercise program is effective in decreasing pain and increasing AROM in patients with chronic low back pain. Thus, the CORE exercise program can be used to manage pain and AROM in patients with chronic low back pain.

  17. Does anterior trunk pain predict a different course of recovery in chronic low back pain?

    DEFF Research Database (Denmark)

    Panagopoulos, John; Hancock, Mark J; Kongsted, Alice;

    2014-01-01

    Patient characteristics associated with the course and severity of low back pain (LBP) and disability have been the focus of extensive research, however, known characteristics do not explain much of the variance in outcomes. The relationship between anterior trunk pain (ATP) and LBP has not been ...

  18. Evaluation of chronic low back pain in osteoporotic patients in treatment with teriparatide

    Directory of Open Access Journals (Sweden)

    Renata Alvarenga Nunes

    2014-03-01

    Full Text Available OBJECTIVE: The objective was to assess the improvement of chronic low back pain in osteoporotic patients treated with teriparatide (TPTD. METHODS: This was an observational study with a convenience sample of 21 patients with osteoporosis using TPTD, 20 mcg/day, between 2006 and 2010, with chronic low back pain (more than three months. Dorsolumbar radiographs and bone densitometry (DXA were performed before and after treatment. For pain measurement the VAS pain scale was used. Data were entered in Excel and processed in STATA/SE 8.0 with Chi2 square or Fisher (p < 0.05. RESULTS: twenty-one patients aged 40-90 (mean 70 years, eight (40% had senile osteoporosis and thirteen (60% had osteoporosis secondary to medications. Seventeen (80% had previous dorsolumbar fractures. Ten (47.5% used TPTD for 24 months, six (27.5 % used the medication for 18 months, four (20% for 12 months and one (5% for six months. Eight patients (40% received previous anti-reabsortive therapy. Thirteen patients (60% exhibited bone mass gain between 0% and 9% while eight (40%, between 10% and 15%. The final average VAS was 2.6 representing an improvement of 4.7 (p< 0.05. CONCLUSION: There was a significant reduction in the severity of low back pain with the use of TPTD (initial mean VAS: 7.3, final VAS: 2.6, improvement: 4.7.

  19. Effects of gyrokinesis exercise on the gait pattern of female patients with chronic low back pain

    OpenAIRE

    Seo, Kook-Eun; Park, Tae-Jin

    2016-01-01

    [Purpose] The purpose of the present study was to use kinematic variables to identify the effects of 8/weeks’ performance of a gyrokinesis exercise on the gait pattern of females with chronic low back pain. [Subjects] The subjects of the present study were females in their late 20s to mid 30s who were chronic back pain patients. [Methods] A 3-D motion analysis system was used to measure the changes in their gait patterns between pre and post-gyrokintic exercise. The SPSS 21.0 statistics progr...

  20. Participant Characteristics Associated with Symptomatic Improvement from Yoga for Chronic Low Back Pain

    OpenAIRE

    Stein, Kim M; Weinberg, Janice; Sherman, Karen J.; Chelsey M. Lemaster; Saper, Robert

    2014-01-01

    Context Studies suggest that yoga is effective for moderate to severe chronic low back pain (cLBP) in diverse predominantly lower socioeconomic status populations. However, little is known about factors associated with benefit from the yoga intervention. Objective Identify factors at baseline independently associated with greater efficacy among participants in a study of yoga for cLBP. Design From September–December 2011, a 12-week randomized dosing trial was conducted comparing weekly vs. tw...

  1. Possibilities of balneotherapy in treatment of subjective symptoms of chronic low back pain (lumbar syndrome)

    OpenAIRE

    Batsialou Ioanna

    2002-01-01

    Introduction Chronic low back pain is a degenerative rheumatic disease and is characterized by various symptoms and clinical signs. Balneotherapy Balneotherapy represents a therapy by various hot or warm baths in natural mineral waters of specific physical and chemical characteristics. When used externally, they have mechanical, chemical and thermic effects. Balneotherapy of lumbar syndrome includes: individual baths, swimming in the pool, hydrokinesitherapy, underwater massage, underwater ex...

  2. Measuring disability in patients with chronic low back pain: the usefulness of different instruments

    OpenAIRE

    Kuijer, Wietske

    2006-01-01

    Measuring disability is an important topic in rehabilitation research in patients with chronic low back pain (CLBP). Due to the major impact of CLBP on functioning in both daily living and work, measuring disability in patients with CLBP is best described in terms of limitations in activities and restrictions in participation in daily living and work. A frequently used measurement instrument in rehabilitation medicine to measure self-reported limitations in activities of daily living (ADL) in...

  3. THE EFFECT OF KINESIO TAPING IN CHRONIC NON-SPECIFIC LOW BACK PAIN

    OpenAIRE

    Makeeva, Anna

    2016-01-01

    The purpose of this thesis is to find out the effect of Kinesio taping on patients with low back pain (LBP). LBP is the most common musculoskeletal disease affecting all human beings. It effects on activities of daily living (ADL). The aim of this thesis is to determine the effect of Kinesio taping on pain and ADL. The research subject will be adults from the “Satakunnan Selkäyhdistys” Back Pain Association with chronic LBP. All participants will be interviewed during the first meeting. Th...

  4. MRI and low back pain

    Science.gov (United States)

    Backache - MRI; Low back pain - MRI; Lumbar pain - MRI; Back strain - MRI; Lumbar radiculopathy - MRI; Herniated intervertebral disk - MRI; Prolapsed intervertebral disk - MRI; Slipped disk - MRI; Ruptured ...

  5. Long-term safety and effectiveness of tanezumab as treatment for chronic low back pain.

    Science.gov (United States)

    Gimbel, Joseph S; Kivitz, Alan J; Bramson, Candace; Nemeth, Mary Anne; Keller, David S; Brown, Mark T; West, Christine R; Verburg, Kenneth M

    2014-09-01

    A noncontrolled, randomized, multicenter study (NCT00924664) evaluated long-term safety and effectiveness of tanezumab in patients with chronic low back pain following a randomized placebo- and active-controlled parent study that evaluated analgesic efficacy. Patients were randomized to tanezumab 10mg (n=321) or 20mg (n=527) administered at 8-week intervals via 3 intravenous injections followed by 4 subcutaneous injections. Effectiveness analyses included change from parent study baseline in Brief Pain Inventory Short Form, Roland Morris Disability Questionnaire, and Patient's Global Assessment of low back pain. Safety assessments included adverse event documentation, physical/neurological examinations, and laboratory tests. Mean treatment duration during the extension study was 194 and 202 days with tanezumab 10 and 20mg, respectively. Both tanezumab doses provided similar and sustained improvements in all effectiveness outcomes. The most frequently reported adverse events were arthralgia, paresthesia, and hypoesthesia. Adverse events initially described as osteonecrosis were reported in 6 patients (tanezumab 10mg, n=2; tanezumab 20mg, n=4); 9 additional patients (tanezumab 10mg, n=7; tanezumab 20mg, n=2) underwent total joint replacement (TJR). A blinded, independent adjudication committee reviewed all 6 patients with reported osteonecrosis and 4 of the 9 patients undergoing TJR. Adjudication outcomes were osteonecrosis (n=0), worsening osteoarthritis (n=5; 1 rapidly progressive), and another diagnosis or indeterminate (n=5). Tanezumab 10mg had better tolerability than tanezumab 20mg, and may represent an effective long-term treatment for chronic low back pain.

  6. Predictive factors for the outcome of multidisciplinary treatments in chronic low back pain at the first multidisciplinary pain center of Japan

    OpenAIRE

    Hayashi, Kazuhiro; Arai, Young-Chang P.; Ikemoto, Tatsunori; Nishihara, Makoto; Suzuki, Shigeyuki; Hirakawa, Tomoe; Matsuo, Shingo; Kobayashi, Mami; Haruta, Midori; Kawabata, Yuka; Togo, Hiroki; Noguchi, Taiji; Hase, Toshiyuki; Hatano, Genki; Ushida, Takahiro

    2015-01-01

    [Purpose] Multidisciplinary treatments are recommended for treatment of chronic low back pain. The aim of this study was to show the associations among multidisciplinary treatment outcomes, pretreatment psychological factors, self-reported pain levels, and history of pain in chronic low back pain patients. [Subjects and Methods] A total of 221 chronic low back pain patients were chosen for the study. The pretreatment scores for the 10-cm Visual Analogue Scale, Hospital Anxiety and Depression ...

  7. Neuropathic Pain in Elderly Patients with Chronic Low Back Painand Effects of Pregabalin: A Preliminary Study

    Science.gov (United States)

    Ito, Kenyu; Hida, Tetsuro; Ito, Sadayuki; Harada, Atsushi

    2015-01-01

    Study Design Preliminary study. Purpose To assess the association of neuropathic pain with chronic low back pain (LBP) and the effect of pregabalin on neuropathic pain in the elderly. Overview of Literature Of those with chronic LBP, 37% were predominantly presenting with neuropathic pain in young adults. Pregabalin is effective for pain in patients with diabetic neuropathy and peripheral neuralgia. No study has reported on the effects of pregabalin for chronic LBP in elderly patients yet. Methods Pregabalin was administered to 32 patients (age, ≥65 years) with chronic LBP for 4 weeks. Pain and activities of daily living were assessed using the Neuropathic Pain Screening Questionnaire (NePSQ), the pain DETECT questionnaire, visual analog scale, the Japanese Orthopedic Association score, the short form of the McGill Pain Questionnaire and the Roland Morris Disability Questionnaire. Modic change and spinal canal stenosis were investigated using magnetic resonance imaging. Results Altogether, 43.3% of patients had neuropathic pain according to the NePSQ and 15.6% patients had pain according to the pain DETECT. The efficacy rate of pregabalin was 73.3%. A significant effect was observed in patients with neuropathic pain after 4 weeks of administration. Conclusions Neuropathic pain was slightly less frequently associated with chronic LBP in the elderly. Pregabalin was effective in reducing pain in patients with chronic LBP accompanied with neuropathic pain. Lumbar spinal stenosis and lower limb symptoms were observed in patients with neuropathic pain. We recommend the use of pregabalin for patients after evaluating a screening score, clinical symptoms and magnetic resonance imaging studies. PMID:25901238

  8. Efficacy of Selected Electrical Therapies on Chronic Low Back Pain: A Comparative Clinical Pilot Study

    Science.gov (United States)

    Rajfur, Joanna; Pasternok, Małgorzata; Rajfur, Katarzyna; Walewicz, Karolina; Fras, Beata; Bolach, Bartosz; Dymarek, Robert; Rosinczuk, Joanna; Halski, Tomasz; Taradaj, Jakub

    2017-01-01

    Background In the currently available research publications on electrical therapy of low back pain, generally no control groups or detailed randomization were used, and such studies were often conducted with relatively small groups of patients, based solely on subjective questionnaires and pain assessment scales (lacking measurement methods to objectify the therapeutic progress). The available literature also lacks a comprehensive and large-scale clinical study. The purpose of this study was to assess the effects of treating low back pain using selected electrotherapy methods. The study assesses the influence of individual electrotherapeutic treatments on reduction of pain, improvement of the range of movement in lower section of the spine, and improvement of motor functions and mobility. Material/Methods The 127 patients qualified for the therapy (ultimately, 123 patients completed the study) and assigned to 6 comparison groups: A – conventional TENS, B – acupuncture-like TENS, C – high-voltage electrical stimulation, D – interferential current stimulation, E – diadynamic current, and F – control group. Results The research showed that using electrical stimulation with interferential current penetrating deeper into the tissues results in a significant and more efficient elimination of pain, and an improvement of functional ability of patients suffering from low back pain on the basis of an analysis of both subjective and objective parameters. The TENS currents and high voltage were helpful, but not as effective. The use of diadynamic currents appears to be useless. Conclusions Selected electrical therapies (interferential current, TENS, and high voltage) appear to be effective in treating chronic low back pain. PMID:28062862

  9. Nordic Walking and chronic low back pain: design of a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Hartvigsen Jan

    2006-10-01

    Full Text Available Abstract Background Low Back Pain is a major public health problem all over the western world. Active approaches including exercise in the treatment of low back pain results in better outcomes for patients, but it is not known exactly which types of back exercises are most beneficial or whether general physical activity provide similar benefits. Nordic Walking is a popular and fast growing type of exercise in Northern Europe. Initial studies have demonstrated that persons performing Nordic Walking are able to exercise longer and harder compared to normal walking thereby increasing their cardiovascular metabolism. Until now no studies have been performed to investigate whether Nordic Walking has beneficial effects in relation to low back pain. The primary aim of this study is to investigate whether supervised Nordic Walking can reduce pain and improve function in a population of chronic low back pain patients when compared to unsupervised Nordic Walking and advice to stay active. In addition we investigate whether there is an increase in the cardiovascular metabolism in persons performing supervised Nordic Walking compared to persons who are advised to stay active. Finally, we investigate whether there is a difference in compliance between persons receiving supervised Nordic Walking and persons doing unsupervised Nordic Walking. Methods One hundred and fifty patients with low back pain for at least eight weeks and referred to a specialized secondary sector outpatient back pain clinic are included in the study. After completion of the standard back centre treatment patients are randomized into one of three groups: A Nordic Walking twice a week for eight weeks under supervision of a specially trained instructor; B Unsupervised Nordic Walking for eight weeks after one training session with an instructor; C A one hour motivational talk including advice to stay active. Outcome measures are pain, function, overall health, cardiovascular ability and

  10. Effect of Yoga on Pain, Brain-Derived Neurotrophic Factor, and Serotonin in Premenopausal Women with Chronic Low Back Pain

    OpenAIRE

    Moseon Lee; Woongjoon Moon; Jaehee Kim

    2014-01-01

    Background. Serotonin and brain-derived neurotrophic factor (BDNF) are known to be modulators of nociception. However, pain-related connection between yoga and those neuromodulators has not been investigated. Therefore, we aimed to evaluate the effect of yoga on pain, BDNF, and serotonin. Methods. Premenopausal women with chronic low back pain practiced yoga three times a week for 12 weeks. At baseline and after 12 weeks, back pain intensity was measured using visual analogue scale (VAS), and...

  11. Comparison of efficacy of neural therapy and physical therapy in chronic low back pain.

    Science.gov (United States)

    Atalay, Nilgun Simsir; Sahin, Fusun; Atalay, Ali; Akkaya, Nuray

    2013-01-01

    The aim of this prospective study was to evaluate the effects of neural therapy, and physical therapy on level of pain, disability, quality of life, and psychological status in patients with chronic low back pain. Patients admitted to the physical therapy and rehabilitation outpatient clinic with the complaint of low back pain of at least 3 months duration. Group 1 (n=27), physical therapy (PT, hotpack, ultrasound, TENS 15 sessions), group 2 (n=33), neural therapy (NT, 1:1 mixture of 20 mg/mL Lidocaine HCl (Jetokain simplex®) and saline for 5 sessions. For pain, Visual Analogue Scale (VAS), for disability Roland Morris Disability Questionnaire (RMDQ), for quality-of-life Nottingham-Health-Profile (NHP), for depression, and anxiety, Hospital Anxiety-Depression Scale (HADS) were used before and after the treatment. Mean age was 47.3±11.32 years, symptom time was 13.78±11.98 months. There were no differences for demographic variables between groups. Significant improvements were detected for VAS, RMDQ, NHP-Pain, NHP-Physical activity, HADS for both of two groups after treatment. In addition to these findings, significant improvements were found for NHP-Energy, NHP-Social isolation in NT group. The differences of pre- and post-treatment values of parameters were evaluated for each group. Although there were no differences for VAS, NHP-sleep, NHP-Emotional reaction, HADS between groups, RMDQ, NHP-Pain, NHP-Physical activity, NHP-Social isolation were higher in NT than PT before treatment, the improvements for these parameters were better in NT than PT. In conclusion both of NT and PT are effective on pain, function, quality of life, anxiety, and depression in patients with chronic low back pain.

  12. EFFECTIVENESS OF KATIVASTHI AND EXERCISE IN CHRONIC LOW BACK PAIN: A RANDOMIZED CONTROL STUDY

    Directory of Open Access Journals (Sweden)

    Panda Ashok Kumar

    2011-02-01

    Full Text Available Chronic low back pain is very common and comprises of 2 .21% in US population and 15% in working groups over the age of 30. In this study there were two groups, one was Kativasthi therapy group and another was Exercise therapy group. Both groups were continued for 10 days. Kativasthi is process specially prepared warm medicated oil kept over low back area with Masa churna (Black gram powder paste boundary over a period of 45 minutes. An open prospective study was conducted to evaluate the effectiveness of Kativasthi (warm oil stagnation procedure in patients of chronic low back pain. Mahanarayan taila is used in Kativasthi for 10 days after Sarvanga Snehana with Mahanarayan taila (oil massage and Sarvanga Baspa Svedana (steam bath. 40 patients, aged 40±10.4 years were divided into two groups by a computer generated random number table. X ray of lumbo-sacral spine (antero-posterior & lateral view was reviewed. Differences of lumbar and ridiculer pains on an analog visual scale, Modified Oswestry Disability score and distance finger ground test were assessed at 0-day & 10th -day. There is significant improvement in all above parameters on 10th day. It was found that Kativasthi was more effective than the conventional exercise practices.

  13. Primary care physicians' attitudes and beliefs towards chronic low back pain: an Asian study.

    Directory of Open Access Journals (Sweden)

    Regina W S Sit

    Full Text Available Chronic low back pain is a serious global health problem. There is substantial evidence that physicians' attitudes towards and beliefs about chronic low back pain can influence their subsequent management of the condition.(1 to evaluate the attitudes and beliefs towards chronic low back pain among primary care physicians in Asia; (2 to study the cultural differences and other factors that are associated with these attitudes and beliefs.A cross sectional online survey was sent to primary care physicians who are members of the Hong Kong College of Family Physician (HKCFP. The Pain Attitudes and Beliefs Scale for Physiotherapist (PABS-PT was used as the questionnaire to determine the biomedical and biopsychosocial orientation of the participants.The mean Biomedical (BM score was 34.8+/-6.1; the mean biopsychosocial (BPS score was 35.6 (+/- 4.8. Both scores were higher than those of European doctors. Family medicine specialists had a lower biomedical score than General practitioners. Physicians working in the public sector tended to have low BM and low BPS scores; whereas physicians working in private practice tended to have high BM and high BPS scores.The lack of concordance in the pain explanatory models used by private and public sector may have a detrimental effect on patients who are under the care of both parties. The uncertain treatment orientation may have a negative influence on patients' attitudes and beliefs, thus contributing to the tension and, perhaps, even ailing mental state of a person with chronic LBP.

  14. Nursing intervention protocol for adult patients experiencing chronic low back pain

    Directory of Open Access Journals (Sweden)

    Nadia Mohamed Taha

    2015-12-01

    Full Text Available Aim: The aim of this study was to evaluate the effectiveness of a nursing intervention protocol targeting the knowledge and practice of adult patients experiencing low back pain. Design: A quasi-experimental research design. Methods: Pre-post assessment of outcome was used in this study. The study was conducted in the outpatient clinic of the physical therapy department at Zagazig University Hospital and Beni-Suef University Hospital, Egypt. Sample: 40 participants diagnosed with chronic low back pain (lasting for longer than six months. Seven of the 40 dropped out during the follow-up phase for personal or logistical reasons. Tools included sections for demographic characteristics, knowledge and practice assessment; in addition to the Oswestry Disability Index, and Visual Analogue Scale (VAS. Results: The application of an instruction protocol intervention for low back pain was effective in improving patient knowledge and practice, with associated amelioration of the severity of pain and disability among them. The effect was still apparent at the three-month follow-up. Conclusion: It is recommended that the study be replicated using a more robust randomized clinical trial design. Nonetheless, the instruction protocol with the designed booklet may be adopted as an element of the care services offered to patients suffering LBP, given the clear positive effects on patient knowledge, which would undoubtedly help them decide on the most preferential management approach.

  15. Effectiveness of a home-based physical therapy program in patients with chronic low back pain

    Directory of Open Access Journals (Sweden)

    Elena SÎRBU

    2017-03-01

    Full Text Available Aim: To demonstrate the effectiveness of a home-based physical therapy program on pain, spine mobility and quality of daily activities in patients with chronic low back pain (CLBP. We also want to show that patients who undergo this program decreased their intake in analgesic and anti-inflammatory drugs. Methods: 18 patients with chronic low back pain were assessed with the following tests: VAS pain scale, Schober’s test and Rolland-Morris questionnaire. Acetaminophen and non-steroidal anti-inflammatory drugs (NSAID consumption was recorded. Over a period of six months all subjects participated in a 45 minutes home-based physical therapy program, three times per week. Before starting this intervention all patients were instructed and exercises were demonstrated in front of them by a physical therapist. Moreover, they received written brochures in order to exercise correctly at home. Follow-up examinations took place at baseline and six months later. Results: We obtained significant differences between pre- and post-intervention assessments of pain (p=0.001, lumbar flexion (p=0.0001 and functional status (p=0.0005 in our group. Moreover, the number of patients who were taken analgesics decreased from 7 (39% to 5 patients (28%. Likewise the number of patients who were taken anti-inflammatory drugs decreased from 11 (61% to 8 (44%. Conclusion: The home-based rehabilitation program was effective in improving the ranges of active lumbar flexion and in decreasing the physical disability caused by low back pain, as well as in reducing the levels of pain. We note that a larger number of patients have given up to the intake of NSAIDs comparative to those who have given up to analgesics.

  16. Isolated Facet Joint Fracture as a Cause of Chronic Low Back Pain and Sciatica

    Directory of Open Access Journals (Sweden)

    Robert W Teasell

    1996-01-01

    Full Text Available A case of facet joint fracture following a rear-end motor vehicle accident who presented with chronic low back pain and sciatica is outlined. Diagnosis was made with 99Tc nuclear bone scan and was confirmed on computed tomographic scan after diagnosis with regular radiographs had failed. Facetectomy relieved pain but led to symptoms related to asymmetric load on the opposite facet joint. Symptoms were substantially relieved with a facet joint deinnervation procedure. Facet joint fracture was felt to occur as a consequence of compression forces on the facet joint at the time of impact.

  17. Yoga to treat nonspecific low back pain.

    Science.gov (United States)

    Carter, Catherine; Stratton, Carol; Mallory, Debra

    2011-08-01

    Low back pain is common and poses a challenge for clinicians to find effective treatment to prevent it from becoming chronic. Chronic low back pain can have a significant impact on an employee's ability to remain an active and productive member of the work force due to increased absenteeism, duty restrictions, or physical limitations from pain. Low back pain is the most common cause of work-related disability among employees younger than 46 years. Advancing technology and less invasive surgical procedures have not improved outcomes for employees who suffer from low back pain. Most continue to experience some pain and dysfunction after conventional treatments such as injections and surgery. An alternative treatment that could reduce nonspecific chronic low back pain would benefit both employees and employers. Exercising and remaining active are part of most guidelines' routine care recommendations but are not well defined.

  18. Reproducibility of tender point examination in chronic low back pain patients as measured by intrarater and inter-rater reliability and agreement

    DEFF Research Database (Denmark)

    Jensen, Ole Kudsk; Callesen, Jacob; Nielsen, Merete Graakjaer;

    2013-01-01

    To evaluate the reliability and agreement of digital tender point (TP) examination in chronic low back pain (LBP) patients.......To evaluate the reliability and agreement of digital tender point (TP) examination in chronic low back pain (LBP) patients....

  19. Comparison between Epidural Block vs. High Intensity Laser Therapy for Controlling Chronic Low Back Pain

    Directory of Open Access Journals (Sweden)

    Badiozaman Radpay

    2016-01-01

    Full Text Available Background: Chronic low back pain is among a wide spread musculoskeletal conditions that is related to disability with high economy cost. There are several treatment modalities for controlling chronic low back pain (CLBP, among them high intensity laser therapy (HILT and epidural blocks (EB use more commonly. This study aimed to evaluate the benefits and hazards of each of these two methods.Materials and Methods: We designed a randomized controlled double blind study during 24 months.101 patients divided in 2 groups (52 in EB and 49 in HILT group. Pain intensity was assessed by using faces pain scales (FPS and LINKERT questionaries' before procedure and during one, four, 12, and 24 weeks after beginning the procedures.Results: There were no differences between two groups in FPS lumber tenderness, straight leg rising test (SLRT, paresthesia, deep tendon reflex (DTR, and imaging changes. Motor problems seem was less in HILT group comparing EB.Conclusion: This study showed both EB and HILT approaches can control the pain intensity and motor activities in CLBP patients. Future studies will clarify the precise importance of each these methods.

  20. Myofascial low back pain treatment.

    Science.gov (United States)

    Sharan, Deepak; Rajkumar, Joshua Samuel; Mohandoss, Mathankumar; Ranganathan, Rameshkumar

    2014-09-01

    Myofascial pain is a common musculoskeletal problem, with the low back being one of the commonest affected regions. Several treatments have been used for myofascial low back pain through physical therapies, pharmacologic agents, injections, and other such therapies. This review will provide an update based on recently published literature in the field of myofascial low back pain along with a brief description of a sequenced, multidisciplinary treatment protocol called Skilled Hands-on Approach for the Release of myofascia, Articular, Neural and Soft tissue mobilization (SHARANS) protocol. A comprehensive multidisciplinary approach is recommended for the successful management of individuals with myofascial low back pain.

  1. Intractable Chronic Low-Back Pain Caused by Ligamentopathia Treated Using a Spinous Process Plate (S-plate

    Directory of Open Access Journals (Sweden)

    Yu-ichiro Ohnishi

    2010-03-01

    Full Text Available We report a case of intractable chronic low-back pain in a gymnast that was caused by ligamentopathia in the interspinous region of the lumbar vertebrae. Sprained interspinous ligaments are a common mechanical cause of acute low-back pain in athletes. Although conservative therapy is generally effective in such cases, in this case it was not. The patient experienced severe low-back pain during lumbar flexion with tension between the L5/S interspinous ligaments. We performed interspinous fixation by using a spinous process plate system, which has been developed for short in situ fusions, and following which the low-back pain resolved. Conservative therapy for low-back pain caused by ligamentopathia is first-line choice, but interspinous fixation with instrumentation might be recommended in intractable cases with conservative therapy.

  2. Effect of yoga on pain, brain-derived neurotrophic factor, and serotonin in premenopausal women with chronic low back pain.

    Science.gov (United States)

    Lee, Moseon; Moon, Woongjoon; Kim, Jaehee

    2014-01-01

    Background. Serotonin and brain-derived neurotrophic factor (BDNF) are known to be modulators of nociception. However, pain-related connection between yoga and those neuromodulators has not been investigated. Therefore, we aimed to evaluate the effect of yoga on pain, BDNF, and serotonin. Methods. Premenopausal women with chronic low back pain practiced yoga three times a week for 12 weeks. At baseline and after 12 weeks, back pain intensity was measured using visual analogue scale (VAS), and serum BDNF and serotonin levels were evaluated. Additionally, back flexibility and level of depression were assessed. Results. After 12-week yoga, VAS decreased in the yoga group (P yoga group (P yoga group (P yoga group, while it reduced (P yoga group, whereas it tended to increase in the control group (P = 0.07). Conclusions. We propose that BDNF may be one of the key factors mediating beneficial effects of yoga on chronic low back pain.

  3. Psychological predictors of substantial pain reduction after minimally invasive radiofrequency and injection treatments for chronic low back pain

    NARCIS (Netherlands)

    van Wijk, Roelof M. A. W.; Geurts, Jos W. M.; Lousberg, Richel; Wynne, Herman J.; Hammink, Edwin; Knape, Johannes T. A.; Groen, Gerbrand J.

    2008-01-01

    Objective. In this post hoc observational study, we investigated psychological predictors of outcome after radiofrequency and injection treatments, commonly performed in the management of chronic low back pain (CLBP). Design & Setting. Data, comprising 161 patients (29 eventually lost to follow-up),

  4. Efficacy of acupuncture for chronic low back pain: protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Barlow William E

    2008-02-01

    Full Text Available Abstract Background Chronic back pain is a major public health problem and the primary reason patients seek acupuncture treatment. Therefore, an objective assessment of acupuncture efficacy is critical for making informed decisions about its appropriate role for patients with this common condition. This study addresses methodological shortcomings that have plagued previous studies evaluating acupuncture for chronic low back pain. Methods and Design A total of 640 participants (160 in each of four arms between the ages of 18 and 70 years of age who have low back pain lasting at least 3 months will be recruited from integrated health care delivery systems in Seattle and Oakland. They will be randomized to one of two forms of Traditional Chinese Medical (TCM acupuncture needling (individualized or standardized, a "control" group (simulated acupuncture, or to continued usual medical care. Ten treatments will be provided over 7 weeks. Study participants and the "Diagnostician" acupuncturists who evaluate participants and propose individualized treatments will be masked to the acupuncture treatment actually assigned each participant. The "Therapist" acupuncturists providing the treatments will not be masked but will have limited verbal interaction with participants. The primary outcomes, standard measures of dysfunction and bothersomeness of low back pain, will be assessed at baseline, and after 8, 26, and 52 weeks by telephone interviewers masked to treatment assignment. General health status, satisfaction with back care, days of back-related disability, and use and costs of healthcare services for back pain will also be measured. The primary analysis comparing outcomes by randomized treatment assignment will be analysis of covariance adjusted for baseline value. For both primary outcome measures, this trial will have 99% power to detect the presence of a minimal clinically significant difference among all four treatment groups and over 80% power for

  5. Fluoroscopic caudal epidural injections in managing chronic axial low back pain without disc herniation, radiculitis, or facet joint pain

    Directory of Open Access Journals (Sweden)

    Manchikanti L

    2012-10-01

    Full Text Available Laxmaiah Manchikanti,1,2 Kimberly A Cash,1 Carla D McManus,1 Vidyasagar Pampati11Pain Management Center of Paducah, Paducah, 2Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USABackground: Chronic low back pain without disc herniation is common. Various modalities of treatments are utilized in managing this condition, including epidural injections. However, there is continued debate on the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections.Methods: A randomized, double-blind, actively controlled trial was conducted. The objective was to evaluate the ability to assess the effectiveness of caudal epidural injections of local anesthetic with or without steroids for managing chronic low back pain not caused by disc herniation, radiculitis, facet joints, or sacroiliac joints. A total of 120 patients were randomized to two groups; one group did not receive steroids (group 1 and the other group did (group 2. There were 60 patients in each group. The primary outcome measure was at least 50% improvement in Numeric Rating Scale and Oswestry Disability Index. Secondary outcome measures were employment status and opioid intake. These measures were assessed at 3, 6, 12, 18, and 24 months after treatment.Results: Significant pain relief and functional status improvement (primary outcome defined as a 50% or more reduction in scores from baseline, were observed in 54% of patients in group 1 and 60% of patients in group 2 at 24 months. In contrast, 84% of patients in group 1 and 73% in group 2 saw significant pain relief and functional status improvement in the successful groups at 24 months.Conclusion: Caudal epidural injections of local anesthetic with or without steroids are effective in patients with chronic axial low back pain of discogenic origin without facet joint pain, disc herniation, and

  6. Trajectories of low back pain

    DEFF Research Database (Denmark)

    Axén, Iben; Leboeuf-Yde, Charlotte

    2013-01-01

    Low back pain is not a self-limiting problem, but rather a recurrent and sometimes persistent disorder. To understand the course over time, detailed investigation, preferably using repeated measurements over extended periods of time, is needed. New knowledge concerning short-term trajectories...... indicates that the low back pain 'episode' is short lived, at least in the primary care setting, with most patients improving. Nevertheless, in the long term, low back pain often runs a persistent course with around two-thirds of patients estimated to be in pain after 12 months. Some individuals never have...... low back pain, but most have it on and off or persistently. Thus, the low back pain 'condition' is usually a lifelong experience. However, subgroups of patients with different back pain trajectories have been identified and linked to clinical parameters. Further investigation is warranted...

  7. Ligamentum flavum hypertrophy in asymptomatic and chronic low back pain subjects.

    Directory of Open Access Journals (Sweden)

    Justin J Munns

    Full Text Available To examine ligamentum flavum thickness using magnetic resonance (MR images to evaluate its association with low back pain symptoms, age, gender, lumbar level, and disc characteristics.Sixty-three individuals were part of this IRB-approved study: twenty-seven with chronic low back pain, and thirty-six as asymptomatic. All patients underwent MR imaging and computed tomography (CT of the lumbar spine. The MR images at the mid-disc level were captured and enlarged 800% using a bilinear interpolation size conversion algorithm that allowed for enhanced image quality. Ligamentum flavum thickness was assessed using bilateral medial and lateral measurements. Disc height at each level was measured by the least-distance measurement method in three-dimensional models created by CT images taken of the same subject. Analysis of variance and t-tests were carried out to evaluate the relationship between ligamentum flavum thickness and patient variables.Ligamentum flavum thickness was found to significantly increase with older age, lower lumbar level, and chronic low back pain (p < 0.03. No difference in ligamentum flavum thickness was observed between right and left sided measurements, or between male and female subjects. Disc height and both ligamentum flavum thickness measurements showed low to moderate correlations that reached significance (p < 0.01. Additionally, a moderate and significant correlation between disc degeneration grade and ligamentum flavum thickness does exist (p <0.001.By measuring ligamentum flavum thickness on MR images at two different sites and comparing degrees of disc degeneration, we found that ligamentum flavum thickness may be closely related to the pathogenesis of pain processes in the spine.

  8. Reduced thoracolumbar fascia shear strain in human chronic low back pain

    Directory of Open Access Journals (Sweden)

    Konofagou Elisa E

    2011-09-01

    Full Text Available Abstract Background The role played by the thoracolumbar fascia in chronic low back pain (LBP is poorly understood. The thoracolumbar fascia is composed of dense connective tissue layers separated by layers of loose connective tissue that normally allow the dense layers to glide past one another during trunk motion. The goal of this study was to quantify shear plane motion within the thoracolumbar fascia using ultrasound elasticity imaging in human subjects with and without chronic low back pain (LBP. Methods We tested 121 human subjects, 50 without LBP and 71 with LBP of greater than 12 months duration. In each subject, an ultrasound cine-recording was acquired on the right and left sides of the back during passive trunk flexion using a motorized articulated table with the hinge point of the table at L4-5 and the ultrasound probe located longitudinally 2 cm lateral to the midline at the level of the L2-3 interspace. Tissue displacement within the thoracolumbar fascia was calculated using cross correlation techniques and shear strain was derived from this displacement data. Additional measures included standard range of motion and physical performance evaluations as well as ultrasound measurement of perimuscular connective tissue thickness and echogenicity. Results Thoracolumbar fascia shear strain was reduced in the LBP group compared with the No-LBP group (56.4% ± 3.1% vs. 70.2% ± 3.6% respectively, p Conclusion Thoracolumbar fascia shear strain was ~20% lower in human subjects with chronic low back pain. This reduction of shear plane motion may be due to abnormal trunk movement patterns and/or intrinsic connective tissue pathology. There appears to be some sex-related differences in thoracolumbar fascia shear strain that may also play a role in altered connective tissue function.

  9. Effect of Tramadol/Acetaminophen on Motivation in Patients with Chronic Low Back Pain.

    Science.gov (United States)

    Tetsunaga, Tomoko; Tetsunaga, Tomonori; Tanaka, Masato; Nishida, Keiichiro; Takei, Yoshitaka; Ozaki, Toshifumi

    2016-01-01

    Background. The contribution of apathy, frequently recognized in individuals with neurodegenerative diseases, to chronic low back pain (LBP) remains unclear. Objectives. To investigate levels of apathy and clinical outcomes in patients with chronic LBP treated with tramadol-acetaminophen. Methods. A retrospective case-control study involving 73 patients with chronic LBP (23 male, 50 female; mean age 71 years) treated with tramadol-acetaminophen (n = 36) and celecoxib (n = 37) was performed. All patients were assessed using the self-reported questionnaires. A mediation model was constructed using a bootstrapping method to evaluate the mediating effects of pain relief after treatment. Results. A total of 35 (55.6%) patients met the criteria for apathy. A four-week treatment regimen in the tramadol group conferred significant improvements in the Apathy scale and numerical rating scale but not in the Rolland-Morris Disability Questionnaire, Pain Disability Assessment Scale, or Pain Catastrophizing Scale. The depression component of the Hospital Anxiety and Depression Scale was lower in the tramadol group than in the celecoxib group. The mediation analysis found that the impact of tramadol-acetaminophen on the change in apathy was not mediated by the pain relief. Conclusions. Tramadol-acetaminophen was effective at reducing chronic LBP and conferred a prophylactic motivational effect in patients with chronic LBP.

  10. Analgesic effectiveness of the association of transcutaneous electrical nerve stimulation and cryotherapy for chronic low back pain

    OpenAIRE

    Abreu,Eliziete Almeida de; Santos, Jean Douglas Moura dos; Ventura,Patrícia Lima

    2011-01-01

    BACKGROUND AND OBJECTIVES: Transcutaneous electrical nerve stimulation (TENS) and cryotherapy are physical therapy resources individually used, since there is the possibility of interaction between TENS and cryotherapy if they are associated. This study aimed at evaluating the analgesic effectiveness of the association or not of TENS and cryotherapy to relieve chronic low back pain. METHOD: Clinical trial involving six chronic low back pain patients distributed in three groups: cryotherapy, T...

  11. Effect of intravenous tropisetron on modulation of pain and central hypersensitivity in chronic low back pain patients.

    Science.gov (United States)

    Neziri, Alban Y; Dickenmann, Martina; Scaramozzino, Pasquale; Andersen, Ole K; Arendt-Nielsen, Lars; Dickenson, Anthony H; Curatolo, Michele

    2012-02-01

    The activation of 5-hydroxytryptamine-3 (5-HT-3) receptors in spinal cord can enhance intrinsic spinal mechanisms of central hypersensitivity, possibly leading to exaggerated pain responses. Clinical studies suggest that 5-HT-3 receptor antagonists may have an analgesic effect. This randomized, double-blind, placebo-controlled crossover study tested the hypothesis that the 5-HT-3 receptor antagonist tropisetron attenuates pain and central hypersensitivity in patients with chronic low back pain. Thirty patients with chronic low back pain, 15 of whom were women (aged 53 ± 14 years) and 15 men (aged 48 ± 14 years), were studied. A single intravenous injection of 0.9% saline solution, tropisetron 2mg, and tropisetron 5mg was administrated in 3 different sessions, in a double-blind crossover manner. The main outcome was the visual analogue scale (VAS) score of spontaneous low back pain before, and 15, 30, 60, and 90 minutes after drug administration. Secondary outcomes were nociceptive withdrawal reflexes to single and repeated electrical stimulation, area of reflex receptive fields, pressure pain detection and tolerance thresholds, conditioned pain modulation, and area of clinical pain. The data were analyzed by analysis of variance and panel multiple regressions. All 3 treatments reduced VAS scores. However, there was no statistically significant difference between tropisetron and placebo in VAS scores. Compared to placebo, tropisetron produced a statistically significant increase in pain threshold after single electrical stimulation, but no difference in all other secondary outcomes was found. A single-dose intravenous administration of tropisetron in patients with chronic low back pain had no significant specific effect on intensity of pain and most parameters of central hypersensitivity.

  12. A pragmatic multi-centred randomised controlled trial of yoga for chronic low back pain: Trial protocol

    OpenAIRE

    Cox, Helen; Tilbrook, Helen; Aplin, John; Chuang, Ling-Hsiang; Hewitt, Catherine; Jayakody, Shalmini; Semlyen, Anna; Soares, Marta O; Torgerson, David; Trewhela, Alison; Watt, Ian; Worthy, Gill

    2010-01-01

    A systematic review revealed three small randomised controlled trials of yoga for low back pain, all of which showed effects on back pain that favoured the yoga group. To build on these studies a larger trial, with longer term follow-up, and a number of different yoga teachers delivering the intervention is required. This study protocol describes the details of a randomised controlled trial (RCT) to determine the effectiveness and cost-effectiveness of Yoga for chronic Low Back Pain, which is...

  13. Effect of core stabilization exercises on functional disability in patients with chronic low back pain

    OpenAIRE

    Amila Kapetanovic; Sabina Jerkovic; Dijana Avdic

    2016-01-01

    Introduction: The aim of this study was to assess core stabilization exercise effects in reducing functional disability in patients with chronic low back pain (CLBP).Methods: This study included total of 90 patients aged 40 to 60 years. After a ten-day rehabilitation program the patients from an examination group (n = 30) performed home exercise program five times a week, patients from a first control group (n = 30) three times a week, while patients from a second control group (n = 30) did n...

  14. Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain.

    Science.gov (United States)

    Witt, Claudia M; Jena, Susanne; Selim, Dagmar; Brinkhaus, Benno; Reinhold, Thomas; Wruck, Katja; Liecker, Bodo; Linde, Klaus; Wegscheider, Karl; Willich, Stefan N

    2006-09-01

    In a randomized controlled trial plus a nonrandomized cohort, the authors investigated the effectiveness and costs of acupuncture in addition to routine care in the treatment of chronic low back pain and assessed whether the effects of acupuncture differed in randomized and nonrandomized patients. In 2001, German patients with chronic low back pain were allocated to an acupuncture group or a no-acupuncture control group. Persons who did not consent to randomization were included in a nonrandomized acupuncture group. All patients were allowed to receive routine medical care in addition to study treatment. Back function (Hannover Functional Ability Questionnaire), pain, and quality of life were assessed at baseline and after 3 and 6 months, and cost-effectiveness was analyzed. Of 11,630 patients (mean age=52.9 years (standard deviation, 13.7); 59% female), 1,549 were randomized to the acupuncture group and 1,544 to the control group; 8,537 were included in the nonrandomized acupuncture group. At 3 months, back function improved by 12.1 (standard error (SE), 0.4) to 74.5 (SE, 0.4) points in the acupuncture group and by 2.7 (SE, 0.4) to 65.1 (SE, 0.4) points among controls (difference=9.4 points (95% confidence interval 8.3, 10.5); pAcupuncture plus routine care was associated with marked clinical improvements in these patients and was relatively cost-effective.

  15. Possibilities of balneotherapy in treatment of subjective symptoms of chronic low back pain (lumbar syndrome

    Directory of Open Access Journals (Sweden)

    Batsialou Ioanna

    2002-01-01

    Full Text Available Introduction Chronic low back pain is a degenerative rheumatic disease and is characterized by various symptoms and clinical signs. Balneotherapy Balneotherapy represents a therapy by various hot or warm baths in natural mineral waters of specific physical and chemical characteristics. When used externally, they have mechanical, chemical and thermic effects. Balneotherapy of lumbar syndrome includes: individual baths, swimming in the pool, hydrokinesitherapy, underwater massage, underwater extension, mud therapy, mud baths. The therapy should be closely monitored for optimal efficacy and it is necessary to examine: functional status of the lumbosacral region, general functional status (level of activity, lower extremities, pain measurement, use of non-steroid anti-rheumatic and analgesic agents. In order to follow-up the effects of therapy and establish the prognosis it is important to perform: detailed anamnesis, anthropometrics measurements, socio-epidemiological research, clinical examinations. Conclusion Lumbar syndrome is usually caused by a degenerative disease of the spinal column. More than 25% of people under 45 years of age are unable to work due to chronic low back pain. That is why preventive measures, prompt diagnosis and adequate therapy are of utmost importance.

  16. Investigating patient expectations and treatment outcome in a chronic low back pain population

    Directory of Open Access Journals (Sweden)

    Sanderson KB

    2012-01-01

    Full Text Available Kristen B Sanderson1, Daniela Roditi1, Steven Z George2, James W Atchison3, Evangelia Banou4, Michael E Robinson11Department of Clinical Health Psychology, 2Department of Physical Therapy, 3Department of Orthopedics and Rehabilitation, University of Florida, Gainesville, FL, USA; 4Chronic Pain Rehabilitation Program, James A Haley VA Hospital, Tampa, FL, USAObjective: This study aimed to measure the outcomes that patients consider clinically meaningful across four treatment domains – (1 pain, (2 fatigue, (3 emotional distress, and (4 level of interference – and determine if patients met their own success criteria. Additionally, the role of expectations in treatment outcome was examined. This study also aimed to determine how change in levels of pain, fatigue, disability, and level of interference varied according to the type of treatment delivered to participants.Patients: Forty-seven chronic low back pain patients were recruited from university-affiliated pain clinics.Design: The study design was longitudinal, consisting of two randomly assigned treatment conditions. The first treatment condition used opioid medication only and the second used both opioid medication and brief cognitive behavioral therapy. Pre- and post-treatment assessments were conducted, which occurred approximately 3 months after the initiation of treatment.Outcome measures: A patient-centered outcomes questionnaire was completed by participants at both pre- and post-treatment assessment.Results: Results suggest that patients did not meet their own success criteria in treatment across any of the four domains. There was a significant main effect of time for level of pain indicating that both treatment groups had a decrease in their level of pain at post-treatment, F(1, 45 = 11.98, P < 0.001. There was a significant main effect of time for level of interference domain indicating that both groups experienced a reduction in the level of pain-related interference with daily

  17. An empirical evaluation of multidimensional clinical outcome in chronic low back pain patients.

    Science.gov (United States)

    Klapow, J C; Slater, M A; Patterson, T L; Doctor, J N; Atkinson, J H; Garfin, S R

    1993-10-01

    Individuals with persisting pain often present a constellation of symptoms that includes pain, health-related impairment and dysphoric mood. It is now widely accepted that comprehensive assessment must address each of these dimensions. Despite recognition of the value of multidimensional assessment, no empirical efforts have validated the construct of a multidimensional clinical outcome presentation based on the dimensions of pain, impairment and dysphoric mood. We employed cluster analytic procedures on standard measures of pain, impairment and depression in chronic low back pain (CLBP) patients (n = 96) attending a general orthopedic clinic in order to empirically characterize multidimensional clinical outcomes. Results indicated that 3 groups could be identified reliably: (1) 'Chronic Pain Syndrome' (n = 25; high levels of pain, impairment and depression), (2) 'Positive Adaptation to Pain' (n = 24; high levels of pain with low levels of impairment and depression) and (3) 'Good Pain Control' (n = 47; low levels of pain, impairment and depression). The reliability of this cluster solution was supported by several tests of internal consistency. Discriminability of the clusters was examined across both the outcome measures themselves and several additional independent variables. The cluster solution was then cross-validated in an independent sample of pain clinic CLBP patients (n = 180) to test its generalizability. Finally the stability of the cluster dimensions over time was tested by re-assessing 36 CLBP patients 6 months after they initially were characterized into 1 of the 3 outcome groups on the same measures. MANOVA results indicated that the outcome groups were differentiated statistically across assessments. The multiple outcome measures did not change significantly across time, nor did the outcome groups change differentially across time on these measures. We conclude that the outcome dimensions of pain, impairment and depression are relatively stable

  18. Fluoroscopic caudal epidural injections in managing chronic axial low back pain without disc herniation, radiculitis, or facet joint pain

    OpenAIRE

    Manchikanti L; Cash KA; McManus CD; Pampati V

    2012-01-01

    Laxmaiah Manchikanti,1,2 Kimberly A Cash,1 Carla D McManus,1 Vidyasagar Pampati11Pain Management Center of Paducah, Paducah, 2Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USABackground: Chronic low back pain without disc herniation is common. Various modalities of treatments are utilized in managing this condition, including epidural injections. However, there is continued debate on the effectiveness, indications, and medical necessity of ...

  19. Chronic Discogenic Low Back Pain and Non-Surgical Treatment Methods: An Update

    Directory of Open Access Journals (Sweden)

    Adem Yıldırım

    2016-03-01

    Full Text Available Low back pain originating from intervertebral disc is de­scribed by two separate but related etiologies: disc her­niation and discogenic pain. When other causes are ex­cluded, prevalence of discogenic pain was reported to be between 17-42%. Diagnostic modalities include clinical examination, imaging, and discography and provoca­tive discography remains to be the golden standard for diagnosis. Treatment methods include noninvasive ap­proaches such as drugs, physiotherapy modalities, and multidisciplinary biopsychosocial rehabilitation; invasive approaches such as intradiscal treatments and epidural injections; and lastly surgical approaches such as fusion and artificial joint replacement. Evidence for drug treat­ment in chronic discogenic low back pain is limited to nonsteroidal anti-inflammatory drugs and opioids which are associated with many adverse outcomes. It has been shown that when noninvasive methods are used together with other modalities patients may obtain additional ben­efits. Evidence base is limited for many other physical and behavioral treatment methods like low back school and specific exercise programs. There is moderate evidence for epidural injections and poor evidence for intradiscal treatments. Evidence for surgical fusions and disc re­placements are similar and it is not superior to multidis­ciplinary biopsychosocial rehabilitation or well-designed physical treatment. Multiple authorities have emphasized potential complications and limited the indication of sur­gical approaches to patients who do not response con­servative treatments. In future, the most promising treat­ments seem to be multidisciplinary and long-term exer­cise programs and/or epidural injections. High quality ran­domized controlled studies with adequate sample sizes and long term follow ups should be designed in order to determine optimal treatment modalities.

  20. Chronic low back pain patients with accompanying leg pain : The relationship between pain extent and pain intensity, disability and health status

    NARCIS (Netherlands)

    Prins, Maarten R.; van der Wurff, Peter; Groen, Gerbrand J.

    2013-01-01

    Accompanying leg pain is commonly observed in patients with chronic low back pain (CLBP) and is assumed to be an indicator for the disorder severity. However, it is still unknown whether it is possible to estimate a patient's functional status by the extent of leg pain present. In a post rehabilitat

  1. Study on Factors Associated With Chronic Low Back Pain in Western India

    Directory of Open Access Journals (Sweden)

    Vikki J Parikh

    2016-06-01

    Full Text Available Introduction: Low back pain is a leading cause of disability. It occurs in similar proportions in all cultures, interferes with quality of life and work performance, and is the most common reason for medical consultations. Few cases of back pain are due to specific causes; most cases are non-specific. Acute back pain is the most common presentation and is usually self-limiting, lasting less than three months regardless of treatment. Chronic back pain is a more difficult problem, which often has strong psychological overlay: work dissatisfaction, boredom, and a generous compensation system contribute to it. Methodology: This is a retrospective study. The study was conducted in private multispecialty hospital of Ahmedabad, Gujarat. Data from April 2014 to March 2015 was analyzed. Permission was taken from the hospital authority to conduct the study and stringent confidentiality of data was maintained at all levels of the project. Result: We have analyzed data of 210 patients diagnosed with chronic low back pain. People between age of 36 years to 40 years were most common culprits. Among these, 82 (39.05% were male and 128 (60.95% were female. Among males, 65 (79.27 were overweight (BMI >= 25.00 and among females, 95 (74.22% were overweight. Disc prolapse was most common diagnosis in both males and females. It was followed by fractures and Lumber spondylosis. Conclusion: Females were more affected by Lower back pain. People in age group of 36 years to 40 years were commonly affected. Disc prolapsed was most common the most common diagnosis. [Natl J Med Res 2016; 6(2.000: 140-142

  2. The effects of extracorporeal shock wave therapy on pain, disability, and depression of chronic low back pain patients.

    Science.gov (United States)

    Han, Hyeonjee; Lee, Daehee; Lee, Sangyong; Jeon, Chunbae; Kim, Taehoon

    2015-02-01

    [Purpose] The purpose of this study was to examine the effects of extracorporeal shock wave therapy on pain, disability, and depression of chronic low back pain patients. [Subjects] In this study, 30 chronic low back pain patients were divided into an extracorporeal shock wave therapy group (ESWTG, n=15) and a conservative physical therapy group (CPTG, n=15). [Methods] The ESWTG received extracorporeal shock wave therapy and the CPTG received general conservative physical therapy two times per week for six weeks. Pain was measured using a visual analog scale (VAS), the degree of disability of the patients was assessed using the Oswestry Disability Index (ODI), and their degree of depression was measured using the Beck depression index (BDI). [Results] In intra-group comparisons, ESWTG and CPTG showed significant decreases in VAS, ODI, and BDI scores. Intergroup comparisons revealed that these decreases in VAS, ODI, and BDI scores were significantly larger in ESWTG than in CPTG. [Conclusion] Extracorporeal shock wave therapy is an effective intervention for the treatment of pain, disability, and depression in chronic low back pain patients.

  3. Auricular Point Acupressure for Chronic Low Back Pain: A Feasibility Study for 1-Week Treatment

    Directory of Open Access Journals (Sweden)

    Chao-Hsing Yeh

    2012-01-01

    Full Text Available Objectives. The objective of this one-group, repeated-measures design was to explore the acceptance of auricular point acupressure (APA to reduce chronic low back pain (CLBP and estimate minimum clinically important differences (MCIDs for pain intensity change. Methods. Subjects received 7-day APA treatment. After appropriate acupoints were identified, vaccaria seeds were carefully taped onto each selected auricular point for 7-day. The Brief Pain Inventory Short Form (BPI was used to collect outcome data. Results. A total of 74 subjects participated in the study. Ten subjects dropped out and the retention rate was 87%. Subjects reported a 46% reduction in BPI worst pain, and over 50% reduction in BPI average pain, overall pain severity and pain interference by the end of study, and 62.5% subjects also reported less pain medication use. The MCIDs for the subscale of BPI ranged from .70 to 1.86 points. The percentage improvement of MCIDs from baseline was between 14.5–24.9%. Discussion. APA appears to be highly acceptable to patients with CLBP. A sham group is needed in order to differentiate the true effects of APA from the possible psychological effects of more frequent visits by the auricular therapist and patients’ expectation of the APA treatment.

  4. Evidence-informed management of chronic low back pain with trigger point injections.

    Science.gov (United States)

    Malanga, Gerard; Wolff, Erin

    2008-01-01

    The management of chronic low back pain (CLBP) has proven very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing amongst available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence-Informed Management of Chronic Low Back Pain Without Surgery. Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.

  5. Predictors of communication preferences in patients with chronic low back pain

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    Farin E

    2013-10-01

    Full Text Available Erik Farin, Lukas Gramm, Erika SchmidtUniversity Freiburg, Medical Center, Department of Quality Management and Social Medicine, Freiburg, GermanyBackground: The objective of this exploratory study was to identify patient-related predictors of communication preferences in patients with chronic low back pain for various dimensions of patient-physician communication (patient participation and orientation, effective and open communication, emotionally supportive communication, communication about personal circumstances.Methods: Eleven rehabilitation centers from various parts of Germany participated in collection of data between 2009 and 2011. A total of 701 patients with chronic low back pain were surveyed at the start of rehabilitation. The patient questionnaire captured communication preferences, pain impact, pain intensity, and psychologic variables (fear avoidance beliefs, illness coherence, control beliefs, communication self-efficacy, and personality characteristics. The rehabilitation physicians filled out a documentation sheet containing information on diagnosis, inability to work, duration of the illness, and comorbidity at the beginning and end of rehabilitation. Hierarchical regression analyses were performed.Results: On average, effective, open, and patient-centered communication was very important for patients with back pain, emotionally supportive communication was important, and communication about personal circumstances was somewhat important. The variance in communication preferences explained by the predictors studied here was 8%–19%. Older patients showed a lower preference for patient-centered and open communication, but a higher preference for communication about personal circumstances. Patients with psychologic risk factors (eg, fear avoidance beliefs, extroverted patients, and patients with high self-efficacy in patient-physician interaction generally had higher expectations of the physician's communicative behavior

  6. EFFECT OF MYOFASCIAL RELEASE THERAPY ON PAIN RELATED DISABILITY, QUALITY OF SLEEP AND DEPRESSION IN OLDER ADULTS WITH CHRONIC LOW BACK PAIN

    OpenAIRE

    Dr. B.Arun, MPT, PhD

    2014-01-01

    Low back pain was experienced by 50% of older adults that has threatened to quality of life. The economic cost of low back pain is more in older adults. Various literatures found that there is strong relationships exist between the low back pain and the psychosocial factors like sleep disturbances, depression, mood sway and chronic illness. Studies has found that depression is one of the commonest psychological problem faced by older adults which relates to other factors like pain, sleep dist...

  7. Investigational pharmacology for low back pain

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    Avinash K Bhandary

    2010-09-01

    Full Text Available Avinash K Bhandary1 , Gary P Chimes2, Gerard A Malanga3 1Department of Physical Medicine and Rehabilitation, 2Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 3New Jersey Sports Medicine Institute; Overlook Hospital; Mountainside Hospital; Rehabilitation Medicine and Electrodiagnosis, St Michael’s Medical Center; Horizon Healthcare Worker’s Compensation Services, Blue Cross and Blue Shield Worker’s Compensation, Summit, NJ, USAStudy design: Review and reinterpretation of existing literature.Objective: This review article summarizes the anatomy and pathogenesis of disease processes that contribute to low back pain, and discusses key issues in existing therapies for chronic low back pain. The article also explains the scientific rationale for investigational pharmacology and highlights emerging compounds in late development.Results/conclusion: While the diverse and complex nature of chronic low back pain continues to challenge clinicians, a growing understanding of chronic low back pain on a cellular level has refined our approach to managing chronic low back pain with pharmacology. Many emerging therapies with improved safety profiles are currently in the research pipeline and will contribute to a multimodal therapeutic algorithm in the near future. With the heterogeneity of the patient population suffering from chronic low back pain, the clinical challenge will be accurately stratifying the optimal pharmacologic approach for each patient.Keywords: low back pain, investigational, pharmacology, drugs

  8. Primary somatosensory cortex in chronic low back pain – a 1H-MRS study

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    Sharma KN

    2011-05-01

    Full Text Available Neena K Sharma1, Kenneth McCarson2, Linda Van Dillen5, Angela Lentz1, Talal Khan3, Carmen M Cirstea1,41Department of Physical Therapy and Rehabilitation Science, 2Department of Pharmacology, Toxicology and Therapeutics, 3Department of Anesthesiology, 4Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS, USA; 5Program in Physical Therapy and Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, MO, USAAbstract: The goal of this study was to investigate whether certain metabolites, specific to neurons, glial cells, and the neuronal-glial neurotransmission system, in the primary somatosensory cortex (SSC, are altered and correlated with clinical characteristics of pain in patients with chronic low back pain (LBP. Eleven LBP patients and eleven age-matched healthy controls were included. N-acetylaspartate (NAA, choline (Cho, myo-inositol (mI, and glutamine/glutamate (Glx were measured with proton magnetic resonance spectroscopy (1H-MRS in left and right SSC. Differences in metabolite concentrations relative to those of controls were evaluated as well as analyses of metabolite correlations within and between SSCs. Relationships between metabolite concentrations and pain characteristics were also evaluated. We found decreased NAA in the left SSC (P = 0.001 and decreased Cho (P = 0.04 along with lower correlations between all metabolites in right SSC (P = 0.007 in LBP compared to controls. In addition, we found higher and significant correlations between left and right mI (P < 0.001 in LBP vs P = 0.1 in controls and between left mI and right Cho (P = 0.048 vs P = 0.6. Left and right NAA levels were negatively correlated with pain duration (P = 0.04 and P = 0.02 respectively while right Glx was positively correlated with pain severity (P = 0.04. Our preliminary results demonstrated significant altered neuronal-glial interactions in SSC, with left neural alterations related to pain duration

  9. The Effects of Kinesio Taping on Potential in Chronic Low Back Pain Patients Anticipatory Postural Control and Cerebral Cortex

    OpenAIRE

    Bae, Sea Hyun; Lee, Jeong Hun; Oh, Kyeong Ae; Kim, Kyung Yoon

    2013-01-01

    [Purpose] This study aimed to examine the effects of kinesio tape applied to chronic low back pain (CLBP) patients on anticipatory postural control and cerebral cortex potential. [Subjects and Methods] Twenty patients whose low back pain had continued for more than 12 weeks were selected and assigned to a control group (n=10) to which ordinary physical therapy was applied and an experimental group (n=10) to which kinesio tape was applied. Anticipatory postural control was evaluated using elec...

  10. A Randomized Clinical Trial of Auricular Point Acupressure for Chronic Low Back Pain: A Feasibility Study

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    Chao Hsing Yeh

    2013-01-01

    Full Text Available Objectives. This prospective, randomized clinical trial (RCT was designed to investigate the feasibility and effects of a 4-week auricular point acupressure (APA for chronic low back pain (CLBP. Methods. Participants were randomized to either true APA (true acupoints with taped seeds on the designated ear points for CLBP or sham APA (sham acupoints with taped seeds but on different locations than those designated for CLBP. The duration of treatment was four weeks. Participants were assessed before treatment, weekly during treatment, and 1 month following treatment. Results. Participants in the true APA group who completed the 4-week APA treatment had a 70% reduction in worst pain intensity, a 75% reduction in overall pain intensity, and a 42% improvement in disability due to back pain from baseline assessment. The reductions of worst pain and overall pain intensity in the true APA group were statistically greater than participants in the sham group (P<0.01 at the completion of a 4-week APA and 1 month followup. Discussion. The preliminary findings of this feasibility study showed a reduction in pain intensity and improvement in physical function suggesting that APA may be a promising treatment for patients with CLBP.

  11. "We need to get you focused": general practitioners' representations of chronic low back pain patients.

    Science.gov (United States)

    Macneela, Pádraig; Gibbons, Andrea; McGuire, Brian; Murphy, Andrew

    2010-07-01

    Although subject to considerable research from perspectives including general practitioners, patients, and perspective guidelines, chronic low back pain (CLBP) continues to be a common but contentious condition in primary care. We used medical consultation records, critical incident interviews, and a think-aloud problem-solving task to examine how general practitioners applied professional knowledge of the condition, especially in relation to psychosocial care. Using qualitative content analysis and thematic analysis, we identified a pragmatic, goal-focused approach to patients, a schema based on biomedical knowledge and tacit theories of motivation. The doctors' expectations for CLBP included uncertainty over symptoms and doubts over patient credibility, which helped to explain an autonomous rather than collaborative approach to managing back pain patients. The findings are discussed in light of social representations theory, self-determination, and research on the therapeutic relationship.

  12. Mind-Body Exercises for Nurses with Chronic Low Back Pain: An Evidence-Based Review

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    Pinky Budhrani-Shani

    2016-01-01

    Full Text Available Background. Chronic low back pain (CLBP among nurses is a growing health concern. The multimodal nature of mind-body exercises has potential to impact physiological and psychological processes associated with chronic pain, affording possible advantages over conventional unimodal therapies. This paper summarizes the prevalence of and risk factors for CLBP among nurses, reviews the effectiveness in treating pain and disability of mind-body exercises (yoga and tai chi for CLBP among the general and nursing population, and describes implications. Methods. Articles, published during or prior to 2015, were systematically identified through the PubMed/MEDLINE, Web of Science, and ScienceDirect databases using the following search terms: nurses, mind-body, integrative, biopsychosocial, yoga, tai chi, back pain, and/or risk factors. Results. Prevalence estimates of CLBP among nurses ranged from 50% to 80%. Associated risk factors for CLBP included lifestyle and physical, psychological, psychosocial, and occupational factors. No published studies were identified that evaluated yoga or tai chi for nurses with CLBP. Studies in the general population suggested that these interventions are effective in reducing pain and disability and may improve factors/processes predictive of CLBP. Conclusion. This review suggests that evaluating the impact of multimodal interventions such as yoga and tai chi for nurses with CLBP warrants investigation.

  13. Mind-Body Exercises for Nurses with Chronic Low Back Pain: An Evidence-Based Review

    Science.gov (United States)

    Arcari, Patricia; Langevin, Helene; Wayne, Peter M.

    2016-01-01

    Background. Chronic low back pain (CLBP) among nurses is a growing health concern. The multimodal nature of mind-body exercises has potential to impact physiological and psychological processes associated with chronic pain, affording possible advantages over conventional unimodal therapies. This paper summarizes the prevalence of and risk factors for CLBP among nurses, reviews the effectiveness in treating pain and disability of mind-body exercises (yoga and tai chi) for CLBP among the general and nursing population, and describes implications. Methods. Articles, published during or prior to 2015, were systematically identified through the PubMed/MEDLINE, Web of Science, and ScienceDirect databases using the following search terms: nurses, mind-body, integrative, biopsychosocial, yoga, tai chi, back pain, and/or risk factors. Results. Prevalence estimates of CLBP among nurses ranged from 50% to 80%. Associated risk factors for CLBP included lifestyle and physical, psychological, psychosocial, and occupational factors. No published studies were identified that evaluated yoga or tai chi for nurses with CLBP. Studies in the general population suggested that these interventions are effective in reducing pain and disability and may improve factors/processes predictive of CLBP. Conclusion. This review suggests that evaluating the impact of multimodal interventions such as yoga and tai chi for nurses with CLBP warrants investigation. PMID:27446610

  14. The RESOLVE Trial for people with chronic low back pain: protocol for a randomised clinical trial

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    Matthew K Bagg

    2017-01-01

    Full Text Available Introduction: Low back pain is the leading worldwide cause of disability, and results in significant personal hardship. Most available treatments, when tested in high-quality randomised, controlled trials

  15. Assessment of Vitamin D status In Patients of Chronic Low Back Pain of Unknown Etiology

    OpenAIRE

    Lodh, Moushumi; Goswami, Binita; Mahajan, Rajni Dawar; Sen, Dipankar; Jajodia, Nirmal; Roy, Abhishek

    2014-01-01

    Low back pain is very disabling and dispiriting because of the physical impediment it causes and its psychological effects. Innumerable factors have been implicated in its etiology. In spite of improvements in diagnostic modalities, a considerable number of such cases fall in the ambiguous zone of unknown etiology or ‘idiopathic.’Early diagnosis of low back pain will allow effective prevention and treatment to be offered. This study was conducted to assess the contribution of vitamin D levels...

  16. The effectiveness of Pilates exercise in people with chronic low back pain: a systematic review.

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    Cherie Wells

    Full Text Available To evaluate the effectiveness of Pilates exercise in people with chronic low back pain (CLBP through a systematic review of randomised controlled trials (RCTs.A search for RCTs was undertaken using Medical Search Terms and synonyms for "Pilates" and "low back pain" within the maximal date range of 10 databases. Databases included the Cumulative Index to Nursing and Allied Health Literature; Cochrane Library; Medline; Physiotherapy Evidence Database; ProQuest: Health and Medical Complete, Nursing and Allied Health Source, Dissertation and Theses; Scopus; Sport Discus; Web of Science.Two independent reviewers were involved in the selection of evidence. To be included, relevant RCTs needed to be published in the English language. From 152 studies, 14 RCTs were included.Two independent reviewers appraised the methodological quality of RCTs using the McMaster Critical Review Form for Quantitative Studies. The author(s, year of publication, and details regarding participants, Pilates exercise, comparison treatments, and outcome measures, and findings, were then extracted.The methodological quality of RCTs ranged from "poor" to "excellent". A meta-analysis of RCTs was not undertaken due to the heterogeneity of RCTs. Pilates exercise provided statistically significant improvements in pain and functional ability compared to usual care and physical activity between 4 and 15 weeks, but not at 24 weeks. There were no consistent statistically significant differences in improvements in pain and functional ability with Pilates exercise, massage therapy, or other forms of exercise at any time period.Pilates exercise offers greater improvements in pain and functional ability compared to usual care and physical activity in the short term. Pilates exercise offers equivalent improvements to massage therapy and other forms of exercise. Future research should explore optimal Pilates exercise designs, and whether some people with CLBP may benefit from Pilates exercise

  17. Segmental stabilization and muscular strengthening in chronic low back pain: a comparative study

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    Fábio Renovato França

    2010-01-01

    Full Text Available OBJECTIVE: To contrast the efficacy of two exercise programs, segmental stabilization and strengthening of abdominal and trunk muscles, on pain, functional disability, and activation of the transversus abdominis muscle (TrA, in individuals with chronic low back pain. DESIGN: Our sample consisted of 30 individuals, randomly assigned to one of two treatment groups: segmental stabilization, where exercises focused on the TrA and lumbar multifidus muscles, and superficial strengthening, where exercises focused on the rectus abdominis, abdominus obliquus internus, abdominus obliquus externus, and erector spinae. Groups were examined to discovere whether the exercises created contrasts regarding pain (visual analogical scale and McGill pain questionnaire, functional disability (Oswestry disability questionnaire, and TrA muscle activation capacity (Pressure Biofeedback Unit = PBU. The program lasted 6 weeks, and 30-minute sessions occurred twice a week. Analysis of variance was used for inter- and intra-group comparisons. The significance level was established at 5%. RESULTS: As compared to baseline, both treatments were effective in relieving pain and improving disability (p<0.001. Those in the segmental stabilization group had significant gains for all variables when compared to the ST group (p<0.001, including TrA activation, where relative gains were 48.3% and -5.1%, respectively. CONCLUSION: Both techniques lessened pain and reduced disability. Segmental stabilization is superior to superficial strengthening for all variables. Superficial strengthening does not improve TrA activation capacity.

  18. Effect of aerobic dance on pain, functional disability and quality of life on patients with chronic low back pain

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    U.A.C. Okafor

    2012-12-01

    Full Text Available Low back pain (LBP is often an indication of pathologicalcondition of the intervertebral discs, vertebral bodies or supporting soft tissuesof the lower vertebral region. Chronic Low Back Pain (CLBP presents withenormous consequence on the general performance of the sufferer, exerting ahuge cost on the individual, the family and the society. Dance therapy is arelatively new approach in the management of low back pain. This study wastherefore designed to investigate the effect of dance therapy on pain, functionaldisability and quality of life in patients with chronic low back pain.Thirty subjects diagnosed with non-specific CLBP particpated in the study.They were randomly divided into 2 groups, A and B, each comprising 15 subjects.In addition to conventional physiotherapy programme given to both groups,subjects in Group A also received aerobic dance, which comprised a four stage protocol. The entire treatment routinewas administered in a group session three times weekly consecutively for six weeks. Data as obtained in the copies ofcompleted questionnaires (Roland Morris Diability questionnaires and Nottingham Health Profile questionnaires andother measurements were summarized using mean, standard deviation and frequency tables. Student T-test was used toanalyze the data at 95 % confidence interval.There was a statistically significant difference (p<0.05 between the pre- and post- intervention scores for painintensity, functional disability and quality of life within the groups. There was also a statistically significant difference(p<0.05 in the mean change (pre/post intervention scores between Group A and Group B for pain intensity,functional disability and quality of life. Also the opinions and testimonies given by participants formed part of theevidence-based data.Whereas both conventional physiotherapy and aerobic dance showed significant effects in the pre/post-interventionscores, the aerobic dance group reported more significant effect in all

  19. Effect of General Health Status on Chronicity of Low Back Pain in Industrial Workers

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    Seyed Mohammad Seyedmehdi

    2016-04-01

    Full Text Available Recognizing patients at a higher risk of developing chronic low back pain (LBP is important in industrial medicine. This study aimed to assess the power and quality of General Health Questionnaire (GHQ for prediction of the odds of chronicity of acute LBP. This study was conducted on industrial workers. All subjects with acute LBP who met the inclusion criteria were enrolled. Demographic characteristics, occupational, physical, and mental parameters and the general health status of subjects were evaluated;  they were followed up for developing chronic LBP for one year. Cigarette smoking, high body mass index, job stress, physical load and high GHQ scores were found to be the risk factors for the progression of acute LBP to chronic LBP (P<0.05. Standing position while working, age, work experience, exercise, level of education, weekly work hours and shift work were not the risk factors for chronic LBP (P>0.05.High GHQ score can be a risk factor for progression of acute LBP to chronic LBP. The GHQ in combination with the Job Content Questionnaire can be used as a quick and simple screening tool for detection of subjects at high risk of chronic LBP when evaluating acute LBP in an occupational setting.

  20. Neurochemical Analysis of Primary Motor Cortex in Chronic Low Back Pain

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    Anda E. Popescu

    2012-08-01

    Full Text Available The involvement of the primary motor cortex (M1 in chronic low back pain (LBP is a relatively new concept. Decreased M1 excitability and an analgesic effect after M1 stimulation have been recently reported. However, the neurochemical changes underlying these functional M1 changes are unknown. The current study investigated whether neurochemicals specific to neurons and glial cells in both right and left M1 are altered. N-Acetylaspartate (NAA and myo-inositol (mI were measured with proton magnetic resonance spectroscopy in 19 subjects with chronic LBP and 14 healthy controls. We also examined correlations among neurochemicals within and between M1 and relationships between neurochemical concentrations and clinical features of pain. Right M1 NAA was lower in subjects with LBP compared to controls (p = 0.008. Left M1 NAA and mI were not significantly different between LBP and control groups. Correlations between neurochemical concentrations across M1s were different between groups (p = 0.008. There were no significant correlations between M1 neurochemicals and pain characteristics. These findings provide preliminary evidence of neuronal depression and altered neuronal-glial interactions across M1 in chronic LBP.

  1. A randomised controlled study of reflexology for the management of chronic low back pain.

    Science.gov (United States)

    Poole, Helen; Glenn, Sheila; Murphy, Peter

    2007-11-01

    The use of complementary and alternative medicine (CAM) for the management of chronic low back pain (CLBP) continues to rise. However, questions regarding the efficacy of many CAM therapies for CLBP remain unresolved. The present study investigated the effectiveness of reflexology for CLBP. A pragmatic randomised controlled trial was conducted. N=243 patients were randomised to one of three groups: reflexology, relaxation, or non-intervention (usual care). All completed a questionnaire booklet before and after the treatment phase, and at six months follow up. This measured their general health status, pain, functioning, coping strategies and mood. After adjusting for pre-treatment scores repeated measures ANCOVA found no significant differences between the groups pre and post treatment on the primary outcome measures of pain and functioning. There was a main effect of pain reduction, irrespective of group. Trends in the data illustrated the pain reduction was greatest in the reflexology group. Thus, the current study does not indicate that adding reflexology to usual GP care for the management of CLBP is any more effective than usual GP care alone.

  2. [Interdisciplinary treatment of chronic low back pain: psychological aspects and personality traits].

    Science.gov (United States)

    Weber, K; Sartori, M; Cedraschi, C; Genevay, S; Canuto, A; Rentsch, D

    2012-02-15

    Evidence on chronic low back pain treatments stresses the need for a multidimensional approach that aims a biopsychosocial rehabilitation. The caregiver team of the rheumatology division of the University Hospitals of Geneva has successfully applied this approach over the last years and this article emphasizes the value of a close collaboration with the division of liaison psychiatry. The use of cognitive-behavioral and psycho-educational techniques guaranties the definition of patient-centred and measurable treatment objectives. The inclusion of a psychotherapy group promotes free expression and sharing of psychological distress. Assessment of personality traits allows for considering the global nature of the patients rather than merely aiming the normalization of their deviant aspects.

  3. The Effectiveness of Mindfulness-based Cognitive Therapy (MBCT and Cognitive Behavior Therapy (CBT on Decreasing Pain, Depression and Anxiety of Patients with Chronic Low Back Pain

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    M Abdolghadery

    2014-02-01

    Conclusion: The results support the effectiveness of MBCT and CBT in decreasing pain, depression and anxiety. Therefore, taking account of these two therapeutic methods is very important for patients with chronic low back pain.

  4. A review of pharmacotherapy for chronic low back pain with considerations for sports medicine.

    Science.gov (United States)

    Peniston, John H

    2012-11-01

    Up to 30% of athletes experience low back pain (LBP) depending on sport type, sex, training intensity and frequency, and technique. United States clinical guidelines define back pain as chronic if it persists for ≥ 12 weeks, and subacute if it persists 4 to sports injuries are likely to lead to chronic pain. Persistent or chronic symptoms are frequently associated with degenerative lumbar disc disease or spondylolytic stress lesions. Exercise therapy is widely used and is the most conservative form of treatment for chronic LBP (cLBP). Pharmacotherapies for cLBP include acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids. Acetaminophen is a well-tolerated first-line pharmacotherapy, but high-dose, long-term use is associated with hepatic toxicity. Nonsteroidal anti-inflammatory drugs can be an effective second-line option if acetaminophen proves inadequate but they have well-known risks of gastrointestinal, cardiovascular, and other systemic adverse effects that increase with patient age, dose amount, and duration of use. The serotonin-norepinephrine reuptake inhibitor, duloxetine, has demonstrated modest efficacy and is associated with systematic adverse events, including serotonin syndrome, which can be dose related or result from interaction with other analgesics. Opioids may be an effective choice for moderate to severe pain but also have significant risks of adverse events and carry a substantial risk of addiction and abuse. Because the course of cLBP may be protracted, patients may require treatment over years or decades, and it is critical that the risk/benefit profiles of pharmacotherapies are closely evaluated to ensure that short- and long-term treatments are optimized for each patient. This article reviews the clinical evidence and the guideline recommendations for pharmacotherapy of cLBP.

  5. Hormonal and reproductive factors are associated with chronic low back pain and chronic upper extremity pain in women--the MORGEN study.

    NARCIS (Netherlands)

    Wijnhoven, Hanneke A H; Vet, Henrica C W de; Smit, Henriëtte A; Picavet, H Susan J

    2006-01-01

    STUDY DESIGN: Cross-sectional study of 11,428 women aged 20-59 years who were included in a postal questionnaire survey in the Dutch general population. OBJECTIVE: To examine how hormonal and reproductive factors are associated with chronic low back pain (LBP) and chronic upper extremity pain (UEP)

  6. Differential Neural Processing during Motor Imagery of Daily Activities in Chronic Low Back Pain Patients.

    Directory of Open Access Journals (Sweden)

    Andrea Vrana

    Full Text Available Chronic low back pain (chronic LBP is both debilitating for patients but also a major burden on the health care system. Previous studies reported various maladaptive structural and functional changes among chronic LBP patients on spine- and supraspinal levels including behavioral alterations. However, evidence for cortical reorganization in the sensorimotor system of chronic LBP patients is scarce. Motor Imagery (MI is suitable for investigating the cortical sensorimotor network as it serves as a proxy for motor execution. Our aim was to investigate differential MI-driven cortical processing in chronic LBP compared to healthy controls (HC by means of functional magnetic resonance imaging (fMRI. Twenty-nine subjects (15 chronic LBP patients, 14 HC were included in the current study. MI stimuli consisted of randomly presented video clips showing every-day activities involving different whole-body movements as well as walking on even ground and walking downstairs and upstairs. Guided by the video clips, subjects had to perform MI of these activities, subsequently rating the vividness of their MI performance. Brain activity analysis revealed that chronic LBP patients exhibited significantly reduced activity compared to HC subjects in MI-related brain regions, namely the left supplementary motor area and right superior temporal sulcus. Furthermore, psycho-physiological-interaction analysis yielded significantly enhanced functional connectivity (FC between various MI-associated brain regions in chronic LBP patients indicating diffuse and non-specific changes in FC. Current results demonstrate initial findings about differences in MI-driven cortical processing in chronic LBP pointing towards reorganization processes in the sensorimotor network.

  7. Antineuropathic and Antinociceptive Drugs Combination in Patients with Chronic Low Back Pain: A Systematic Review

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    Carlo Luca Romanò

    2012-01-01

    Full Text Available Purpose. Chronic low back pain (LBP is often characterized by both nociceptive and neuropathic components. While various monotherapies have been reported of only limited efficacy, combining drugs with different mechanisms of action and targets appears a rational approach. Aim of this systematic review is to assess the efficacy and safety of different combined pharmacological treatments, compared to monotherapy or placebo, for the pharmacological treatment of chronic LBP. Methods. Published papers, written or abstracted in English from 1990 through 2011, comparing combined pharmacological treatments of chronic LBP to monotherapy or placebo were reviewed. Results. Six articles met the inclusion criteria. Pregabalin combined with celecoxib or opioids was shown to be more effective than either monotherapy. Oxycodone-paracetamol versus previous treatments and tramadol-paracetamol versus placebo were also reported as effective, while morphine-nortriptyline did not show any benefit over any single agent. Conclusions. In spite of theoretical advantages of combined pharmacological treatments of chronic LBP, clinical studies are remarkably few. Available data show that combined therapy, including antinociceptive and antineuropathic agents is more effective than monotherapy, with similar side effects.

  8. Antineuropathic and Antinociceptive Drugs Combination in Patients with Chronic Low Back Pain: A Systematic Review

    Science.gov (United States)

    Romanò, Carlo Luca; Romanò, Delia; Lacerenza, Marco

    2012-01-01

    Purpose. Chronic low back pain (LBP) is often characterized by both nociceptive and neuropathic components. While various monotherapies have been reported of only limited efficacy, combining drugs with different mechanisms of action and targets appears a rational approach. Aim of this systematic review is to assess the efficacy and safety of different combined pharmacological treatments, compared to monotherapy or placebo, for the pharmacological treatment of chronic LBP. Methods. Published papers, written or abstracted in English from 1990 through 2011, comparing combined pharmacological treatments of chronic LBP to monotherapy or placebo were reviewed. Results. Six articles met the inclusion criteria. Pregabalin combined with celecoxib or opioids was shown to be more effective than either monotherapy. Oxycodone-paracetamol versus previous treatments and tramadol-paracetamol versus placebo were also reported as effective, while morphine-nortriptyline did not show any benefit over any single agent. Conclusions. In spite of theoretical advantages of combined pharmacological treatments of chronic LBP, clinical studies are remarkably few. Available data show that combined therapy, including antinociceptive and antineuropathic agents is more effective than monotherapy, with similar side effects. PMID:22619711

  9. EFFECT OF HIP MOBILIZATION WITH EXERCISES FOR SUBJECTS WITH CHRONIC NON SPECIFIC LOW BACK PAIN ASSOCIATED WITH HIP IMPAIRMENT

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    Chintan Patel

    2015-02-01

    Full Text Available Background:There is a basic assumption from the studies on hip–LBP relationship that suboptimal function of the hip might result in an alteration of the mechanics of the lumbopelvic region. Evidence is mounting to support the possibility that low back pain may be result of hip rotation deficits. The excessive or limited hip rotation range of motion could be a predisposing factor for low back dysfunction. Exercises and hip joint mobilization, individually found to be effective in chronic nonspecific low back pain with hip impairment. Hence, the purpose is to find the effect of hip joint mobilization with stretching exercises on intensity of pain and functional disability for subjects with chronic nonspecific low back pain associated with hip impairment. Method: An experimental study design selected 30 subjects with chronic low back pain associated with Hip impairment randomized 15 subjects each into Study and Control group. Control group received stretching exercises while Study group received hip joint mobilization with stretching exercises thrice a week for 3 weeks. Pain intensity was measured using Visual Analogue Scale and Functional disability was measured by Modified Oswestry Disability Index for LBP before and after 2 weeks of treatment. Results: There is statistically significant difference in improvement in means of VAS and Modified ODI when analyzed within the group. When the post-intervention means were compared between Study and Control group there is a statistically significant difference in means after 2 weeks of treatment. Conclusion: The present study concluded that the two weeks duration of combined hip joint mobilization with stretching exercises significantly effective on improving pain and functional disability than only stretching exercise regimen for chronic non-specific low back pain associated with Hip impairment.

  10. Effects of gyrokinesis exercise on the gait pattern of female patients with chronic low back pain.

    Science.gov (United States)

    Seo, Kook-Eun; Park, Tae-Jin

    2016-01-01

    [Purpose] The purpose of the present study was to use kinematic variables to identify the effects of 8/weeks' performance of a gyrokinesis exercise on the gait pattern of females with chronic low back pain. [Subjects] The subjects of the present study were females in their late 20s to mid 30s who were chronic back pain patients. [Methods] A 3-D motion analysis system was used to measure the changes in their gait patterns between pre and post-gyrokintic exercise. The SPSS 21.0 statistics program was used to perform the paired t-test, to compare the gait patterns of pre-post-gyrokinesis exercise. [Results] In the gait analysis, pre-post-gyrokinesis exercise gait patterns showed statistically significant differences in right and left step length, stride length, right-left step widths, and stride speed. [Conclusion] Gait pattern analysis revealed increases in step length, stride length, and stride speed along with a decrease in step width after 8 weeks of gyrokinesis exercise, demonstrating it improved gait pattern.

  11. Multivariate classification of structural MRI data detects chronic low back pain.

    Science.gov (United States)

    Ung, Hoameng; Brown, Justin E; Johnson, Kevin A; Younger, Jarred; Hush, Julia; Mackey, Sean

    2014-04-01

    Chronic low back pain (cLBP) has a tremendous personal and socioeconomic impact, yet the underlying pathology remains a mystery in the majority of cases. An objective measure of this condition, that augments self-report of pain, could have profound implications for diagnostic characterization and therapeutic development. Contemporary research indicates that cLBP is associated with abnormal brain structure and function. Multivariate analyses have shown potential to detect a number of neurological diseases based on structural neuroimaging. Therefore, we aimed to empirically evaluate such an approach in the detection of cLBP, with a goal to also explore the relevant neuroanatomy. We extracted brain gray matter (GM) density from magnetic resonance imaging scans of 47 patients with cLBP and 47 healthy controls. cLBP was classified with an accuracy of 76% by support vector machine analysis. Primary drivers of the classification included areas of the somatosensory, motor, and prefrontal cortices--all areas implicated in the pain experience. Differences in areas of the temporal lobe, including bordering the amygdala, medial orbital gyrus, cerebellum, and visual cortex, were also useful for the classification. Our findings suggest that cLBP is characterized by a pattern of GM changes that can have discriminative power and reflect relevant pathological brain morphology.

  12. Acupuncture Treatment of Chronic Low Back Pain by Using the Jingjin (Meridian Sinews) Model.

    Science.gov (United States)

    Legge, David

    2015-10-01

    This case report details the unexpected and sustained relief from chronic low back pain in a patient after a single acupuncture treatment. The treatment administered on that occasion was based on the jingjin (i.e., "meridian sinew") model of traditional acupuncture. Treatments based on the jingjin model involve needling the ah shi (i.e., locally tender) points in myofascial tissue along the jingjin pathway. Tight chains can be needled to treat symptoms that are either close to or at some distance from the site of the needling treatment. In this patient, the points were in the gastrocnemius muscle and the hamstring muscles, which are part of the Bladder jingjin pathway. The patient, a 69-year-old woman, had had back pain for more than 40 years. The relief from the pain occurred within a day after the treatment and, at the time of this report, the relief has persisted for 5 months. This report examines two possible mechanisms for such a result: (1) a local increase in the extensibility of the hamstrings could be responsible or (2) the complex interactions within the central nervous system that are involved in acupuncture treatment could be more important factors.

  13. Experiences of chronic low back pain: a meta-ethnography of qualitative research.

    Science.gov (United States)

    MacNeela, Padraig; Doyle, Catherine; O'Gorman, David; Ruane, Nancy; McGuire, Brian E

    2015-01-01

    Chronic low back pain (CLBP) is associated with a number of costly disability-related outcomes. It has received increasing attention from qualitative researchers studying its consequences for personal, social, and health care experiences. As research questions and methods diversify, there is a growing need to integrate findings emerging from these studies. A meta-ethnography was carried out to synthesise the findings of 38 separate qualitative articles published on the subjective experience of CLBP between 1994 and 2011. Studies were identified following a literature search and quality appraisal. Four themes were proposed after a process of translating the meaning of text extracts from the findings sections across all the articles. The themes referred to the undermining influence of pain, its disempowering impact on all levels, unsatisfying relationships with health care professionals, and learning to live with the pain. The findings are dominated by wide-ranging distress and loss but also acknowledge self-determination and resilience. Implications of the meta-ethnography for clinicians and future qualitative research are outlined, including the need to study relatively unexamined facets of subjective experience such as illness trajectory and social identity.

  14. SPECT/CT imaging of the lumbar spine in chronic low back pain: a case report

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    Carstensen Michael H

    2011-01-01

    Full Text Available Abstract Mechanical low back pain is a common indication for Nuclear Medicine imaging. Whole-body bone scan is a very sensitive but poorly specific study for the detection of metabolic bone abnormalities. The accurate localisation of metabolically active bone disease is often difficult in 2D imaging but single photon emission computed tomography/computed tomography (SPECT/CT allows accurate diagnosis and anatomic localisation of osteoblastic and osteolytic lesions in 3D imaging. We present a clinical case of a patient referred for evaluation of chronic lower back pain with no history of trauma, spinal surgery, or cancer. Planar whole-body scan showed heterogeneous tracer uptake in the lumbar spine with intense localisation to the right lateral aspect of L3. Integrated SPECT/CT of the lumbar spine detected active bone metabolism in the right L3/L4 facet joint in the presence of minimal signs of degenerative osteoarthrosis on CT images, while a segment demonstrating more gross degenerative changes was more quiescent with only mild tracer uptake. The usefulness of integrated SPECT/CT for anatomical and functional assessment of back pain opens promising opportunities both for multi-disciplinary clinical assessment and treatment for manual therapists and for research into the effectiveness of manual therapies.

  15. ‘Omics’ biomarkers associated with chronic low back pain: protocol of a retrospective longitudinal study

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    Allegri, Massimo; Klersy, Catherine; Wang, Wei; Sim, Moira; Gieger, Christian; Manz, Judith; Pemberton, Iain K; MacDougall, Jane; Williams, Frances MK; Van Zundert, Jan; Buyse, Klaas; Lauc, Gordan; Gudelj, Ivan; Primorac, Dragan; Skelin, Andrea; Aulchenko, Yurii S; Karssen, Lennart C; Kapural, Leonardo; Rauck, Richard; Fanelli, Guido

    2016-01-01

    Introduction Chronic low back pain (CLBP) produces considerable direct costs as well as indirect burdens for society, industry and health systems. CLBP is characterised by heterogeneity, inclusion of several pain syndromes, different underlying molecular pathologies and interaction with psychosocial factors that leads to a range of clinical manifestations. There is still much to understand in the underlying pathological processes and the non-psychosocial factors which account for differences in outcomes. Biomarkers that may be objectively used for diagnosis and personalised, targeted and cost-effective treatment are still lacking. Therefore, any data that may be obtained at the ‘-omics’ level (glycomics, Activomics and genome-wide association studies—GWAS) may be helpful to use as dynamic biomarkers for elucidating CLBP pathogenesis and may ultimately provide prognostic information too. By means of a retrospective, observational, case-cohort, multicentre study, we aim to investigate new promising biomarkers potentially able to solve some of the issues related to CLBP. Methods and analysis The study follows a two-phase, 1:2 case–control model. A total of 12 000 individuals (4000 cases and 8000 controls) will be enrolled; clinical data will be registered, with particular attention to pain characteristics and outcomes of pain treatments. Blood samples will be collected to perform -omics studies. The primary objective is to recognise genetic variants associated with CLBP; secondary objectives are to study glycomics and Activomics profiles associated with CLBP. Ethics and dissemination The study is part of the PainOMICS project funded by European Community in the Seventh Framework Programme. The study has been approved from competent ethical bodies and copies of approvals were provided to the European Commission before starting the study. Results of the study will be reviewed by the Scientific Board and Ethical Committee of the PainOMICS Consortium. The

  16. Low Back Pain in Athletes.

    Science.gov (United States)

    Rovere, G D

    1987-01-01

    In brief: Low back pain in seasoned athletes is not common, but when present it can limit participation. While direct blows or hyperlor-dotic positions can cause low back pain in certain sports, the most common cause is overuse and resultant strains or sprains of the paravertebral muscles and ligaments. Such injuries cause acute pain and spasm, which sometimes do not appear for 24 hours or longer. Diagnosis is based on history, ruling out of systemic maladies, physical examination, and, if necessary, supplemental tests such as x-rays, myelograms, and bone scans. Treatment of low back pain due to overuse is, sequentially, bed rest and ice for 24 to 36 hours, heat and massage, analgesics as needed, and a lumbosacral support until flexion and strengthening exercises have returned the damaged part to normal.

  17. A Comparison of the Effects of Pilates and McKenzie Training on Pain and General Health in Men with Chronic Low Back Pain: A Randomized Trial

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    Hasanpour-Dehkordi, Ali; Dehghani, Arman; Solati, Kamal

    2017-01-01

    Background: Today, chronic low back pain is one of the special challenges in healthcare. There is no unique approach to treat chronic low back pain. A variety of methods are used for the treatment of low back pain, but the effects of these methods have not yet been investigated adequately. Aim: The aim of this study was to compare the effects of Pilates and McKenzie training on pain and general health of men with chronic low back pain. Materials and Methods: Thirty-six patients with chronic low back pain were chosen voluntarily and assigned to three groups of 12 each: McKenzie group, Pilates group, and control group. The Pilates group participated in 1-h exercise sessions, three sessions a week for 6 weeks. McKenzie group performed workouts 1 h a day for 20 days. The control group underwent no treatment. The general health of all participants was measured by the General Health Questionnaire 28 and pain by the McGill Pain Questionnaire. Results: After therapeutic exercises, there was no significant difference between Pilates and McKenzie groups in pain relief (P = 0.327). Neither of the two methods was superior over the other for pain relief. However, there was a significant difference in general health indexes between Pilates and McKenzie groups. Conclusion: Pilates and McKenzie training reduced pain in patients with chronic low back pain, but the Pilates training was more effective to improve general health. PMID:28216860

  18. A comparison of the effects of pilates and mckenzie training on pain and general health in men with chronic low back pain: A randomized trial

    Directory of Open Access Journals (Sweden)

    Ali Hasanpour-Dehkordi

    2017-01-01

    Full Text Available Background: Today, chronic low back pain is one of the special challenges in healthcare. There is no unique approach to treat chronic low back pain. A variety of methods are used for the treatment of low back pain, but the effects of these methods have not yet been investigated adequately. Aim: The aim of this study was to compare the effects of Pilates and McKenzie training on pain and general health of men with chronic low back pain. Materials and Methods: Thirty-six patients with chronic low back pain were chosen voluntarily and assigned to three groups of 12 each: McKenzie group, Pilates group, and control group. The Pilates group participated in 1-h exercise sessions, three sessions a week for 6 weeks. McKenzie group performed workouts 1 h a day for 20 days. The control group underwent no treatment. The general health of all participants was measured by the General Health Questionnaire 28 and pain by the McGill Pain Questionnaire. Results: After therapeutic exercises, there was no significant difference between Pilates and McKenzie groups in pain relief (P = 0.327. Neither of the two methods was superior over the other for pain relief. However, there was a significant difference in general health indexes between Pilates and McKenzie groups. Conclusion: Pilates and McKenzie training reduced pain in patients with chronic low back pain, but the Pilates training was more effective to improve general health.

  19. Effect of Yoga on Pain, Brain-Derived Neurotrophic Factor, and Serotonin in Premenopausal Women with Chronic Low Back Pain

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    Moseon Lee

    2014-01-01

    Full Text Available Background. Serotonin and brain-derived neurotrophic factor (BDNF are known to be modulators of nociception. However, pain-related connection between yoga and those neuromodulators has not been investigated. Therefore, we aimed to evaluate the effect of yoga on pain, BDNF, and serotonin. Methods. Premenopausal women with chronic low back pain practiced yoga three times a week for 12 weeks. At baseline and after 12 weeks, back pain intensity was measured using visual analogue scale (VAS, and serum BDNF and serotonin levels were evaluated. Additionally, back flexibility and level of depression were assessed. Results. After 12-week yoga, VAS decreased in the yoga group (P<0.001, whereas it increased (P<0.05 in the control group. Back flexibility was improved in the yoga group (P<0.01. Serum BDNF increased in the yoga group (P<0.01, whereas it tended to decrease in the control group (P=0.05. Serum serotonin maintained in the yoga group, while it reduced (P<0.01 in the control group. The depression level maintained in the yoga group, whereas it tended to increase in the control group (P=0.07. Conclusions. We propose that BDNF may be one of the key factors mediating beneficial effects of yoga on chronic low back pain.

  20. Yoga for veterans with chronic low back pain: Design and methods of a randomized clinical trial.

    Science.gov (United States)

    Groessl, Erik J; Schmalzl, Laura; Maiya, Meghan; Liu, Lin; Goodman, Debora; Chang, Douglas G; Wetherell, Julie L; Bormann, Jill E; Atkinson, J Hamp; Baxi, Sunita

    2016-05-01

    Chronic low back pain (CLBP) afflicts millions of people worldwide, with particularly high prevalence in military veterans. Many treatment options exist for CLBP, but most have limited effectiveness and some have significant side effects. In general populations with CLBP, yoga has been shown to improve health outcomes with few side effects. However, yoga has not been adequately studied in military veteran populations. In the current paper we will describe the design and methods of a randomized clinical trial aimed at examining whether yoga can effectively reduce disability and pain in US military veterans with CLBP. A total of 144 US military veterans with CLBP will be randomized to either yoga or a delayed treatment comparison group. The yoga intervention will consist of 2× weekly yoga classes for 12weeks, complemented by regular home practice guided by a manual. The delayed treatment group will receive the same intervention after six months. The primary outcome is the change in back pain-related disability measured with the Roland-Morris Disability Questionnaire at baseline and 12-weeks. Secondary outcomes include pain intensity, pain interference, depression, anxiety, fatigue/energy, quality of life, self-efficacy, sleep quality, and medication usage. Additional process and/or mediational factors will be measured to examine dose response and effect mechanisms. Assessments will be conducted at baseline, 6-weeks, 12-weeks, and 6-months. All randomized participants will be included in intention-to-treat analyses. Study results will provide much needed evidence on the feasibility and effectiveness of yoga as a therapeutic modality for the treatment of CLBP in US military veterans.

  1. EFFECT OF MYOFASCIAL RELEASE THERAPY ON PAIN RELATED DISABILITY, QUALITY OF SLEEP AND DEPRESSION IN OLDER ADULTS WITH CHRONIC LOW BACK PAIN

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    Dr. B.Arun, MPT, PhD

    2014-02-01

    Full Text Available Low back pain was experienced by 50% of older adults that has threatened to quality of life. The economic cost of low back pain is more in older adults. Various literatures found that there is strong relationships exist between the low back pain and the psychosocial factors like sleep disturbances, depression, mood sway and chronic illness. Studies has found that depression is one of the commonest psychological problem faced by older adults which relates to other factors like pain, sleep disturbances ect.. Physiotherapy has been shown very effective in the management of chronic low back pain. Various approaches in physiotherapy play a major role in rehabilitation of patients with chronic low back pain. This study estimates to find out the effect of myofascial release therapy on pain related disability, quality of sleep and depression in older adults with chronic low back pain. Study is a single group pre test and post test design. 37 Patients with chronic low back pain were selected from a community setup. Selected subjects were undergone 6 weeks of myofascial release therapy along with moist heat therapy. At the end the outcome measured are pain related disability using pain disability index, Quality of sleep using Insomnia severity index and depression using beck depression inventory. The paired ‘t’ test was used to find out the differences between variables. The result showed that there was a significant improvement in the pre test and post test variables. The beck depression inventory was 21.3 (p<0.05%, and the pain disability index was 24.9 (p<0.05%. The study concludes that the myofascial release therapy is very effective in reducing the pain related disability, quality of sleep and depression on older adults with chronic low back pain.

  2. Trunk strength and lumbar paraspinal muscle activity during isometric exercise in chronic low-back pain patients and controls.

    Science.gov (United States)

    Cassisi, J E; Robinson, M E; O'Conner, P; MacMillan, M

    1993-02-01

    The purpose of this study was to describe trunk strength and lumbar paraspinal muscle activity across five angles of flexion during isometric exercise and rest in chronic low-back pain patients and control subjects. High muscle tension as measured by surface integrated electromyography is predicted by a muscle spasm model, and low muscle tension is predicted by a muscle deficiency model. Prior lumbar surgery had no affect on peak torque or maximum surface integrated electromyography data. Both groups produced greater torque and less surface integrated electromyography in more flexed positions. Chronic low-back pain patients exhibited lower peak torque and lower maximum surface integrated electromyography bilaterally during isometric extension effort across all angles. A muscle deficiency model of chronic low back pain was supported by these data and a muscle spasm model was not supported. Discriminant analyses indicated that monitoring maximum surface integrated electromyography of lumbar muscles during isometric effort facilitates classification of chronic low-back pain patients. Future directions are discussed in terms of applying psychophysiologic methods to pain rehabilitation.

  3. Defining the Role of Cognitive Behavioral Therapy in Treating Chronic Low Back Pain: An Overview.

    Science.gov (United States)

    Hanscom, David A; Brox, Jens Ivar; Bunnage, Ray

    2015-12-01

    Study Design Narrative review of the literature. Objectives Determine if the term cognitive behavioral therapy (CBT) is useful in clinical care and research. What literature supports these variables being relevant to the experience of chronic pain? What effects of CBT in treating these factors have been documented? What methods and platforms are available to administer CBT? Methods Chronic low back pain (CLBP) is a complex neurologic disorder with many components. CBT refers to a broad family of therapies that address both maladaptive thoughts and behaviors. There are several ways to deliver it. CLBP was broken into five categories that affect the perception of pain, and the literature was reviewed to see the effects of CBT on these variables. Results The term cognitive behavioral therapy has little use in future research because it covers such a wide range of therapies. CBT should always be defined by the problem it is intended to solve. The format and method of delivery should be defined because they have implications for outcomes. They are readily available even at the primary care level. The effectiveness of CBT is unquestioned regarding its effectiveness in treating each of the variables that affect CLBP. It is unclear why it is not more widely implemented. Conclusions CBT represents a family of therapies that are effective for a wide range of problems, many of which coexist with and influence CLBP. Each of the variables can be improved with focused CBT. Early, widespread adoption of CBT in treating and preventing CLBP is recommended. Future research and clinical care should focus on strategies to operationalize these well-documented treatments utilizing a public health approach.

  4. The effect of continuous ultrasound on chronic low back pain: protocol of a randomized controlled trial

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    Naghdi Soofia

    2011-03-01

    Full Text Available Abstract Background Chronic non-specific low-back pain (LBP is one of the most common and expensive musculoskeletal disorders in industrialized countries. Similar to other countries in the world, LBP is a common health and socioeconomic problem in Iran. One of the most widely used modalities in the field of physiotherapy for treating LBP is therapeutic ultrasound. Despite its common use, there is still inconclusive evidence to support its effectiveness in this group of patients. This randomised trial will evaluate the effectiveness of continuous ultrasound in addition to exercise therapy in patients with chronic LBP. Methods and design A total of 46 patients, between the ages 18 and 65 years old who have had LBP for more than three months will be recruited from university hospitals. Participants will be randomized to receive continuous ultrasound plus exercise therapy or placebo ultrasound plus exercise therapy. These groups will be treated for 10 sessions during a period of 4 weeks. Primary outcome measures will be functional disability and pain intensity. Lumbar flexion and extension range of motion, as well as changes in electromyography muscle fatigue indices, will be measured as secondary outcomes. All outcome measures will be measured at baseline, after completion of the treatment sessions, and after one month. Discussion The results of this trial will help to provide some evidence regarding the use of continuous ultrasound in chronic LBP patients. This should lead to a more evidence-based approach to clinical decision making regarding the use of ultrasound for LBP. Trial registration Netherlands Trial Register (NTR: NTR2251

  5. Golf and low back pain

    OpenAIRE

    村田, 豊

    2011-01-01

    Lumbar spinal disease is one of the“locomotive syndrome”. Most common disease for advanced people is lumbar spinal canal stenosis(LSCS), on the other hand, most common disease for young adult people is lumbar disc herniation(LDH). Both LSCS and LDH can cause low back pain and severe sciatica of lower extremities. Golf is one of the most favorite sports for any generation worldwide. Sometimes golf can cause low back pain, however we can prevent the injuries of lumbar from playing golf. The ach...

  6. Postural deviations from chronic low back pain and correction through exercise therapy

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    Farahpour N

    2007-06-01

    Full Text Available Background: It has been shown that five deficits of the proprioceptive system and poor motor skills are associated with chronic low back pain (CLBP. However, the exact mechanism is unknown. The objectives of this study were to assess the dynamic postural balance behavior of CLBP patients, as well as the effects of a specific exercise therapy for the treatment of CLBP and related postural imbalances. Methods: Sixteen females with CLBP and 30 healthy females all between 20 and 40 years of age, of similar height and weight, voluntarily participated in this study. Patients underwent a three-month therapeutic exercise program. The disability and back pain of the patients were measured using the Oswestry and Quebec questionnaires, respectively. A dynamic stability platform system (Biodex was used to evaluate the postural imbalances in both groups. All measurements of the experimental group were repeated after the therapy. Results: Overall deviation of center of gravity (COG from COBOS in patients and controls were 3 (±0.3 and 1.3 (±0.2, respectively. Thus, postural imbalances were 2.3 times greater in the patients than those of the controls. After the treatment, the disability and pain of the patients were diminished by 53% and 58%, respectively. Furthermore, with the improvement of the patients COG deviation, both groups had similar posture. Conclusions: The postural orientation of CLBP patients was significantly improved by the therapeutic exercise program. The applied exercise therapy significantly reduced both the pain and the disability of the patients. Based on these conclusions, we recommend that postural correction be included in regular therapeutic exercise programs.

  7. Effects of an exercise program in individuals with chronic low back pain

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    Maurice Zanini

    2014-09-01

    Full Text Available Introduction: Low back pain is a major cause of medical appointments, work disability and hospitalization. Aim: To measure changes in back pain scores and spinal functional capacity in individuals with low back pain after an exercise program. Methods: Non-randomized controlled trial of 40 participants (20 in the experimental group and 20 in the control group. Patients from both groups were evaluated before and after the program. The program consisted of flexibility training using joint mobilization and stretching exercises for the upper and lower limbs and back, as well as strength training for the abdominal muscles and hamstrings. Participants in the control group did not receive any exercise-related interventions, only medical care. Results: the experimental group showed significant improvements in pain score (P

  8. A comparison between pulsed radiofrequency and electro-acupuncture for relieving pain in patients with chronic low back pain.

    Science.gov (United States)

    Lin, Mu-Lien; Lin, Mu-Hung; Fen, Jun-Jeng; Lin, Wei-Tso; Lin, Chii-Wann; Chen, Po-Quang

    2010-01-01

    Many treatment options for chronic low back pain are available, including varied forms of electric stimulation. But little is known about the electricity effect between electro-acupuncture and pulsed radiofrequency. The objective of this study is to assess the difference in effectiveness of pain relief between pulsed radiofrequency and electro-acupuncture. Visual analog score (VAS) pain score, the Oswestry disability index (ODI) to measure a patient's permanent functional disability, and Short form 36 (SF-36) which is a survey used in health assessment to determine the cost-effectiveness of a health treatment, were used as rating systems to measure the pain relief and functional improvement effect of pulsed radiofrequency and electro-acupuncture, based on the methodological quality of the randomized controlled trials, the relevance between the study groups, and the consistency of the outcome evaluation. First, the baseline status before therapy shows no age and gender influence in the SF-36 and VAS score but it is significant in the ODI questionnaire. From ANOVA analyses, it is apparent that radiofrequency therapy is a significant improvement over electro-acupuncture therapy after one month. But electro-acupuncture also showed functional improvement in the lumbar spine from the ODI. This study provides sufficient evidence of the superiority of pulsed radiofrequency (PRF) therapy for low back pain relief compared with both electro-acupuncture (EA) therapy and the control group. But the functional improvement of the lumbar spine was proved under EA therapy only. Both therapies are related to electricity effects.

  9. Neuromuscular adaptations predict functional disability independently of clinical pain and psychological factors in patients with chronic non-specific low back pain.

    Science.gov (United States)

    Dubois, Jean-Daniel; Abboud, Jacques; St-Pierre, Charles; Piché, Mathieu; Descarreaux, Martin

    2014-08-01

    Patients with chronic low back pain exhibit characteristics such as clinical pain, psychological symptoms and neuromuscular adaptations. The purpose of this study was to determine the independent contribution of clinical pain, psychological factors and neuromuscular adaptations to disability in patients with chronic low back pain. Clinical pain intensity, pain catastrophizing, fear-avoidance beliefs, anxiety, neuromuscular adaptations to chronic pain and neuromuscular responses to experimental pain were assessed in 52 patients with chronic low back pain. Lumbar muscle electromyographic activity was assessed during a flexion-extension task (flexion relaxation phenomenon) to assess both chronic neuromuscular adaptations and neuromuscular responses to experimental pain during the task. Multiple regressions showed that independent predictors of disability included neuromuscular adaptations to chronic pain (β=0.25, p=0.006, sr(2)=0.06), neuromuscular responses to experimental pain (β=-0.24, p=0.011, sr(2)=0.05), clinical pain intensity (β=0.28, p=0.002, sr(2)=0.08) and psychological factors (β=0.58, ppain intensity and psychological factors, and contribute to inter-individual differences in patients' disability. This suggests that disability, in chronic low back pain patients, is determined by a combination of factors, including clinical pain, psychological factors and neuromuscular adaptations.

  10. Do analgesics improve functioning in patients with chronic low back pain? An explorative triple-blinded RCT

    NARCIS (Netherlands)

    Schiphorst Preuper, Henrica; Geertzen, Jan. H. B.; van Wijhe, Marten; Boonstra, Anne M.; Molmans, Barbara H. W.; Dijkstra, Pieter U.; Reneman, Michiel F.

    2014-01-01

    Treatment of patients with chronic low back pain (CLBP) aims to reduce disability, improve functional capacity, and participation. Time contingent prescription of analgesics is a treatment modality in CLBP. The impact of analgesics on functional capacity is unknown. Aim of the study was to explore t

  11. Measurement Properties of the NIH-minimal Dataset Dutch Language Version in Patients With Chronic Low Back Pain

    NARCIS (Netherlands)

    Boer, Annemarie; Dutmer, Alisa L; Preuper, Henrica R Schiphorst; van der Woude, Lucas H V; Stewart, Roy E; Deyo, Richard A; Reneman, Michiel F; Soer, Remko

    2017-01-01

    STUDY DESIGN: Validation study with cross sectional and longitudinal measurements OBJECTIVE.: To translate the US National Institute of Health (NIH)-minimal dataset for clinical research on chronic low back pain into the Dutch language and to test its validity and reliability among people with chron

  12. Individuals with chronic low back pain do not modulate the level of transversus abdominis muscle contraction across different postures.

    Science.gov (United States)

    Miura, Takuya; Yamanaka, Masanori; Ukishiro, Kengo; Tohyama, Harukazu; Saito, Hiroshi; Samukawa, Mina; Kobayashi, Takumi; Ino, Takumi; Takeda, Naoki

    2014-12-01

    The aim of this study was to evaluate the thickness of the transversus abdominis (TrA) muscle in three basic postures in subjects with and without chronic low back pain. Subjects were classified into a chronic low back pain group (n = 27) and a healthy control group (n = 23). The thickness of the TrA muscle was measured at rest and during the abdominal drawing-in manoeuvre (ADIM) in supine, sitting and standing postures using B-mode ultrasound imaging. Contraction ratio (TrA thickness during the ADIM/TrA thickness at rest) was calculated for each posture. At rest, the TrA thickness in the sitting and standing postures was significantly greater than in the supine posture (p contraction ratio was also significantly higher in the control group than in the chronic low back pain group in all three postures. These results indicate that the automatic postural contraction of the TrA observed in the control subjects in the sitting and standing postures was not demonstrated in subjects with chronic low back pain. The present study revealed the one aspect of different response of the TrA muscle to changing posture between two groups.

  13. Longitudinal associations between physical load and chronic low back pain in the general population: the Doetichem Cohort Study

    NARCIS (Netherlands)

    Oostrom, S.H.; Verschuren, M.; Vet, de H.C.; Boshuizen, H.C.; Picavet, H.S.

    2012-01-01

    Study Design. Prospective cohort study. Objective. We explored long-term associations between physical load exposure and chronic low back pain (LBP) using data from an ongoing population-based cohort study. Summary of Background Data. Physical load in work or daily life is often studied in relation

  14. Disrupted TH17/Treg balance in patients with chronic low back pain.

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    Benjamin Luchting

    Full Text Available Chronic low back pain (CLBP is a leading cause of disability and costs in health care systems worldwide. Despite extensive research, the exact pathogenesis of CLBP, particularly the individual risk of chronification remains unclear. To investigate a possible role of the adaptive immune system in the pathophysiology of CLBP, we analyzed T cell related cytokine profiles, T cell related mRNA expression patterns and the distribution of T cell subsets in 37 patients suffering from nonspecific CLBP before and after multimodal therapy in comparison to 25 healthy controls. Serum patterns of marker cytokines were analyzed by Luminex technology, mRNA expression of cytokines and specific transcription factors was measured by real-time PCR, and distribution of TH1-, TH2-, TH17- and regulatory T cell (Tregs subsets was determined by multicolor flow cytometry. We found that CLBP patients exhibit an increased number of anti-inflammatory Tregs, while pro-inflammatory TH17 cells are decreased, resulting in an altered TH17/Treg ratio. Accordingly, FoxP3 and TGF-β-mRNA expression was elevated, while expression of IL-23 was reduced. Serum cytokine analyses proved to be unsuitable to monitor the adaptive immune response in CLBP patients. We further show that even after successful therapy with lasting reduction of pain, T cell subset patterns remained altered after a follow-up period of 6 months. These findings suggest an involvement of TH17/Treg cells in the pathogenesis of CLBP and emphasize the importance of these cells in the crosstalk of pain and immune response.German Clinical Trial Register: Registration Trial DRKS00005954.

  15. Sling exercise for chronic low back pain: a systematic review and meta-analysis.

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    Yu-Shan Yue

    Full Text Available BACKGROUND: Trials on sling exercise (SE, commonly performed to manage chronic low back pain (LBP, yield conflicting results. This study aimed to review the effects of SE on chronic LBP. METHODS: The randomized controlled trials comparing SE with other treatments or no treatment, published up to August 2013, were identified by electronic searches. Primary outcomes were pain, function, and return to work. The weighted mean difference (WMD and 95% confidence interval (CI were calculated, using a random-effects model. RESULTS: Risk of bias was rated as high in 9 included trials, where some important quality components such as blinding were absent and sample sizes were generally small. We found no clinically relevant differences in pain or function between SE and other forms of exercise, traditional Chinese medical therapy, or in addition to acupuncture. Based on two trials, SE was more effective than thermomagnetic therapy at reducing pain (short-term: WMD -13.90, 95% CI -22.19 to -5.62; long-term: WMD -26.20, 95% CI -31.32 to -21.08 and improving function (short-term: WMD -10.54, 95% CI -14.32 to -6.75; long-term: WMD -25.75, 95% CI -30.79 to -20.71. In one trial we found statistically significant differences between SE and physical agents combined with drug therapy (meloxicam combined with eperisone hydrochloride but of borderline clinical relevance for pain (short-term: WMD -15.00, 95% CI -19.64 to -10.36 and function (short-term: WMD -10.00; 95% CI -13.70 to -6.30. There was substantial heterogeneity among the two trials comparing SE and thermomagnetic therapy; both these trials and the trial comparing SE with physical agents combined with drug therapy had serious methodological limitations. INTERPRETATION: Based on limited evidence from 2 trials, SE was more effective for LBP than thermomagnetic therapy. Clinically relevant differences in effects between SE and other forms of exercise, physical agents combined with drug therapy, traditional

  16. Combination of taping with Back School in patients with chronic low back pain: a randomized controlled clinical trial

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    Andres Tana

    2016-11-01

    Full Text Available Introduction: 70-85% of the general population suffers from back pain. Back School programs have being effective in the treatment of chronic low back pain. Taping may be useful in reducing pain and normalizing muscle function. The objective of this study was to evaluate the effectiveness of the combination of taping with Back School at short- and long-term. Methods: Randomized controlled clinical trial. The experimental group used tape and made Back Scholl and the control group only made Back School. At the beginning and the end of treatment, pain was evaluated with a visual analogue scale, the flexibility determined with the Modified Finger Tip-to-Floor Test and functionality was calculated with the Roland Morris Disability Questionnaire. Depression was recorded with the Depression Beck Inventory just at the beginning. Results: 220 patients were enrolled, only 42 in the experimental group and 33 in the control group completed the treatment. The variation of pain between the first and the fifth session showed no differences between groups regardless of time (p = 0.329. There were no differences between groups in functionality (p = 0.75, flexibility (p = 0.20 and depression. Conclusion: The combination of taping and Back School compared with only Back School was not more effective in reducing pain, increasing functionality and flexibility in patients with chronic low back pain. Key words: Taping; chronic low back pain; spine school; therapy exercises; flexibility; depression.

  17. Physiotherapy Modalities used in the Management of Chronic Low Back Pain

    Directory of Open Access Journals (Sweden)

    V. Naidoo

    2012-12-01

    Full Text Available Chronic low back pain (CLBP is a costly andcommon medical problem accounting for 75-90% of compensationcosts as a result of repeated treatments, long term work absenteeismand social support-unemployment compensation. Physiotherapytreatment modalities are commonly used in the management ofCLBP. Data on the management of CLBP by physiotherapists inlow income countries are scarce.A cross-sectional survey was used to investigate the managementof CLBP by physiotherapists in Kwazulu-Natal (KZN. Theobjectives of the study were to establish: the commonly used physiotherapymodalities; reasons; and the evidence base used for their choice. Six hundred and eighty-five self-administeredquestionnaires were posted to all registered physiotherapists in KZN.Of 213 returned questionnaires, 141 (20.6% met the inclusion criteria as they managed patients with CLBP.General exercises (30%; spinal mobilisation (28%; myofascial release (18%, education (12% and training oflocal stabilisers(12% were the commonly used treatment modalities. Key reasons for the selection of the treatmentmodalities were undergraduate education received; own clinical experience and the attendance of postgraduate courses/physiotherapy conferences.From the reasons specified for the selection of treatment modalities, the use of written current available literaturethrough reading of journal articles was sparsely utilized.

  18. The effect of lumbar stabilization exercises and thoracic mobilization and exercises on chronic low back pain patients.

    Science.gov (United States)

    Heo, Min-Yeong; Kim, Kyoung; Hur, Beom-Young; Nam, Chan-Woo

    2015-12-01

    [Purpose] To investigate whether pain, balance, and stabilization of the lumbar region can be improved through thoracic mobilization in addition to lumbar stabilizaing exercises. [Subjects and Methods] This study recruited 36 subjects with chronic low back pain lasting more than 12 weeks. The subjects recruited for this study participated voluntarily, and provided their signed consent to participation. [Results] Improvement in balance was largest in the lumbar stabilization exercise group, followed by the thoracic mobilization and exercise group, and the traditional physical therapy group, in decreasing order of effect. [Conclusion] In conclusion, lumbar stabilization exercises combined with thoracic mobilization had greater effects on stabilization of the lumbar region pain relief, and improvement of the function of the patients with chronic low back pain.

  19. Zhong Yi acupuncture and low-back pain: traditional Chinese medical acupuncture differential diagnoses and treatments for chronic lumbar pain.

    Science.gov (United States)

    Birch, S; Sherman, K

    1999-10-01

    Little attention has been given to selecting treatments in clinical trials of acupuncture. Yet in order to perform objective tests of this procedure, it is crucial that the selected treatments are considered representative of the style of practice being tested. We examined 16 traditional Chinese medicine (TCM) acupuncture texts or treatment articles to determine the consistency of diagnosis and recommended treatment for chronic low-back pain. Although 24 diagnostic patterns were described by 1 or more texts, only 4 patterns were described by at least half of the texts. Most texts (12/16) described only 3 or 4 patterns. These could be categorized into 3 broad types: cold, damp, wind, heat channel obstruction patterns; kidney vacuity patterns (sometimes differentiated into yang and yin patterns); and blood (or blood and qi) stasis patterns. Several acupuncture points were recommended by most texts regardless of the diagnosis, whereas other acupoints were recommended for specific diagnostic patterns. There was, however, substantial variation between texts in recommended acupoints, with less than 20% of all acupoints recommended by half or more of the texts. This varibility will make it difficult to select TCM treatments for clinical trials of chronic low-back pain that have wide applicability. We believe that examining treatment patterns in actual clinical practice is crucial in this situation. We suggest that this method of selecting treatments should be part of the process used when selecting treatments for all clinical trials of acupuncture, regardless of the style of practice.

  20. Ignoring the sacroiliac joint in chronic low back pain is costly

    OpenAIRE

    Polly DW; Cher D

    2016-01-01

    David W Polly,1,2 Daniel Cher3 1Department of Orthopedic Surgery, 2Department of Neurosurgery, University of Minnesota, Minneapolis, MN, 3SI-BONE, Inc., San Jose, CA, USA Background: Increasing evidence supports minimally invasive sacroiliac joint (SIJ) fusion as a safe and effective treatment for SIJ dysfunction. Failure to include the SIJ in the diagnostic evaluation of low back pain could result in unnecessary health care expenses. Design: Decision analytic cost model. Methods: A decision...

  1. The quadratus lumborum and low back pain.

    Science.gov (United States)

    de Franca, G G; Levine, L J

    1991-02-01

    Two cases of low back pain from quadratus lumborum myofascial trigger points are presented. One of the patients suffered from an acute episode while the other had a chronic condition. This condition may be more common than previously believed. The quadratus lumborum should be examined in patients presenting with flank pain as well as low back, buttock and lateral hip pain. Thoracolumbar joint dysfunction may often coexist with quadratus lumborum myofascitis and must be treated for optimal results. Myofascial therapy directed at restoring muscle length and function, coupled with joint manipulation to related dysfunctional areas, was implemented. Diagnosis and treatment are outlined.

  2. Comparing Physical Therapy Accompanying Exercise with Only Exercise Treatments in Patients with Chronic Mechanical Low Back Pain

    Directory of Open Access Journals (Sweden)

    Özlem Yılmaz

    2015-08-01

    Full Text Available Objective: Investigating and comparing the effects of exercise and physical therapy accompanying exercise treatments in patients with chronic low back pain. Materials and Methods: Twenty three patients with mechanical type low back existing more than 3 months were included one of the exercise or the physical therapy+exercise groups according to their application sequence. Both of the groups performed lumbar flexion and extension exercises, strengthening of the lumbar and abdominal muscle exercises and iliopsoas, hamstring and quadriceps stretching exercises two times a day for 14 days. The physical therapy group was given hot pack+therapeutic ultrasound+ interferential current for 10 days additionally. Degree of the low back pain was evaluated with visual analog scale (VAS, range of joint motion was evaluated with hand finger floor distance (HFFD and Modified Schober test, functional status was evaluated with Modified Oswestry Low Back Pain Scale and quality of life was evaluated with Short form-36 (SF-36 before and a month after the treatments. Results: In both groups (exercise group: average age 59 years, 21 females, 2 males; physical therapy group: average age 60 years, 20 females, 3 males pain intensity and HFFD decreased and Modified Schober increased, functionality recovered, pain and physical functions of SF-36 improved after the treatments. SF-36-physical role difficulty also improved in the exercise group. Decrease in pain, increase in HFFD andimproving of the functional status were all significantly more in the physical therapy group. There were no difference between the groups in terms of Modified Schober measurement and changes of the quality of life. Conclusions: Exercises and exercise+physical therapy are both effective in chronic low back pain. Successful results can be taken by addition of the physical therapy in patients who do not benefit sufficiently from exercise therapy. (Turkish Journal of Osteoporosis 2015;21: 73-8

  3. Unspecific chronic low back pain – a simple functional classification tested in a case series of patients with spinal deformities

    Directory of Open Access Journals (Sweden)

    Werkmann Mario

    2009-02-01

    Full Text Available Abstract Background Up to now, chronic low back pain without radicular symptoms is not classified and attributed in international literature as being "unspecific". For specific bracing of this patient group we use simple physical tests to predict the brace type the patient is most likely to benefit from. Based on these physical tests we have developed a simple functional classification of "unspecific" low back pain in patients with spinal deformities. Methods Between January 2006 and July 2007 we have tested 130 patients (116 females and 14 males with spinal deformities (average age 45 years, ranging from 14 years to 69 and chronic unspecific low back pain (pain for > 24 months along with the indication for brace treatment for chronic unspecific low back pain. Some of the patients had symptoms of spinal claudication (n = 16. The "sagittal realignment test" (SRT was applied, a lumbar hyperextension test, and the "sagittal delordosation test" (SDT. Additionally 3 female patients with spondylolisthesis were tested, including one female with symptoms of spinal claudication and 2 of these patients were 14 years of age and the other 43yrs old at the time of testing. Results 117 Patients reported significant pain release in the SRT and 13 in the SDT (>/= 2 steps in the Roland & Morris VRS. 3 Patients had no significant pain release in both of the tests ( Pain intensity was high (3,29 before performing the physical tests (VRS-scale 0–5 and low (1,37 while performing the physical test for the whole sample of patients. The differences where highly significant in the Wilcoxon test (z = -3,79; p In the 16 patients who did not respond to the SRT in the manual investigation we found hypermobility at L5/S1 or a spondylolisthesis at level L5/S1. In the other patients who responded well to the SRT loss of lumbar lordosis was the main issue, a finding which, according to scientific literature, correlates well with low back pain. The 3 patients who did not

  4. Effectiveness of focused structural massage and relaxation massage for chronic low back pain: protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Deyo Richard A

    2009-10-01

    Full Text Available Abstract Background Chronic back pain is a major public health problem and the primary reason patients seek massage treatment. Despite the growing use of massage for chronic low back pain, there have been few studies of its effectiveness. This trial will be the first evaluation of the effectiveness of relaxation massage for chronic back pain and the first large trial of a focused structural form of massage for this condition. Methods and Design A total of 399 participants (133 in each of three arms between the ages of 20 and 65 years of age who have low back pain lasting at least 3 months will be recruited from an integrated health care delivery system. They will be randomized to one of two types of massage ("focused structural massage" or "relaxation massage", or continued usual medical care. Ten massage treatments will be provided over 10 weeks. The primary outcomes, standard measures of dysfunction and bothersomeness of low back pain, will be assessed at baseline and after 10, 26, and 52 weeks by telephone interviewers masked to treatment assignment. General health status, satisfaction with back care, days of back-related disability, perceived stress, and use and costs of healthcare services for back pain will also be measured. Outcomes across assigned treatment groups will be compared using generalized estimating equations, accounting for participant correlation and adjusted for baseline value, age, and sex. For both primary outcome measures, this trial will have at least 85% power to detect the presence of a minimal clinically significant difference among the three treatment groups and 91% power for pairwise comparisons. Secondary analyses will compare the proportions of participants in each group that improve by a clinically meaningful amount. Conclusion Results of this trial will help clarify the value of two types of massage therapy for chronic low back pain. Trial registration Clinical Trials.gov NCT 00371384.

  5. Fixed-site high-frequency transcutaneous electrical nerve stimulation for treatment of chronic low back and lower extremity pain

    Science.gov (United States)

    Gozani, Shai N

    2016-01-01

    Objective The objective of this study was to determine if fixed-site high-frequency transcutaneous electrical nerve stimulation (FS-TENS) is effective in treating chronic low back and lower extremity pain. Background Transcutaneous electrical nerve stimulation is widely used for treatment of chronic pain. General-purpose transcutaneous electrical nerve stimulation devices are designed for stimulation anywhere on the body and often cannot be used while the user is active or sleeping. FS-TENS devices are designed for placement at a pre-determined location, which enables development of a wearable device for use over extended time periods. Methods Study participants with chronic low back and/or lower extremity pain self-administered an FS-TENS device for 60 days. Baseline, 30-, and 60-day follow-up data were obtained through an online questionnaire. The primary outcome measure was the patient global impression of change. Pain intensity and interference were assessed using the Brief Pain Inventory. Changes in use of concomitant pain medications were evaluated with a single-item global self-rating. Results One hundred and thirty participants were enrolled, with 88 completing the 60-day follow-up questionnaire. Most participants (73.9%) were 50 years of age or older. At baseline, low back pain was identified by 85.3%, lower extremity pain by 71.6%, and upper extremity pain by 62.5%. Participants reported widespread pain, at baseline, with a mean of 3.4 (standard deviation 1.1) pain sites. At the 60-day follow-up, 80.7% of participants reported that their chronic pain had improved and they were classified as responders. Baseline characteristics did not differentiate non-responders from responders. There were numerical trends toward reduced pain interference with walking ability and sleep, and greater pain relief in responders. There was a large difference in use of concomitant pain medications, with 80.3% of responders reporting a reduction compared to 11.8% of non

  6. Reasons for drop-out from rehabilitation in patients of Turkish and Moroccan origin with chronic low back pain in the Netherlands : a qualitative study

    NARCIS (Netherlands)

    Sloots, Maurits; Dekker, Jos H. M.; Pont, Menno; Bartels, Edien A. C.; Geertzen, Jan H. B.; Dekker, Joost

    2010-01-01

    Objective: To explore which factors led to drop-out in patients of Turkish and Moroccan origin with chronic nonspecific low back pain who participated in a rehabilitation programme. Subjects: Patients of Turkish or Moroccan origin with chronic non-specific low back pain (n=23) from 2 rehabilitation

  7. Prognosis and course of work-participation in patients with chronic non-specific low back pain: A 12-month follow-up cohort study

    NARCIS (Netherlands)

    Verkerk, K.; Luijsterburg, P.A.J.; Pool-Goudzwaard, A.; Heymans, M.W.; Ronchetti, I.; Miedema, H.S.; Koes, B.W.

    2015-01-01

    OBJECTIVE: To investigate the clinical course of, and prognostic factors for, work-participation in patients with chronic non-specific low back pain. METHODS: A total of 1,608 patients with chronic non-specific low back pain received a multidisciplinary therapy and were evaluated at baseline an

  8. The Evaluation of Satisfaction Level of Stability Training Exercises in the Patients with Mechanical Nonspecific Chronic Low Back Pain

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    N. Karimi

    2009-07-01

    Full Text Available Introduction & Objective: There is limited evidence on chronic low back patients' perception and satisfaction of the treatment with spinal stabilization exercises and their overall experience of the treatment program. The objective of this study was to evaluate the satisfaction level of patients with mechanical nonspecific chronic low back pain after participating in a stability training program. Materials & Methods: At first, a methodological study was designed to develop a satisfaction questionnaire, and then content validity and test-retest reliability of it were determined. All patients (n=43 participated in a stability training program within a randomized controlled trial. Finally they filled in satisfaction questionnaire. Results: Distribution of demographic variables were normal (P>0.43. 53.5% of the patients had solitary type occupations. 58.1% had history of sport activities. Also, pain location and extension in 46.5% and 65.2% were in lumbar region only. After stability training program, pain decreased (p<0.001 and functional ability as Oswestry and Quebec scales scores increased (p<0.002 significantly. Overall score of satisfaction questionnaire was 16±4.07.Conclusion: Patients with chronic mechanical low back pain were satisfied after participation in stability training program. Pain reduction and better functional ability may be two factors contributing to the satisfaction of these patients.

  9. Effect of core stabilization exercises on functional disability in patients with chronic low back pain

    Directory of Open Access Journals (Sweden)

    Amila Kapetanovic

    2016-04-01

    Full Text Available Introduction: The aim of this study was to assess core stabilization exercise effects in reducing functional disability in patients with chronic low back pain (CLBP.Methods: This study included total of 90 patients aged 40 to 60 years. After a ten-day rehabilitation program the patients from an examination group (n = 30 performed home exercise program five times a week, patients from a first control group (n = 30 three times a week, while patients from a second control group (n = 30 did not perform the exercises at all. The patients performed core stabilization exercises of moderate intensity once a day in 30 minutes sessions. The patient's functional disability was estimated using the Oswestry Disability Index (ODI.Results: After two months of rehabilitation there was a statistically significant increase in functional ability in patients who performed the core stabilization exercises five times a week(p = 0.0001 and in patients who performed the core stabilization exercises three times per week (p = 0.0001. A statistically significant difference in functional ability was not recorded in patients who did not perform the exercises. The analysis of the average values of the ODI differences at the beginning and after two months of rehabilitation showed a statistically significant difference between the group who did not perform the exercises and the group who performed the core stabilization exercises three times a week (p = 0.0001, and between the group who did not perform the exercises and the group who performed the core stabilization exercises five times a week (p = 0.0001.Conclusions: The implementation of the core stabilization exercises leads to a reduction of functional disability in patients with CLBP.

  10. Effectiveness of mindfulness meditation on pain and quality of life of patients with chronic low back pain

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    Sudha Banth

    2015-01-01

    Effectiveness of mindfulness meditation on pain and quality of life of patients with chronic low back pain Eighty-eight patients diagnosed as NSCLBP by physician and randomly assigned to experimental (MBSR+ usual medical care and the control group (usual medical care only. The subjects assessed in 3 times frames; before, after and 4 weeks after intervention by Mac Gil pain and standard brief quality of life scales. Data obtained from the final sample analyzed by ANCOVA using SPSS software. Results: The findings showed MBSR was effective in reduction of pain severity and the patients who practiced 8 sessions meditation reported significantly lower pain than patients who only received usual medical care. There was a significant effect of the between subject factor group (F [1, 45] = 16.45, P < 0.001 and (F [1, 45] = 21.51, P < 0.001 for physical quality of life and (F [1, 45] = 13.80, P < 0.001 and (F [1, 45] = 25.07, P < 0.001 mental quality of life respectively. Conclusion: MBSR as a mind-body therapy including body scan, sitting and walking meditation was effective intervention on reduction of pain severity and improvement of physical and mental quality of life of female patients with NSCLBP.

  11. Comparing core stability and traditional trunk exercise on chronic low back pain patients using three functional lumbopelvic stability tests.

    Science.gov (United States)

    Shamsi, Mohammad Bagher; Sarrafzadeh, Javad; Jamshidi, Aliashraf

    2015-02-01

    It is a matter of controversy whether core stability exercise is preferred to other types of exercise for chronic low back pain. Lumbopelvic stability is an important element in low back pain. No study was found using lumbopelvic stability tests in comparing core stability and other exercises. The single leg squat, dip test, and runner pose test appear to be suitable as tests for lumbopelvic stability. The aim of this study was to compare "core stability" and "traditional trunk exercise" using these tests and also the Oswestry disability questionnaire and pain intensity. Twenty-nine non-specific chronic low back pain subjects were alternately allocated in one of the two exercise groups. For both groups, a 16-sessions exercise program was provided. Before and after training: (1) video was recorded while subjects performed the tests; (2) Oswestry disability questionnaire was completed; and (3) pain intensity was measured by visual analogue scale. The test videos were scored by three physiotherapists. Statistical analysis revealed a significant improvement in stability test scores (p = 0.020 and p = 0.041) and reduction in disability (p stability or equal effectiveness of TTE and CSE on improving LPS. The non-significant differences may also be attributable to the lack of sensitivity of our tests to assess stability change in two groups after training given the relatively small sample size.

  12. Kinesio Taping® is not better than placebo in reducing pain and disability in patients with chronic non-specific low back pain: a randomized controlled trial

    OpenAIRE

    Luz Júnior,Maurício A.; Manoel V. Sousa; Neves, Luciana A. F. S.; Aline A. C. Cezar; Costa, Leonardo O. P.

    2015-01-01

    Background: Kinesio Taping® has been widely used in clinical practice. However, it is unknown whether this type of tape is more effective than placebo taping in patients with chronic lower back pain. Objective: To compare the effectiveness of Kinesio Taping® in patients with chronic non-specific low back pain against a placebo tape and a control group. Method: This is a 3-arm, randomized controlled trial with a blinded assessor. Sixty patients with chronic non-specific low back pain were r...

  13. Neural correlates of fear of movement in patients with chronic low back pain versus pain-free individuals

    Directory of Open Access Journals (Sweden)

    Michael Lukas Meier

    2016-07-01

    Full Text Available Fear of movement (FOM can be acquired by a direct aversive experience such as pain or by social learning through observation and instruction. Excessive FOM results in heightened disability and is an obstacle for recovery from acute, subacute, and chronic low back pain (cLBP. FOM has further been identified as a significant explanatory factor in the Fear Avoidance (FA model of cLBP that describes how individuals experiencing acute back pain may become trapped into a vicious circle of chronic disability and suffering. Despite a wealth of evidence emphasizing the importance of FOM in cLBP, to date, no related neural correlates in patients were found and this therefore has initiated a debate about the precise contribution of fear in the FA model. In the current fMRI study, we applied a novel approach encompassing 1 video clips of potentially harmful activities for the back as FOM inducing stimuli and 2 the assessment of FOM in both, cLBP patients (N = 20 and age- and gender-matched pain-free subjects (N = 20. Derived from the FA model, we hypothesized that FOM differentially affects brain regions involved in fear processing in patients with cLBP compared to pain-free individuals due to the recurrent pain and subsequent avoidance behaviour. The results of the whole brain voxel-wise regression analysis revealed that 1 FOM positively correlated with brain activity in fear-related brain regions such as the amygdala and the insula and 2 Differential effects of FOM between patients with cLBP and pain-free subjects were found in the extended amygdala and in its connectivity to the anterior insula. Current findings support the FOM component of the FA model in cLBP.

  14. Primary sacral hydatid cyst mimicking a neurogenic tumor in chronic low back pain: Case report and review of the literature

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    Manuel Segura-Trepichio

    2016-01-01

    Full Text Available Hydatid disease is caused by infection of Echinococcus granulosus. Bone hydatid cyst presentation without hepatic affectation is infrequent and occurs in 0,5-2% of cases. This rare condition makes clinicians not always aware of the disease, and as a result, misdiagnosis of spinal echinococcosis is common. We present a case of a 48-year-old female patient with primary sacral hydatidosis. Chronic low back pain radiating to the left buttock was the only symptom. The magnetic resonance imaging (MRI suggested a neurogenic tumor versus giant cell tumor. Biopsy and pathological study revealed a hydatid cyst. Anthelmintic and surgical treatment was performed. At 12 months after surgery, the patient is free of recurrence. In patients with chronic low back pain and a MR suggestive of neurogenic tumor, spinal hydatid cyst should be considered in the differential diagnosis. It is recommended the assistance of an anesthesiologist during biopsy to avoid an anaphylactic shock.

  15. Primary Sacral Hydatid Cyst Mimicking a Neurogenic Tumor in Chronic Low Back Pain: Case Report and Review of the Literature

    Science.gov (United States)

    Segura-Trepichio, Manuel; Montoza-Nuñez, Jose Manuel; Candela-Zaplana, David; Herrero-Santacruz, Josefa; Pla-Mingorance, Fernando

    2016-01-01

    Hydatid disease is caused by infection of Echinococcus granulosus. Bone hydatid cyst presentation without hepatic affectation is infrequent and occurs in 0,5-2% of cases. This rare condition makes clinicians not always aware of the disease, and as a result, misdiagnosis of spinal echinococcosis is common. We present a case of a 48-year-old female patient with primary sacral hydatidosis. Chronic low back pain radiating to the left buttock was the only symptom. The magnetic resonance imaging (MRI) suggested a neurogenic tumor versus giant cell tumor. Biopsy and pathological study revealed a hydatid cyst. Anthelmintic and surgical treatment was performed. At 12 months after surgery, the patient is free of recurrence. In patients with chronic low back pain and a MR suggestive of neurogenic tumor, spinal hydatid cyst should be considered in the differential diagnosis. It is recommended the assistance of an anesthesiologist during biopsy to avoid an anaphylactic shock. PMID:28163523

  16. 慢性腰痛的哲学思考%Philosophical Thinking on Chronic Low Back Pain

    Institute of Scientific and Technical Information of China (English)

    彭亦良

    2012-01-01

    Chronic low back pain is one of the most common symptom of orthopedic outpatients, there are complex causes and clinical manifestations, it is very difficult to diagnosis and treatment, only constant reconsider, higher level of diagnosis and better efficacy for chronic low back pain can be achieved.%慢性腰痛是临床最常见的病症之一,其临床表现错综复杂,真正病因扑朔迷离,诊断和治疗均非常困难,只有对其进行不断反思,才能进一步提高慢性腰痛的诊断水平和治疗效果.

  17. Long-term experience with implanted intrathecal drug administration systems for failed back syndrome and chronic mechanical low back pain

    Directory of Open Access Journals (Sweden)

    Treharne GJ

    2002-06-01

    Full Text Available Abstract Background Continuous intrathecal drug delivery has been shown in open studies to improve pain and quality of life in those with intractable back pain who have had spinal surgery. There is limited data on long term effects and and even less for patients with mechanical back pain without prior spinal surgery. Methods We have investigated spinal drug administration systems for patients with failed back syndrome and chronic mechanical low back pain by patient questionnaire study of the efficacy of this therapy and a case notes review. Results 36 patients (97% of 37 approached completed questionnaires, 24 with failed back syndrome and 12 with chronic mechanical low back pain. Recalled pre-treatment levels with current post-treatment levels of pain and a range of quality of life measures (recorded on 11-point numerical rating scales were compared. Pain improved significantly in both groups (Wilcoxan signed ranks test, p 0.005, Wilcoxan signed ranks test with Bonferroni correction. Diamorphine was used in all 37 patients, bupivacaine in 32, clonidine in 27 and baclofen in 3. The mean dose of diamorphine increased for the first 2 years but did not change 2–6 years post implant, averaging 4.5 mg/day. Revision surgery was required in 24% of cases, but reduced to 12% in the later years of our experience. Conclusions We conclude that spinal drug administration systems appear to be of benefit in alleviating pain in the failed back syndrome and chronic mechanical low back pain but need to be examined prospectively.

  18. Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study

    OpenAIRE

    Morone, Natalia E.; Greco, Carol M.; Weiner, Debra K.

    2007-01-01

    The objectives of this pilot study were to assess the feasibility of recruitment and adherence to an eight-session mindfulness meditation program for community-dwelling older adults with chronic low back pain (CLBP) and to develop initial estimates of treatment effects. It was designed as a randomized, controlled clinical trial. Participants were 37 community-dwelling older adults aged 65 years and older with CLBP of moderate intensity occurring daily or almost every day. Participants were ra...

  19. Physiotherapy and a Homeopathic Complex for Chronic Low Back Pain Due to Osteoarthritis: A Randomized, Controlled Pilot Study

    OpenAIRE

    Pellow, Janice

    2016-01-01

    Abstract:Context: Osteoarthritis (OA) is a common cause of chronic low back pain (CLBP) and can be managed with the use of drug therapy and physiotherapy. Homeopathic remedies may assist in the management of OA; however, research that supports their effectiveness is limited. Objectives: The study aimed to investigate the efficacy of a homeopathic complex in combination with physiotherapy in the treatment of CLBP due to OA. Design: The study was a six-week, randomized, double-blind, placebo-co...

  20. Low Back Pain Common Among Kids

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_163320.html Low Back Pain Common Among Kids Sports injuries are ... 30, 2017 MONDAY, Jan. 30, 2017 (HealthDay News) -- Low back pain is common in school-age American ...

  1. Treatment of chronic low back pain in patients with spinal deformities using a sagittal re-alignment brace

    Directory of Open Access Journals (Sweden)

    Weiss Hans-Rudolf

    2009-03-01

    Full Text Available Abstract Background For adult scoliosis patients with chronic low back pain bracing is initially indicated before spinal surgery is considered. Until recently there has been a lack of research into the effect upon pain reductions in the mid and long-term. Promising results have been documented in short-term studies for the application of a sagittal re-alignment brace in patients with spinal deformities and along with pain; however mid-term and long-term results are not yet available. The purpose of this study is to investigate the mid-term effects of this brace with respect to pain control. Materials and methods 67 patients (58 females and 9 males with chronic low back pain (> 24 months and the diagnosis of scoliosis or hyperkyphosis were treated with a sagittal re-alignment brace (physio-logic brace™ between January 2006 and July 2007. The indication for this kind of brace treatment was derived from a positive sagittal re-alignment test (SRT and the exclusion of successful conservative treatment during the last 24 months. The aim of this type of conservative intervention was to avoid surgery for chronic low back pain. Results The average pain intensity was measured on the Roland and Morris VRS (5 steps before treatment. This was 3.3 (t1, at the time of brace adjustment it was 2.7 (t2 and after at an average observation time of 18 months it was 2.0 (t3. The differences were highly significant in the Wilcoxon test. Discussion Short-term measurements showed that a significant pain reduction is possible in chronic postural low back pain using a sagittal re-alignment brace inducing lumbar re-lordosation. In a preliminary report at adjustment (t2, highly significant improvements of pain intensity have also been demonstrated. At 6 months of treatment however, no improvement was measured. The improvement of the mid-term effects (18 months found in this study compared to the preliminary report may be due to the changed approach to compliance: whilst

  2. Efficacy of Manual Therapy versus Conventional Physical Therapy in Chronic Low Back Pain Due to Lumbar Spondylosis. A Pilot Study

    Directory of Open Access Journals (Sweden)

    Arti Sharma

    2015-06-01

    Full Text Available Objectives: The objective of this work was to compare the efficacy of Maitland mobilization and conventional physical therapy on pain response, range of motion (ROM and functional ability in patients with chronic low back pain due to lumbar spondylosis. Methods: A total sample of 30 subjects (40–70 years of age with complaints of slow insidious onset of low back pain (LBP, with or without radiation not less than three months duration and decrease ROM were randomly assigned to: group-I, Maitland mobilization and lumbar stabilization exercises; group-II conventional physical therapy (traction, strengthening, stretching exercises. and outcomes were assessed for dependent variables. Results: There is statically a significant difference between pre and post measurement readings with time (p = 0.00 and between groups (p < 0.05 with respect to pain and function, but, with respect to ROM readings, showed statistical significance with time (p = 0.00 and no significance between groups (p > 0.05, indicating manual therapy group-I is improving faster and better than conventional physical therapy group-II. Conclusion: Our results showed that manual therapy interventions are more effective in managing low back pain, and function and range of motion of the lumbar spine than conventional physical therapy treatment.

  3. Do MRI findings identify patients with chronic low back pain and Modic changes who respond best to rest or exercise

    DEFF Research Database (Denmark)

    Jensen, Rikke K; Kent, Peter; Hancock, Mark

    2015-01-01

    BACKGROUND: No previous clinical trials have investigated MRI findings as effect modifiers for conservative treatment of low back pain. This hypothesis-setting study investigated if MRI findings modified response to rest compared with exercise in patients with chronic low back pain and Modic...... changes. METHODS: This study is a secondary analysis of a randomised controlled trial comparing rest with exercise. Patients were recruited from a specialised outpatient spine clinic and included in a clinical trial if they had chronic low back pain and an MRI showing Modic changes. All patients received...... or with large Modic changes Type 1 were all potentially important in size (-0.99 (95 % CI -3.28 to 1.29), -1.49 (-3.73 to 0.75), -1.49 (-3.57 to 0.58), respectively) but the direction of the effect was the opposite to what we had hypothesized-that people with these findings would benefit more from rest than...

  4. Prevalence and proposed mechanisms of chronic low back pain in baseball: part i.

    Science.gov (United States)

    Wasser, Joseph G; Zaremski, Jason L; Herman, Daniel C; Vincent, Heather K

    2017-01-27

    The prevalence of low back pain (LBP) among active baseball players ranges between 3 and 15%. The execution of baseball-specific manoeuvres, such as pitching or batting, may be related to the onset of LBP. These baseball motions are complex and require appropriate activation of the core musculature to produce a well-timed motion with forces minimized at the extremities. The spine, core and back musculature are involved with acceleration and deceleration of rotational motions. This narrative review synopsizes the available evidence of the prevalence of and mechanical factors underlying LBP in the baseball population. Possible mechanical mechanisms linking baseball play to LBP include aberrant motion, improper timing, high lumbar stress due to mechanical loading and lumbopelvic strength deficits. Potential clinical implications relating to these possible mechanical mechanisms will also be highlighted. The state of the evidence suggests that there are deficits in understanding the role of baseball motion and playing history in the development of spine conditions.

  5. Kinesio Taping to generate skin convolutions is not better than sham taping for people with chronic non-specific low back pain: a randomised trial

    OpenAIRE

    Patrícia do Carmo Silva Parreira; Lucíola da Cunha Menezes Costa; Ricardo Takahashi; Luiz Carlos Hespanhol Junior; Maurício Antônio da Luz Junior; Tatiane Mota da Silva; Leonardo Oliveira Pena Costa

    2014-01-01

    Question: For people with chronic low back pain, does Kinesio Taping, applied according to the treatment manual to create skin convolutions, reduce pain and disability more than a simple application without convolutions? Design: Randomised trial with concealed allocation, intention-to-treat analysis and blinded assessment of some outcomes. Participants: 148 participants with chronic non-specific low back pain. Intervention: Experimental group participants received eight sessions (over four we...

  6. Efficacy of adding the kinesio taping method to guideline-endorsed conventional physiotherapy in patients with chronic nonspecific low back pain: a randomised controlled trial

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    Added, Marco A N; Costa, Leonardo O. P.; Fukuda, Thiago Y.; de Freitas, Diego G; Salomão, Evelyn C; Monteiro, Renan L; Costa, Lucíola d C M

    2013-01-01

    Abstract Background Chronic nonspecific low back pain is a significant health condition with high prevalence worldwide and it is associated with enormous costs to society. Clinical practice guidelines show that many interventions are available to treat patients with chronic low back pain, but the vast majority of these interventions have a modest effect in reducing pain and disability. An intervention that has been widespread in recent y...

  7. Evidence of effectiveness of herbal antiinflammatory drugs in the treatment of painful osteoarthritis and chronic low back pain.

    Science.gov (United States)

    Chrubasik, J E; Roufogalis, B D; Chrubasik, S

    2007-07-01

    Treatment with herbal medicines is very popular in Europe. In order to get information on the evidence of effectiveness of oral herbal medicines in the treatment of pain in the joints or lower back, OVID(MEDLINE), PUBMED and COCHRANE COLLABORATION LIBRARY were searched back to 1985 for systematic reviews. The level of evidence of effectiveness was defined as strong - at least two confirmatory studies demonstrating a clinical relevant effect, moderate - one confirmatory study with a clinical relevant effect and/or multiple exploratory studies of good quality; otherwise the evidence was insufficient or conflicting in the case of inconsistent findings. Fifteen systematic reviews were identified. The evidence of effectiveness was strong for a proprietary unsaponifiable avocado soybean fraction and Harpagophytum preparations containing > 50 mg harpagoside in the daily dosage, moderate for ginger and a proprietary rose hip and seed powder, insufficient for Boswellia serrata gum resin and other herbal preparations and inconsistent for a proprietary willow bark extract. Further rigorous studies are required to confirm the usefulness of herbal medicines in the treatment of osteoarthritic complaints and chronic low back pain in order to enable acceptance of the herbal medicines into the treatment guidelines.

  8. Psychosocial approaches to the prevention of chronic pain: the low back paradigm.

    Science.gov (United States)

    Kendall, N A

    1999-09-01

    Psychosocial factors have the potential to influence an acute musculoskeletal pain problem at three distinct phases: the onset of pain; the seeking and receiving of health care and income support; and the development of chronic pain-related disability and work loss. Clinical management that ignores psychosocial factors has done little to stem the flow of individuals from acute to chronic pain and disability. Psychosocial factors are no longer considered as mere secondary reactions to pain. We now recognize that psychosocial factors are usually the best predictors of chronicity, and that many of the learned behaviours apparent in chronic musculoskeletal pain have their genesis in the first few days and weeks of the problem. These circumstances have combined to shift an emphasis onto the early care provided for patients by primary care health professionals. The concept of Red Flags as signs of serious disease has been extended to the readily understood idea of Yellow Flags that indicate psychosocial barriers to recovery. For many individuals these issues need to be addressed so that the risk of developing long-term disability and work loss can be reduced. Doing this is not mutually exclusive with providing for the biomedical needs of patients.

  9. The patient-physician relationship in patients with chronic low back pain as a predictor of outcomes after rehabilitation.

    Science.gov (United States)

    Farin, Erik; Gramm, Lukas; Schmidt, Erika

    2013-06-01

    For patients with chronic diseases, especially those with chronic low back pain, the patient-physician relationship is significant for treatment adherence. In a sample of N = 688 low back pain patients, we examined the hypothesis that aspects of the patient-physician relationship (e.g. satisfaction with care, trust in the physician, patient participation) have a significant association with outcomes (pain, disability, quality of life, pain-related psychological impairment) after a multimodal treatment program (rehabilitation) after adjusting for a number of sociodemographic, medical, and psychological factors. Results show that the patient-physician relationship is significantly associated with the outcome. In the medium term (6 months after rehabilitation), the effect of the patient-physician relationship is clearer than in the short term (end of rehabilitation). In addition, risk factors for less improvement are female gender, higher age, low income, comorbidity, low treatment motivation, fear avoidance beliefs, and external locus of control. Future studies should examine the causal paths between the relationship variables and the outcome variables.

  10. Tactile thresholds are preserved yet complex sensory function is impaired over the lumbar spine of chronic non-specific low back pain patients. A preliminary investigation

    OpenAIRE

    Wand, BM; Di Pietro, FS; George, PJ; O'Connell, NE

    2010-01-01

    Objectives: To investigate impairments in sensory function in chronic non-specific low back pain patients and the relationship between any impairment and the clinical features of the condition. Design: A cross-sectional case-control study. Setting: Laboratory based study. Participants: Nineteen chronic non-specific low back pain patients and nineteen healthy controls. Main Outcome measures: Tactile threshold, two point discrimination distance and accuracy at a task involving recognizing lett...

  11. Changes in pain intensity and health related quality of life with Iyengar yoga in nonspecific chronic low back pain: A randomized controlled study

    OpenAIRE

    Nambi, Gopal S; Dipika Inbasekaran; Ratan Khuman; Surbala Devi; Shanmugananth; Jagannathan, K.

    2014-01-01

    Background: Nonspecific chronic low back (nCLBP) pain is prevalent among adult population and often leads to functional limitations, psychological symptoms, lower quality of life (QOL), and higher healthcare costs. The purpose of this study was to determine the efficacy of Iyengar yoga therapy on pain intensity and health related quality of life (HRQOL) with nCLBP. Aim of the Study: To compare the effect of Iyengar yoga therapy and conventional exercise therapy on pain intensity and HRQOL...

  12. EFFECTS OF STABILIZATION EXERCISE USING A BALL ON MUTIFIDUS CROSS-SECTIONAL AREA IN PATIENTS WITH CHRONIC LOW BACK PAIN

    Directory of Open Access Journals (Sweden)

    SinHo Chung

    2013-09-01

    Full Text Available The purpose of this study was to compare the effects of lumbar stabilization exercises using balls to the effects of general lumbar stabilization exercises with respect to changes in the cross section of the multifidus (MF, weight bearing, pain, and functional disorders in patients with non-specific chronic low back pain. Twelve patients participated in either a 8 week (3 days per week stabilization exercise program using balls and control group (n = 12. The computer tomography (CT was used to analyze MF cross-sectional areas (CSA and Tetrax balancing scale was used to analyze left and right weight bearing differences. Both groups had significant changes in the CSA of the MF by segment after training (p < 0.05 and the experimental group showed greater increases at the L4 (F = 9.854, p = 0.005 and L5 (F = 39. 266, p = 0.000. Both groups showed significant decreases in weight bearing, from 9.25% to 5.83% in the experimental group and from 9.33% to 4.25% in the control group (p < 0.05, but did not differ significantly between the two groups. These results suggests that stabilization exercises using ball can increases in the CSA of the MF segments, improvement in weight bearing, pain relief, and recovery from functional disorders, and the increases in the CSA of the MF of the L4 and L5 segments for patients with low back pain

  13. Low back pain: a twentieth century health care enigma.

    Science.gov (United States)

    Waddell, G

    1996-12-15

    Despite greater knowledge, expertise, and health care resources for spinal pathologies, chronic disability resulting from nonspecific low back pain is rising exponentially in western society. Medical care certainly has not solved the everyday symptom of low back pain and even may be reinforcing and exacerbating the problem. An historic review shows that there is no change in the pathology or prevalence of low back pain: What has changed in our understanding and management. There are striking differences in health care for low back pain in the United States and the United Kingdom, although neither delivers the kind of care recommended by recent evidence-based guidelines. Medical care for low back pain in the United States is specialist-oriented, of high technology, and of high cost, but 40% of American patients seek chiropractic care for low back pain instead. National Health Service care for low back pain in the United Kingdom is underfunded, too little and too late, and 55% of British patients pay for private therapy instead. Despite the different health care systems, treatment availability, and costs, there seems to be little difference in clinical outcomes or the social impact of low back pain in the two countries. There is growing dissatisfaction with health care for low back pain on both sides of the Atlantic. Future health care for patients with nonspecific low back pain should be designed to meet their specific needs.

  14. Return to competition in a chronic low back pain runner: beyond a therapeutic exercise approach, a case report

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    Sergio Veneziani

    2014-09-01

    Full Text Available Chronic low back pain (CLBP is a disabling condition affecting both quality of life and performance in athletes. Several approaches have been proposed in the field of physiotherapy, manual therapy, physical exercise and counseling. None apparently is outdoing the other with the exception of trunk stability exercises in specific conditions. The present paper describes a clinical success in managing a CLBP runner affected by MRI documented disk herniation via dietary change. Dietary changes allowed our patient that had failed with previous standard therapeutic approaches, to regain an optimal pain-free condition. We advance the hypothesis that a visceral-autonomic concomitant or primary disturbance possibly generating mild gastrointestinal discomfort in CLBP patients should be ruled out as a possible cause of pain and disability at the somato-motor level.

  15. Return to competition in a chronic low back pain runner: beyond a therapeutic exercise approach, a case report

    Directory of Open Access Journals (Sweden)

    Sergio Veneziani

    2014-05-01

    Full Text Available Chronic low back pain (CLBP is a disabling condition affecting both quality of life and performance in athletes. Several approaches have been proposed in the field of physiotherapy, manual therapy, physical exercise and counseling. None apparently is outdoing the other with the exception of trunk stability exercises in specific conditions. The present paper describes a clinical success in managing a CLBP runner affected by MRI documented disk herniation via dietary change. Dietary changes allowed our patient that had failed with previous standard therapeutic approaches, to regain an optimal pain-free condition. We advance the hypothesis that a visceral-autonomic concomitant or primary disturbance possibly generating mild gastrointestinal discomfort in CLBP patients should be ruled out as a possible cause of pain and disability at the somato-motor level.

  16. Effects of Pain Acceptance and Pain Control Strategies on Physical Impairment in Individuals with Chronic Low Back Pain

    Science.gov (United States)

    Vowles, Kevin E.; McNeil, Daniel W.; Gross, Richard T.; McDaniel, Michael L.; Mouse, Angela; Bates, Mick; Gallimore, Paula; McCall, Cindy

    2007-01-01

    Psychosocial treatments for chronic pain are effective. There is a need, however, to understand the processes involved in determining how these treatments contribute to behavior change. Control and acceptance strategies represent two potentially important processes involved in treatment, although they differ significantly in approach. Results from…

  17. Cognition and emotional decision-making in chronic low back pain: an ERPs study during Iowa gambling task

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    Stefano eTamburin

    2014-11-01

    Full Text Available Previous reports documented abnormalities in cognitive functions and decision-making (DM in patients with chronic pain, but these changes are not consistent across studies. Reasons for these discordant findings might include the presence of confounders, variability in chronic pain conditions, and the use of different cognitive tests. The present study was aimed to add evidence in this field, by exploring the cognitive profile of a specific type of chronic pain, i.e.: chronic low back pain (cLBP.Twenty four cLBP patients and 24 healthy controls underwent a neuropsychological battery and we focused on emotional DM abilities by means of Iowa gambling task (IGT. During IGT, behavioral responses and the electroencephalogram (EEG were recorded in 12 patients and 12 controls. Event-related potentials (ERPs were averaged offline from EEG epochs locked to the feedback presentation (4000 ms duration, from 2000 ms before to 2000 ms after the feedback onset separately for wins and losses and the feedback-related negativity (FRN and P300 peak-to-peak amplitudes were calculated. Among cognitive measures, cLBP patients scored lower than controls in the modified card sorting test (MCST and the score in this test was significantly influenced by pain duration and intensity. Behavioural IGT results documented worse performance and the absence of a learning process during the test in cLBP patients compared to controls, with no effect of pain characteristics. ERPs findings documented abnormal feedback processing in patients during IGT.cLBP patients showed poor performance in the MCST and the IGT. Abnormal feedback processing may be secondary to impingement of chronic pain in brain areas involved in DM or suggest the presence of a predisposing factor related to pain chronification. These abnormalities might contribute to the impairment in the work and family settings that often cLBP patients report.

  18. Assessment of Effectiveness of Percutaneous Adhesiolysis in Managing Chronic Low Back Pain Secondary to Lumbar Central Spinal Canal Stenosis

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    Laxmaiah Manchikanti, Kimberly A. Cash, Carla D. McManus, Vidyasagar Pampati

    2013-01-01

    Full Text Available Background: Chronic persistent low back and lower extremity pain secondary to central spinal stenosis is common and disabling. Lumbar surgical interventions with decompression or fusion are most commonly performed to manage severe spinal stenosis. However, epidural injections are also frequently performed in managing central spinal stenosis. After failure of epidural steroid injections, the next sequential step is percutaneous adhesiolysis and hypertonic saline neurolysis with a targeted delivery. The literature on the effectiveness of percutaneous adhesiolysis in managing central spinal stenosis after failure of epidural injections has not been widely studied.Study Design: A prospective evaluation.Setting: An interventional pain management practice, a specialty referral center, a private practice setting in the United States.Objective: To evaluate the effectiveness of percutaneous epidural adhesiolysis in patients with chronic low back and lower extremity pain with lumbar central spinal stenosis.Methods: Seventy patients were recruited. The initial phase of the study was randomized, double-blind with a comparison of percutaneous adhesiolysis with caudal epidural injections. The 25 patients from the adhesiolysis group continued with follow-up, along with 45 additional patients, leading to a total of 70 patients. All patients received percutaneous adhesiolysis and appropriate placement of the Racz catheter, followed by an injection of 5 mL of 2% preservative-free lidocaine with subsequent monitoring in the recovery room. In the recovery room, each patient also received 6 mL of 10% hypertonic sodium chloride solution, and 6 mg of non-particulate betamethasone, followed by an injection of 1 mL of sodium chloride solution and removal of the catheter.Outcomes Assessment: Multiple outcome measures were utilized including the Numeric Rating Scale (NRS, the Oswestry Disability Index 2.0 (ODI, employment status, and opioid intake with assessment at 3, 6

  19. Evidence-informed management of chronic low back pain with nonsteroidal anti-inflammatory drugs, muscle relaxants, and simple analgesics.

    Science.gov (United States)

    Malanga, Gerard; Wolff, Erin

    2008-01-01

    The management of chronic low back pain (CLBP) has proven to be very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing amongst available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence-Informed Management of Chronic Low Back Pain Without Surgery. Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.

  20. Effects of lumbar stabilization exercise on functional disability and lumbar lordosis angle in patients with chronic low back pain.

    Science.gov (United States)

    Cho, Igsoo; Jeon, Chunbae; Lee, Sangyong; Lee, Daehee; Hwangbo, Gak

    2015-06-01

    [Purpose] This study examined the effects of lumbar stabilization exercises on the functional disability and lumbar lordosis angles in patients with chronic low back pain. [Subjects] The subjects were 30 patients with chronic low back pain divided into a lumbar stabilization exercise group (n = 15) and a conservative treatment group (n = 15). [Methods] The lumbar stabilization exercise and conservative treatment groups performed an exercise program and conservative physical treatment, respectively. Both programs were performed 3 times a week for 6 weeks. The degree of functional disability was assessed by the Oswestry disability index, and lumbar lordosis angles were measured by plain radiography. [Results] The Oswestry disability index decreased significantly in the both groups; however, it was significantly lower in the lumbar stabilization exercise group. The lumbar lordosis angle increased significantly in the lumbar stabilization exercise group after treatment and was also significantly greater than that in the conservative treatment group. [Conclusion] Lumbar stabilization exercise is more effective than conservative treatment for improving functional disability and lumbar lordosis angles.

  1. Reduction of chronic non-specific low back pain: A randomised controlled clinical trial on acupuncture and baclofen

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    Rastqar Ali

    2010-04-01

    Full Text Available Abstract Background Chronic non-specific low back pain (LBP is a prevalent (80% and multi-dimensional illness. This study aims to test whether acupuncture, baclofen, or combined treatment with acupuncture and baclofen alleviates symptoms of non-specific chronic LBP in men. Methods Eight-four (84 men aged 50-60 years with non-specific chronic LBP were randomly assigned to four groups: the baclofen group received only baclofen (30 mg/day; the acupuncture group received only acupuncture at selected acupoints; the acupuncture + baclofen group received combined treatment with acupuncture and baclofen treatments; and the control group received no pain reduction treatment. After five weeks of treatment, visual analogue scale (VAS and self-reported pain disability with the Roland-Morris Disability Questionnaire (RDQ were conducted for outcome measures. Results After treatment, the baclofen, acupuncture and acupuncture + baclofen groups all had lower VAS and RDQ scores. Significantly higher reduction and improvement in VAS and RDQ scores were found in the acupuncture and acupuncture + baclofen groups compared to the baclofen group. Conclusion The present study indicates that the combined treatment of acupuncture and baclofen is more effective than baclofen treatment alone to reduce pain in patients with non-specific chronic LBP. Trial registration number ACTRN12609000698279

  2. Cost-effectiveness of Acupuncture for Chronic Nonspecific Low Back Pain.

    Science.gov (United States)

    Taylor, Penny; Pezzullo, Lynne; Grant, Suzanne J; Bensoussan, Alan

    2014-09-01

    Cost-effectiveness is a major criterion underpinning decisions in mainstream health care. Acupuncture is increasingly used in patients with chronic lower back pain (LBP), but there is a lack of evidence on cost-effectiveness. The objective of this study was to assess the cost-effectiveness of acupuncture in alleviating chronic LBP either alone or in conjunction with standard care compared with patients receiving routine care, and/or sham. To determine effectiveness, we undertook meta-analyses which found a significant improvement in pain in those receiving acupuncture and standard care compared with those receiving standard care alone. For acupuncture and standard care vs. standard care and sham, a weak positive effect was found for weeks 12 to 16, but this was not significant. For acupuncture alone vs. standard care alone, a significant positive effect was found at week 8, but not at weeks 26 or 52. The main outcome parameters for our cost-effectiveness analysis were the incremental cost-effectiveness ratio (ICER) of acupuncture treatment presented as cost (A$) per disability-adjusted life-year (DALY) saved. The WHO benchmark for a very highly cost-effective intervention is one that costs less than gross domestic product per capita per quality-adjusted life-year (QALY) gained or DALY averted, or less than around $A52,000 in 2009 (the base year for the analysis). According to this threshold, acupuncture as a complement to standard care for relief of chronic LBP is highly cost-effective, costing around $48,562 per DALY avoided. When comorbid depression is alleviated at the same rate as pain, cost is around $18,960 per DALY avoided. Acupuncture as a substitute for standard care was not found to be cost-effective unless comorbid depression was included. According to the WHO cost-effectiveness threshold values, acupuncture is a cost-effective treatment strategy in patients with chronic LBP.

  3. Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism.

    Science.gov (United States)

    O'Sullivan, Peter

    2005-11-01

    Low back pain (LBP) is a very common but largely self-limiting condition. The problem arises however, when LBP disorders do not resolve beyond normal expected tissue healing time and become chronic. Eighty five percent of chronic low back pain (CLBP) disorders have no known diagnosis leading to a classification of 'non-specific CLBP' that leaves a diagnostic and management vacuum. Even when a specific radiological diagnosis is reached the underlying pain mechanism cannot always be assumed. It is now widely accepted that CLBP disorders are multi-factorial in nature. However the presence and dominance of the patho-anatomical, physical, neuro-physiological, psychological and social factors that can influence the disorder is different for each individual. Classification of CLBP pain disorders into sub-groups, based on the mechanism underlying the disorder, is considered critical to ensure appropriate management. It is proposed that three broad sub-groups of CLBP disorders exist. The first group of disorders present where underlying pathological processes drive the pain, and the patients' motor responses in the disorder are adaptive. A second group of disorders present where psychological and/or social factors represent the primary mechanism underlying the disorder that centrally drives pain, and where the patient's coping and motor control strategies are mal-adaptive in nature. Finally it is proposed that there is a large group of CLBP disorders where patients present with either movement impairments (characterized by pain avoidance behaviour) or control impairments (characterized by pain provocation behaviour). These pain disorders are predominantly mechanically induced and patients typically present with mal-adaptive primary physical and secondary cognitive compensations for their disorders that become a mechanism for ongoing pain. These subjects present either with an excess or deficit in spinal stability, which underlies their pain disorder. For this group

  4. A STUDY TO ANALYSE THE EFFICACY OF MODIFIED PILATES BASED EXERCISES AND THERAPEUTIC EXERCISES IN INDIVIDUALS WITH CHRONIC NON SPECIFIC LOW BACK PAIN: A RANDOMIZED CONTROLLED TRAIL

    Directory of Open Access Journals (Sweden)

    U.Albert Anand,

    2014-06-01

    Full Text Available Background: Chronic low back pain is an expensive and difficult condition to treat. Low back pain is the most common musculoskeletal symptoms seen in 85 % of individuals in their life time. One of the interventions widely used by physiotherapists in the treatment of chronic non-specific low back pain (CNLBP is exercise therapy based upon the Pilates principles. Objective: The purpose of the study was to find out the effect of Modified Pilates based exercises for patients with Chronic Non Specific Low Back Pain. Design: A randomized controlled trial, pre test-post test design Setting: The study was conducted in Out Patient Department of physiotherapy, K.G Hospital, Coimbatore, India. Patients: Fifty– two physically active subjects between 18 – 60 years old with Chronic Non specific Low Specific Pain of more than 12 weeks’ duration were randomly assigned into 2 groups. Interventions: Group A subjects underwent a Modified specific Pilates based exercises with Flexibility Exercises & Group B Subjects underwent a Therapeutic Exercises with Flexibility Exercises were conducted over of 8 weeks. Measurements: Back specific Functional Status outcome were measured with the Oswestry Disability Index and pain intensity were measured with Visual analogue scale. Conclusion: The study concluded that the Modified specific Pilates based exercises helps in reducing the pain, improve the back specific function, improve general health, personal Care, Social Life and flexibility in individuals with non specific chronic low back pain than the therapeutic exercise group.

  5. Effectiveness of Pilates exercise in treating people with chronic low back pain: a systematic review of systematic reviews

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    Wells Cherie

    2013-01-01

    Full Text Available Abstract Background Systematic reviews provide clinical practice recommendations that are based on evaluation of primary evidence. When systematic reviews with the same aims have different conclusions, it is difficult to ascertain which review reported the most credible and robust findings. Methods This study examined five systematic reviews that have investigated the effectiveness of Pilates exercise in people with chronic low back pain. A four-stage process was used to interpret findings of the reviews. This process included comparison of research questions, included primary studies, and the level and quality of evidence of systematic reviews. Two independent reviewers assessed the level of evidence and the methodological quality of systematic reviews, using the National Health and Medical Research Council hierarchy of evidence, and the Revised Assessment of Multiple Systematic Reviews respectively. Any disagreements were resolved by a third researcher. Results A high level of consensus was achieved between the reviewers. Conflicting findings were reported by the five systematic reviews regarding the effectiveness of Pilates in reducing pain and disability in people with chronic low back pain. Authors of the systematic reviews included primary studies that did not match their questions in relation to treatment or population characteristics. A total of ten primary studies were identified across five systematic reviews. Only two of the primary studies were included in all of the reviews due to different inclusion criteria relating to publication date and status, definition of Pilates, and methodological quality. The level of evidence of reviews was low due to the methodological design of the primary studies. The methodological quality of reviews varied. Those which conducted a meta-analysis obtained higher scores. Conclusion There is inconclusive evidence that Pilates is effective in reducing pain and disability in people with chronic low back

  6. Complementary and alternative medical therapies for chronic low back pain: What treatments are patients willing to try?

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    Erro Janet

    2004-07-01

    Full Text Available Abstract Background Although back pain is the most common reason patients use complementary and alternative medical (CAM therapies, little is known about the willingness of primary care back pain patients to try these therapies. As part of an effort to refine recruitment strategies for clinical trials, we sought to determine if back pain patients are willing to try acupuncture, chiropractic, massage, meditation, and t'ai chi and to learn about their knowledge of, experience with, and perceptions about each of these therapies. Methods We identified English-speaking patients with diagnoses consistent with chronic low back pain using automated visit data from one health care organization in Boston and another in Seattle. We were able to confirm the eligibility status (i.e., current low back pain that had lasted at least 3 months of 70% of the patients with such diagnoses and all eligible respondents were interviewed. Results Except for chiropractic, knowledge about these therapies was low. Chiropractic and massage had been used by the largest fractions of respondents (54% and 38%, respectively, mostly for back pain (45% and 24%, respectively. Among prior users of specific CAM therapies for back pain, massage was rated most helpful. Users of chiropractic reported treatment-related "significant discomfort, pain or harm" more often (23% than users of other therapies (5–16%. Respondents expected massage would be most helpful (median of 7 on a 0 to 10 scale and meditation least helpful (median of 3 in relieving their current pain. Most respondents indicated they would be "very likely" to try acupuncture, massage, or chiropractic for their back pain if they did not have to pay out of pocket and their physician thought it was a reasonable treatment option. Conclusions Most patients with chronic back pain in our sample were interested in trying therapeutic options that lie outside the conventional medical spectrum. This highlights the need for additional

  7. Fascial Manipulation® for chronic aspecific low back pain: a single blinded randomized controlled trial [version 2; referees: 2 approved

    OpenAIRE

    Mirco Branchini; Francesca Lopopolo; Ernesto Andreoli; Ivano Loreti; Aurélie M Marchand; Antonio Stecco

    2016-01-01

    Background: The therapeutic approach to chronic aspecific low back pain (CALBP) has to consider the multifactorial aetiology of the disorder. International guidelines do not agree on unequivocal treatment indications. Recommendations for fascial therapy are few and of low level evidence but several studies indicate strong correlations between fascial thickness and low back pain. This study aims at comparing the effectiveness of Fascial Manipulation® associated with a physiotherapy program fol...

  8. Fascial Manipulation® for chronic aspecific low back pain: a single blinded randomized controlled trial [version 1; referees: 2 approved

    OpenAIRE

    Mirco Branchini; Francesca Lopopolo; Ernesto Andreoli; Ivano Loreti; Aurélie M Marchand; Antonio Stecco

    2015-01-01

    Background: The therapeutic approach to chronic aspecific low back pain (CALBP) has to consider the multifactorial aetiology of the disorder. International guidelines do not agree on unequivocal treatment indications. Recommendations for fascial therapy are few and of low level evidence but several studies indicate strong correlations between fascial thickness and low back pain. This study aims at comparing the effectiveness of Fascial Manipulation® associated with a physiotherapy program fol...

  9. The psychometric properties of the Roland Morris disability questionnaire for patients with chronic mechanical low back pain

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    H. Buchanan

    2007-02-01

    Full Text Available Purpose: Functional status measures are currently not widelyused in South Africa to facilitate clinical decision-making or document treatment outcomes for patients with low back pain (LBP. This study investigated the internal consistency and clinical utility of a back-specific functional status measure, the Roland Morris Disability Questionnaire (RMDQ, and determined its ability to confirm the need for spinal fusion surgery. Method: Aretrospective, descriptive design was used with 42 patients with chronic mechanical low back pain who consulted a private Orthopaedic surgeon in Cape Town over a one year  period. All patients completed the RMDQ prior to their consultation. On completion of the medical examination, a rating for surgery was determined for each patient. The completed questionnaires were analysed using Statistical Package for the Social Sciences (SPSS. Results: The mean RMDQ score was 8.6 (N=42; median=9.0; range=2-21. Cronbach’s alpha showed a high internal consistency between items (.92. A categorical principal component analysis (CATPCA identified two distinct dimensions in the RMDQ. Item reduction improved the internal consistency and thus the construct validity of the RMDQ. There was a low correlation between the surgeon’s rating for surgery and RMDQ scores (r=.40; P<.01. Conclusion: The RMDQ shows some good psychometric properties but some adjustments could improve it. The RMDQ cannot be used to predict the need for spinal fusion surgery.

  10. [Physical therapy in low back pain].

    Science.gov (United States)

    Muff, L; Stucki, G

    1996-09-10

    We report on physical measures in the treatment of patients with lower back pain due to mechanical factors. Acute low back pain improves mostly without specific measures. Intervention for this condition is useful for prevention of relapses. More demanding and difficult is the treatment of chronic lumbar back pain. After an exact diagnosis, information about the disease, the therapeutic procedure and the prognosis follow in order to agree on a common therapeutic goal. To this goal, a close cooperation between physician, physiotherapist, possibly a psychologist and a social worker, is optimal. The employer should be involved in the rehabilitation on the workplace. Patients should become mobilized inspite of pain, and the return to their workplace should be prepared step by step. The most important physiotherapeutic modalities are demonstrated.

  11. The effectiveness of acupuncture in treating chronic non-specific low back pain: a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Hutchinson Amanda J P

    2012-10-01

    Full Text Available Abstract Background Low back pain is a common musculoskeletal disorder defined as pain and soreness, muscle tension, or stiffness in the lumbosacral area of the spine which does not have a specific cause. Low back pain results in high health costs and incapacity to work causing an economic burden to society. The optimal management of non-specific low back pain appears to be undecided. Recently published guidelines support the use of acupuncture for treating non-specific low back pain and it has become a popular alternative treatment modality for patients with low back pain. Methods A comprehensive systematic literature search was conducted through Medline using Ovid and Medical Subject Headings for randomized controlled trials published in the last 10 years. The outcomes scored were subjective pain scores and functional outcome scores. Results Eighty two randomized studies were identified, of which 7 met our inclusion criteria. Three studies found a significant difference in pain scores when comparing acupuncture, or sham acupuncture, with conventional therapy or no care. Two studies demonstrated a significant difference between acupuncture treatment and no treatment or routine care at 8 weeks and 3 months. Three studies demonstrated no significant difference between acupuncture and minimal/sham acupuncture with no difference in pain relief or function over 6 to 12 months. Conclusions This review provides some evidence to support acupuncture as more effective than no treatment, but no conclusions can be drawn about its effectiveness over other treatment modalities as the evidence is conflicting.

  12. The effect of pelvic floor muscle exercise on women with chronic non-specific low back pain.

    Science.gov (United States)

    Mohseni-Bandpei, Mohammad A; Rahmani, Nahid; Behtash, Hamid; Karimloo, Masoud

    2011-01-01

    Dysfunction of spinal stability seems to be one of the causes of low back pain (LBP). It is thought that a large number of muscles have a role in spinal stability including the pelvic floor muscle (PFM). The purpose of this study was to investigate the effect of PFM exercise in the treatment of chronic LBP. After ethical approval, a randomized controlled clinical trial was carried out on 20 women with chronic LBP. Patients were randomly allocated into two groups: an experimental and a control group. The control group was given routine treatment including electrotherapy and general exercises; and the experimental group received routine treatment and additional PFM exercise. Pain intensity, functional disability and PFM strength and endurance were measured before, immediately after intervention and at 3 months follow-up. In both groups pain and functional disability were significantly reduced following treatment (p0.05). All measurements were improved in both groups (p<0.01) although patients in the experimental group showed greater improvement in PFM strength and endurance (p<0.01). It seems that the PFM exercise combined with routine treatment was not superior to routine treatment alone in patients with chronic LBP.

  13. Measuring Psychosocial Variables in Patients With (Sub) Acute Low Back Pain Complaints, at Risk for Chronicity A Validation Study of the Acute Low Back Pain Screening Questionnaire-Dutch Language Version

    NARCIS (Netherlands)

    Heneweer, Hans; van Woudenberg, Nienke J.; van Genderen, Frank; Vanhees, Luc; Wittink, Harriet

    2010-01-01

    Study Design. A validation study of the Acute Low Back Pain Screening Questionnaire Dutch Language Version (ALBPSQ-DLV). Objective. To determine internal consistency, construct and convergent validity of the ALBPSQ-DLV in a population of patients with (sub) acute low back pain (LBP) referred to prim

  14. [Low back pain of unfavourable progression].

    Science.gov (United States)

    de la Peña Parra, E; Calle Romero, Y; García Sánchez, V C; Sanz Pozo, B

    2013-01-01

    We present the case of a patient with chronic low back pain with an unfavourable progression despite the prescribed pharmacological treatment. The patient had symptoms associated with compression of the sciatic nerve in an atypical area. As it passed through the piriformis muscle, it was diagnosed as piriformis muscle syndrome. This diagnosis was based on the clinical signs and symptoms and the determination of the tests performed, with the imaging tests being absolutely normal. Treatment is basically with non-steroidal anti-inflammatory drugs, muscle relaxants and stretching exercises of this muscle.

  15. Generalized deep-tissue hyperalgesia in patients with chronic low-back pain

    DEFF Research Database (Denmark)

    O'Neill, Søren; Manniche, Claus; Graven-Nielsen, Thomas;

    2007-01-01

    and anterior tibialis muscles. Mechanical pressure (thresholds and supra-threshold) and injection of hypertonic saline (pain intensity, duration, distribution) were used. Pain intensity to experimental stimuli was assessed on a visual analogue scale (VAS). Patients demonstrated significantly higher pain...

  16. Provocative diskography: safety and predictive value in the outcome of spinal fusion or pain intervention for chronic low-back pain

    Directory of Open Access Journals (Sweden)

    Willems PC

    2014-12-01

    Full Text Available Paul C Willems Department of Orthopedic Surgery, CAPHRI Research School, Maastricht University Medical Center, Maastricht, the Netherlands Abstract: There is still no clear definition of diskogenic low-back pain and no consensus on a generally agreed test, such as provocative diskography (PD, to diagnose painful disk degeneration, and probably more importantly, to predict the outcome of therapy intended to reduce pain that is presumed to be diskogenic in nature. Nevertheless, PD is the most specific procedure to diagnose diskogenic low-back pain. Its accuracy, however, is rather low or at best unknown. Although rare, the most prevalent complication, postdiskography diskitis, can be devastating for the individual patient, so all measures, like strict sterile conditions and antibiotic prophylaxis, should be taken to avoid this complication. It is advised to perform the procedure in a pressure-controlled way with a constant low flow, and optionally computed tomography imaging. PD should not be performed in morphologically normal disks. A standardized execution of the test should be established in order to perform high-quality studies to determine its accuracy to lead to meaningful interventions, and find best practices for diagnosis and treatment of diskogenic back pain. Possibly, PD may have detrimental effects on the disk, causing early degeneration, although it is unknown whether this will be related to clinical symptoms. Especially with these possible adverse side effects in mind, the risk–benefit ratio with the lack of clear benefits from treatments provided, and possible complications of disk puncture, the rationale for PD is questionable, which should be stressed to patients in the process of shared decision making. Diskography as a stand-alone test is not recommended in clinical decision making for patients with chronic low-back pain. Keywords: provocative diskography, chronic low-back pain, prognostic accuracy, spinal fusion, pain

  17. Assessment of the quality of life through the SF-36 questionnaire in patients with chronic nonspecific low back pain.

    Science.gov (United States)

    Adorno, Marta Lúcia Guimarães Resende; Brasil-Neto, Joaquim Pereira

    2013-07-01

    The objective of this study was to evaluate the quality of life (QL) with the use of the SF-36 Questionnaire in patients with chronic nonspecific low back pain (CNLBP). Thirty patients with CNLBP were randomly assigned to one of three groups (Iso group (Isostretching), GPR group (Global Postural Reeducation), and the Iso+GPR group. Patients underwent physical therapy assessment with the use of the Vertebral Spine Assessment, the Visual Analog Scale of Pain (VASP), and the SF-36 life quality questionnaire before the first session (first assessment), after three months of treatment (second assessment) and reassessed two months after the final session in the follow-up (third assessment). The results indicated that both physical therapy techniques reduced pain (p<0.001); when the techniques (Iso+GPR) were combined, the reduction in pain was significantly greater; and, in the follow-up assessment, the GPR method was more efficient. As for the QL, physical therapy techniques were effective after the interventions (p<0.001), and the Iso method was more effective when patients were reassessed in the follow-up. We conclude that the physical therapy techniques used in this study were efficient to treat CNLBP in the patients since they reduced pain and increased QL according to the results of the SF-36 questionnaire. Level of Evidence II, Randomized Controlled Clinical Trial.

  18. 肌肉疲劳与慢性腰痛研究进展%Research Progress of Muscle Fatigue and Chronic Low Back Pain

    Institute of Scientific and Technical Information of China (English)

    唐能章; 陈少清; 林建平; 王诗忠

    2015-01-01

    慢性腰痛是骨科及康复学科常见的肌肉骨骼疾病,有关肌肉疲劳的研究有助于认识慢性腰痛的发病机制.腰部肌肉长期处于疲劳状态可导致慢性损伤,易疲劳性增加,肌肉耐力下降,最终可能导致腰痛.目前多采用表面肌电图研究慢性腰痛患者腰部肌肉功能的改变及慢性腰痛与肌肉疲劳之间的关系.%Chronic low back pain is a kind of common musculoskeletal disease in orthopedics department and rehabilitation subject, related study of muscle fatigue is helpful to understand pathogenesis of chronic low back pain. The long-term fatigue of waist muscles can lead to chronic injury, in-creasing fatigue and decreasing muscle endurance, which may eventually bring about low back pain. Surface electromyography is used to study the waist muscle function changes of patients with chronic low back pain and the relationship between chronic low back pain and muscle fatigue at pres-ent.

  19. No association between level of vitamin D and chronic low back pain in Swedish primary care: a cross-sectional case-control study

    OpenAIRE

    Thörneby, Andreas; Nordeman, Lena Margareta; Johanson, Else Hellebö

    2016-01-01

    Objective Assessment of vitamin D levels and deficiency status in individuals with chronic low back pain (CLBP) in a Swedish general population, compared with controls matched for sex and age. Design Cross-sectional case-control study. Setting Primary care, southern Sweden. Subjects Participants (n = 44) with self-reported low back pain for at least 3 months and individually sex- and age-matched controls without a chronic pain condition (n = 44), recruited from the general population by rando...

  20. A Controlled and Retrospective Study of 144 Chronic Low Back Pain Patients to Evaluate the Effectiveness of an Intensive Functional Restoration Program in France

    Directory of Open Access Journals (Sweden)

    Isabelle Caby

    2016-04-01

    Full Text Available Study Design: A controlled and retrospective study of 144 chronic low back pain patients to evaluate the effectiveness of an intensive functional restoration program in France. Objective: Evaluating the efficiency of an intensive, dynamic and multidisciplinary functional restoration program in patients with chronic low back pain (LBP, during 6 and 12 months follow up. Summary of background data: Chronic low back pain disease has a multifactor nature, involving physical, psychological professional and social factors. A functional restoration program (FRP has been included in a multidisciplinary training program which provides an efficient therapeutic solution. However, the effectiveness of an FRP has not been yet established. Methods: 144 subjects (71 males, 73 females with chronic low back pain were included in a functional restoration program. The FRP includes physiotherapy and occupational therapy interventions together with psychological counselling. Patients participated as in- or outpatients 6 h per day, 5 days a week over 5 weeks. Pain intensity, trunk flexibility, trunk strength, lifting ability, quality of life and return to work were recorded before, immediately after, and at 6 months and 12 months after the treatment period. Results: All outcome measures were significantly higher just after the FRP (144 patients and at 6 and 12 months (from available data in 31 subjects compared to pre-treatment values. This FRP for chronic low back pain maintained its benefits whatever the patient’s activities. Conclusions: The effects reflected on all outcome measures, both on short and long term follow-up. The multidisciplinary FRP for chronic low back pain patients durably stopped the de-conditioning syndrome and involved new life-style habits for the patient, daily pain management and a return to work.

  1. Comparison of yoga versus stretching for chronic low back pain: protocol for the Yoga Exercise Self-care (YES trial

    Directory of Open Access Journals (Sweden)

    Hawkes Rene J

    2010-03-01

    Full Text Available Abstract Background Back pain, one of the most prevalent conditions afflicting American adults, is the leading reason for using complementary and alternative medicine (CAM therapies. Yoga is an increasingly popular "mind-body" CAM therapy often used for relieving back pain and several small studies have found yoga effective for this condition. This study will assess whether yoga is effective for treating chronic low back pain compared with self care and exercise and will explore the mechanisms responsible for any observed benefits. Methods/Design A total of 210 participants with low back pain lasting at least 3 months will be recruited from primary care clinics of a large healthcare system based in Seattle. They will be randomized in a 2:2:1 ratio to receive 12 weekly yoga classes, 12 weekly conventional therapeutic exercise classes of comparable physical exertion, or a self-care book. Interviewers masked to participants' treatment group will assess outcomes at baseline and 6, 12 and 26 weeks after randomization. Primary outcomes will be back-related dysfunction and symptom bothersomeness. In addition, data will be collected on physical measurements (e.g., flexion at baseline and 12 weeks and saliva samples will be obtained at baseline, 6 and 12 weeks. Information will be collected on specific physical, psychological, and physiological factors to allow exploration of possible mechanisms of action through which yoga could relieve back pain and dysfunction. The effectiveness of yoga will be assessed using analysis of covariance (using general estimating equations - GEE within an intention-to-treat context. If yoga is found effective, further analyses will explore whether yoga's benefits are attributable to physical, psychological and/or physiological factors. Conclusions This study will provide the clearest evidence to date about the value of yoga as a therapeutic option for treating chronic back pain, and if the results are positive, will help

  2. Efficacy of the Pilates method for pain and disability in patients with chronic nonspecific low back pain: a systematic review with meta-analysis

    Directory of Open Access Journals (Sweden)

    Gisela C. Miyamoto

    2013-12-01

    Full Text Available OBJECTIVE: To systematically review the available evidence on the efficacy of the Pilates method in patients with chronic nonspecific low back pain. METHOD: Searches were performed in MEDLINE, EMBASE, PEDro, SciELO, LILACS, CINAHL and CENTRAL in March 2013. Randomized controlled trials that tested the effectiveness of the Pilates method (against a nontreatment group, minimal intervention or other types of interventions in adults with chronic low back pain were included regardless the language of publication. The outcome data were extracted from the eligible studies and were combined using a meta-analysis approach. RESULTS: The searches identified a total of 1,545 articles. From these, eight trials were considered eligible, and seven trials were combined in the meta-analysis. The comparison groups were as follows: Pilates versus other types of exercises (n=2 trials, and Pilates versus no treatment group or minimal intervention (n=4 trials for short term pain; Pilates versus minimal intervention for short-term disability (n=4.We determined that Pilates was not better than other types of exercises for reducing pain intensity. However, Pilates was better than a minimal intervention for reducing short-term pain and disability (pain: pooled mean difference=1.6 points; 95% CI 1.4 to 1.8; disability: pooled mean difference=5.2 points; 95% CI 4.3 to 6.1. CONCLUSIONS: Pilates was better than a minimal intervention for reducing pain and disability in patients with chronic low back pain. Pilates was not better than other types of exercise for short-term pain reduction.

  3. The Effects of Kinesio Taping on Potential in Chronic Low Back Pain Patients Anticipatory Postural Control and Cerebral Cortex

    Science.gov (United States)

    Bae, Sea Hyun; Lee, Jeong Hun; Oh, Kyeong Ae; Kim, Kyung Yoon

    2013-01-01

    [Purpose] This study aimed to examine the effects of kinesio tape applied to chronic low back pain (CLBP) patients on anticipatory postural control and cerebral cortex potential. [Subjects and Methods] Twenty patients whose low back pain had continued for more than 12 weeks were selected and assigned to a control group (n=10) to which ordinary physical therapy was applied and an experimental group (n=10) to which kinesio tape was applied. Anticipatory postural control was evaluated using electromyography, and movement-related cortical potential (MRCP) was assessed using electroencephalography. Clinical evaluation was performed using a visual analogue scale and the Oswestry disability index. [Results] According to the analysis results for anticipatory postural control, there were significant decreases in the transversus abdominis (TrA) muscle and the external oblique muscle in both groups. Among them, the TrA of the experimental group exhibited the greatest differences. According to the results of a between-group comparison, there was significant difference in the TrA between the two groups. There was also a significant decrease in the MRCP of both groups. In particular, changes in the movement monitoring potential (MMP) of the experimental group were greatest at Fz, C3, Cz, and C4. According to the between-group comparison, there were significant differences in MMP at F3, C3, and Cz. Both groups saw VAS and ODI significantly decrease. Among them, the ODI of the experimental group underwent the greatest change. [Conclusion] Kinesio tape applied to CLBP patients reduced their pain and positively affected their anticipatory postural control and MRCP. PMID:24396190

  4. The effects of kinesio taping on potential in chronic low back pain patients anticipatory postural control and cerebral cortex.

    Science.gov (United States)

    Bae, Sea Hyun; Lee, Jeong Hun; Oh, Kyeong Ae; Kim, Kyung Yoon

    2013-11-01

    [Purpose] This study aimed to examine the effects of kinesio tape applied to chronic low back pain (CLBP) patients on anticipatory postural control and cerebral cortex potential. [Subjects and Methods] Twenty patients whose low back pain had continued for more than 12 weeks were selected and assigned to a control group (n=10) to which ordinary physical therapy was applied and an experimental group (n=10) to which kinesio tape was applied. Anticipatory postural control was evaluated using electromyography, and movement-related cortical potential (MRCP) was assessed using electroencephalography. Clinical evaluation was performed using a visual analogue scale and the Oswestry disability index. [Results] According to the analysis results for anticipatory postural control, there were significant decreases in the transversus abdominis (TrA) muscle and the external oblique muscle in both groups. Among them, the TrA of the experimental group exhibited the greatest differences. According to the results of a between-group comparison, there was significant difference in the TrA between the two groups. There was also a significant decrease in the MRCP of both groups. In particular, changes in the movement monitoring potential (MMP) of the experimental group were greatest at Fz, C3, Cz, and C4. According to the between-group comparison, there were significant differences in MMP at F3, C3, and Cz. Both groups saw VAS and ODI significantly decrease. Among them, the ODI of the experimental group underwent the greatest change. [Conclusion] Kinesio tape applied to CLBP patients reduced their pain and positively affected their anticipatory postural control and MRCP.

  5. Analgesic effect of repetitive transcranial magnetic stimulation (rTMS) in patients with chronic low back pain.

    Science.gov (United States)

    Ambriz-Tututi, Mónica; Alvarado-Reynoso, Beatriz; Drucker-Colín, René

    2016-08-22

    The objective of the present study was to assess the benefits of 1-week repetitive transcranial magnetic stimulation (rTMS) in patients with chronic low back pain (LBP). The visual analogue scale (VAS), Short Form McGill pain questionnaire (SF-MPQ), and Short Form 36 Health Survey were used to evaluate the effect of this treatment. Eighty-two patients diagnosed with LBP were divided randomly into three groups: rTMS-treated group, sham group, and physical therapy-treated group. We observed a significant reduction in VAS and SF-MPQ scores in the rTMS-treated group, but not in the sham group. Moreover, patients who received rTMS had a lower mean pain score than patients treated with physical therapy. Our study suggests that rTMS produces safe, significant, and long-term relief in patients with LBP without evident side effects. This study shows for the first time that long-term repeated sessions of rTMS decrease pain perception of LBP. Bioelectromagnetics. © 2016 Wiley Periodicals, Inc.

  6. EFFECTS OF POSTEROANTERIOR LUMBAR SPINE MOBILIZATIONS ON PAIN, ROM AND FUNCTIONAL DISABILITY IN FEMALE SUBJECTS WITH CHRONIC NONSPECIFIC LOW BACK PAIN

    Directory of Open Access Journals (Sweden)

    C. Shanthi

    2014-12-01

    Full Text Available Background: Chronic nonspecific low back pain (CNSLBP i.e., low back pain of at least 12 weeks duration without a specific cause is a major cause of activity limitation, absenteeism , and high health care expenses. The prevalence of CNSLBP is estimated approximately 23% and activity limitation due to LBP have been found to be 11% to 12% of the population. Previous studies comparing the efficacy of postero-anterior mobilisation and prone-press ups were done and revealed statistically significant improvements in extension ranges but not clinical relevant improvements. This is possibly attributable to single session of interventions. So long term gains in pain reduction and lumbar extension cannot be assumed. Hence this study would be intending to prove the effect of postero-anterior mobilisation and prone press ups on chronic non-specific low back pain after 6 weeks and their clinical application. Method: 30 subjects who met the inclusion criteria were selected randomly from the department of physiotherapy, SVIMS and BIRRD, Tirupati. The study conducted for a period of 6 weeks.2 groups were formed with 15 in each group. PA lumbar glide and prone press up's was given to group I and only prone press up's was given to group II. Subjects were evaluated pre and post treatment for VAS, extension ROM of lumbar spine and functional disability. Result: Results showed that there exists a statistical significance between the groups in all the 3 parameters. Present randomized clinical trial provided evidence to support the use of postero-anterior mobilisation and prone press-ups in relieving pain, improving ROM and reducing disability in subjects with non-specific low back pain. In addition, results supported that postero-anterior mobilisation was more effective than prone press-ups.

  7. Changes in pain intensity and health related quality of life with Iyengar yoga in nonspecific chronic low back pain: A randomized controlled study

    Directory of Open Access Journals (Sweden)

    Gopal S Nambi

    2014-01-01

    Full Text Available Background: Nonspecific chronic low back (nCLBP pain is prevalent among adult population and often leads to functional limitations, psychological symptoms, lower quality of life (QOL, and higher healthcare costs. The purpose of this study was to determine the efficacy of Iyengar yoga therapy on pain intensity and health related quality of life (HRQOL with nCLBP. Aim of the Study: To compare the effect of Iyengar yoga therapy and conventional exercise therapy on pain intensity and HRQOL in nonspecific chronic low back pain. Materials and Methods: Experimental study with random sampling technique. Subjects/Intervention: Sixty subjects who fulfilled the selection criteria were randomly assigned to Iyengar yoga (yoga group, n = 30 and control group (exercise group, n = 30. Participants completed low back pain evaluation form and HRQOL-4 questionnaire before their intervention and again 4 weeks and 6 month later. Yoga group underwent 29 yogic postures training and exercise group had undergone general exercise program for 4 weeks. Statistics: Repeated measures analysis of variance (ANOVA was used to analyze group differences over time, while controlling for baseline differences. Results: Patients in both groups experienced significant reduction in pain and improvement in HRQOL. In visual analogue scale (VAS yoga group showed reduction of 72.81% ( P = 0.001 as compared to exercise group 42.50% ( P = 0.001. In HRQOL, yoga group showed reduction of 86.99% ( P = 0.001 as compared to exercise group 67.66% ( P = 0.001. Conclusion: These results suggest that Iyengar yoga provides better improvement in pain reduction and improvement in HRQOL in nonspecific chronic back pain than general exercise.

  8. Cost-effectiveness of minimal interventional procedures for chronic mechanical low back pain: design of four randomised controlled trials with an economic evaluation

    Directory of Open Access Journals (Sweden)

    Maas Esther T

    2012-12-01

    Full Text Available Abstract Background Minimal interventional procedures are frequently applied in patients with mechanical low back pain which is defined as pain presumably resulting from single sources: facet, disc, sacroiliac joint or a combination of these. Usually, these minimal interventional procedures are an integral part of a multidisciplinary pain programme. A recent systematic review issued by the Dutch Health Insurance Council showed that the effectiveness of these procedures for the total group of patients with chronic low back pain is yet unclear and cost-effectiveness unknown. The aim of the study is to evaluate whether a multidisciplinary pain programme with minimal interventional procedures is cost-effective compared to the multidisciplinary pain programme alone for patients with chronic mechanical low back pain who did not respond to conservative primary care and were referred to a pain clinic. Methods All patients with chronic low back pain who are referred to one of the 13 participating pain clinics will be asked to participate in an observational study. Patients with a suspected diagnosis of facet, disc or sacroiliac joint problems will receive a diagnostic block to confirm this diagnosis. If confirmed, they will be asked to participate in a Randomized Controlled Trial (RCT. For each single source a separate RCT will be conducted. Patients with a combination of facet, disc or sacroiliac joint problems will be invited for participation in a RCT as well. An economic evaluation from a societal perspective will be performed alongside these four RCTs. Patients will complete questionnaires at baseline, 3 and 6 weeks, 3, 6, 9 and 12 months after start of the treatment. Costs will be collected using self-completed cost questionnaires. Discussion No trials are yet available which have evaluated the cost-effectiveness of minimal interventional procedures in patients with chronic mechanical low back pain, which emphasizes the importance of this study

  9. Perceptions of sitting posture among members of the community, both with and without non-specific chronic low back pain.

    Science.gov (United States)

    O'Sullivan, Kieran; O'Keeffe, Mary; O'Sullivan, Leonard; O'Sullivan, Peter; Dankaerts, Wim

    2013-12-01

    Physiotherapists perceive upright, lordotic sitting postures to be important in the management of non-specific chronic low back pain (NSCLBP). Little is known about the perceptions of the wider community about seated posture, despite this being an important consideration before attempting to change seated posture. This study investigated perceptions of the best and worst sitting postures among members of the community, both with (n = 120) and without (n = 235) NSCLBP. Participants with NSCLBP perceived posture to be more important (p neck and shoulders in good alignment were preferred. However, what people considered "straight" varied considerably. 78% selected a slumped sitting posture as their worst posture, which was more frequent than any other posture (p pain, disability or back pain beliefs. Interestingly, a very upright sitting posture was the second most popular selection as both the best (19%) and worst (15%) posture. Overall, lordotic lumbar postures were strongly favoured among members of the community, which is broadly in line with the previously reported perceptions of physiotherapists.

  10. Clinical response and relapse in patients with chronic low back pain following osteopathic manual treatment: results from the OSTEOPATHIC Trial.

    Science.gov (United States)

    Licciardone, John C; Aryal, Subhash

    2014-12-01

    Clinical response and relapse following a regimen of osteopathic manual treatment (OMT) were assessed in patients with chronic low back pain (LBP) within the OSTEOPATHIC Trial, a randomized, double-blind, sham-controlled study. Initial clinical response and subsequent stability of response, including final response and relapse status at week 12, were determined in 186 patients with high baseline pain severity (≥50 mm on a 100-mm visual analogue scale). Substantial improvement in LBP, defined as 50% or greater pain reduction relative to baseline, was used to assess clinical response at weeks 1, 2, 4, 6, 8, and 12. Sixty-two (65%) patients in the OMT group attained an initial clinical response vs. 41 (45%) patients in the sham OMT group (risk ratio [RR], 1.45; 95% confidence interval [CI], 1.11-1.90). The median time to initial clinical response to OMT in these patients was 4 weeks. Among patients with an initial clinical response prior to week 12, 13 (24%) patients in the OMT group vs. 18 (51%) patients in the sham OMT group relapsed (RR, 0.47; 95% CI, 0.26-0.83). Overall, 49 (52%) patients in the OMT group attained or maintained a clinical response at week 12 vs. 23 (25%) patients in the sham OMT group (RR, 2.04; 95% CI, 1.36-3.05). The large effect size for short-term efficacy of OMT was driven by stable responders who did not relapse.

  11. Approach to low back pain - acupuncture.

    Science.gov (United States)

    Ee, Carolyn

    2014-05-01

    This article forms part of our allied health series for 2014, which aims to provide information about the management approach of different allied health professionals, using the case example of uncomplicated, mechanical low back pain.

  12. Mindfulness meditation for the treatment of chronic low back pain in older adults: a randomized controlled pilot study.

    Science.gov (United States)

    Morone, Natalia E; Greco, Carol M; Weiner, Debra K

    2008-02-01

    The objectives of this pilot study were to assess the feasibility of recruitment and adherence to an eight-session mindfulness meditation program for community-dwelling older adults with chronic low back pain (CLBP) and to develop initial estimates of treatment effects. It was designed as a randomized, controlled clinical trial. Participants were 37 community-dwelling older adults aged 65 years and older with CLBP of moderate intensity occurring daily or almost every day. Participants were randomized to an 8-week mindfulness-based meditation program or to a wait-list control group. Baseline, 8-week and 3-month follow-up measures of pain, physical function, and quality of life were assessed. Eighty-nine older adults were screened and 37 found to be eligible and randomized within a 6-month period. The mean age of the sample was 74.9 years, 21/37 (57%) of participants were female and 33/37 (89%) were white. At the end of the intervention 30/37 (81%) participants completed 8-week assessments. Average class attendance of the intervention arm was 6.7 out of 8. They meditated an average of 4.3 days a week and the average minutes per day was 31.6. Compared to the control group, the intervention group displayed significant improvement in the Chronic Pain Acceptance Questionnaire Total Score and Activities Engagement subscale (P=.008, P=.004) and SF-36 Physical Function (P=.03). An 8-week mindfulness-based meditation program is feasible for older adults with CLBP. The program may lead to improvement in pain acceptance and physical function.

  13. Mechanical therapy for low back pain.

    Science.gov (United States)

    Guild, Donald Grant

    2012-09-01

    Physical therapy and manual medicine for low back pain encompass many different treatment modalities. There is a vast variety of techniques that physical therapists commonly use in the treatment of low back pain. Some of the therapies include, but are certainly not limited to, education, exercise, lumbar traction, manual manipulation, application of heat, cryotherapy, and ultrasonography. Many of these approaches are discussed specifically in this article.

  14. Acupuncture for chronic low back pain in long-term follow-up: a meta-analysis of 13 randomized controlled trials.

    Science.gov (United States)

    Xu, Mai; Yan, Shi; Yin, Xu; Li, Xiuyang; Gao, Shuguang; Han, Rui; Wei, Licheng; Luo, Wei; Lei, Guanghua

    2013-01-01

    Chronic low back pain is one of the most common reasons that people seek medical treatment, and the consequent disability creates a great financial burden on individuals and society. The etiology of chronic low back pain is not clear, which means it is often refractory to treatment. Acupuncture has been reported to be effective in providing symptomatic relief of chronic low back pain. However, it is not known whether the effects of acupuncture are due to the needling itself or nonspecific effects arising from the manipulation. To determine the effectiveness of acupuncture therapy, a meta-analysis was performed to compare acupuncture with sham acupuncture and other treatments. Overall, 2678 patients were identified from thirteen randomized controlled trials. The meta-analysis was performed by a random model (Cohen's test), using the I-square test for heterogeneity and Begg's test to assess for publication bias. Clinical outcomes were evaluated by pain intensity, disability, spinal flexion, and quality of life. Compared with no treatment, acupuncture achieved better outcomes in terms of pain relief, disability recovery and better quality of life, but these effects were not observed when compared to sham acupuncture. Acupuncture achieved better outcomes when compared with other treatments. No publication bias was detected. Acupuncture is an effective treatment for chronic low back pain, but this effect is likely to be produced by the nonspecific effects of manipulation.

  15. Kinesio Taping® is not better than placebo in reducing pain and disability in patients with chronic non-specific low back pain: a randomized controlled trial

    Science.gov (United States)

    Luz, Maurício A.; Sousa, Manoel V.; Neves, Luciana A. F. S.; Cezar, Aline A. C.; Costa, Leonardo O. P.

    2015-01-01

    Background: Kinesio Taping ® has been widely used in clinical practice. However, it is unknown whether this type of tape is more effective than placebo taping in patients with chronic lower back pain. Objective: To compare the effectiveness of Kinesio Taping ® in patients with chronic non-specific low back pain against a placebo tape and a control group. Method: This is a 3-arm, randomized controlled trial with a blinded assessor. Sixty patients with chronic non-specific low back pain were randomized into one of the three groups: Kinesio Taping ® group (n=20), Micropore® (placebo) group (n=20) and control group (n=20). Patients allocated to both the Kinesio Taping ® group and the placebo group used the different types of tape for a period of 48 hours. The control group did not receive any intervention. The outcomes measured were pain intensity (measured by an 11-point numerical rating scale) and disability (measured by the 24-item Roland Morris Disability Questionnaire). A blinded assessor measured the outcomes at baseline, 48 hours and 7 days after randomization. Results: After 48 hours, there was a statistically significant difference between the Kinesio Taping ® group versus the control group (mean between-group difference = -3.1 points, 95% CI=-5.2 to -1.1, p=0.003), but no difference when compared to the placebo group (mean between-group difference= 1.9 points, 95% CI=-0.2 to 3.9, p=0.08). For the other outcomes no differences were observed. Conclusions: The Kinesio Taping ® is not better than placebo (Micropore®) in patients with chronic low back pain. PMID:26647750

  16. Kinesio Taping® is not better than placebo in reducing pain and disability in patients with chronic non-specific low back pain: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Maurício A. Luz Júnior

    2015-12-01

    Full Text Available Background: Kinesio Taping® has been widely used in clinical practice. However, it is unknown whether this type of tape is more effective than placebo taping in patients with chronic lower back pain. Objective: To compare the effectiveness of Kinesio Taping® in patients with chronic non-specific low back pain against a placebo tape and a control group. Method: This is a 3-arm, randomized controlled trial with a blinded assessor. Sixty patients with chronic non-specific low back pain were randomized into one of the three groups: Kinesio Taping® group (n=20, Micropore® (placebo group (n=20 and control group (n=20. Patients allocated to both the Kinesio Taping® group and the placebo group used the different types of tape for a period of 48 hours. The control group did not receive any intervention. The outcomes measured were pain intensity (measured by an 11-point numerical rating scale and disability (measured by the 24-item Roland Morris Disability Questionnaire. A blinded assessor measured the outcomes at baseline, 48 hours and 7 days after randomization. Results: After 48 hours, there was a statistically significant difference between the Kinesio Taping® group versus the control group (mean between-group difference = -3.1 points, 95% CI=-5.2 to -1.1, p=0.003, but no difference when compared to the placebo group (mean between-group difference= 1.9 points, 95% CI=-0.2 to 3.9, p=0.08. For the other outcomes no differences were observed. Conclusions: The Kinesio Taping® is not better than placebo (Micropore® in patients with chronic low back pain.

  17. Designing, validation, and feasibility of integrated yoga therapy module for chronic low back pain

    Directory of Open Access Journals (Sweden)

    Nitin J Patil

    2015-01-01

    Conclusion: The designed IYTM was validated by thirty yoga experts and later evaluated on a small sample. This study has shown that the validated IYTM is feasible, had no adverse effects and was useful in alleviating pain, disability, and perceived stress in patients with CLBP. However, randomized control trials with larger sample are needed to strengthen the study.

  18. The natural course of low back pain

    DEFF Research Database (Denmark)

    Lemeunier, Nadège; Leboeuf-Yde, Charlotte; Gagey, Olivier

    2012-01-01

    Most patients in the secondary care sector consulting for low back pain (LBP) seem to have a more or less constant course of pain during the ensuing year. Fewer patients with LBP in the primary care sector report continual pain over a one-year period. However, not much is known about the long...

  19. Real-world treatment patterns and opioid use in chronic low back pain patients initiating duloxetine versus standard of care

    Directory of Open Access Journals (Sweden)

    Andrews JS

    2013-11-01

    Full Text Available Jeffrey Scott Andrews,1 Ning Wu,2 Shih-Yin Chen,2 Xia Yu,2 Xiaomei Peng,1 Diego Novick1 1Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA; 2Evidera, Lexington, MA, USA Abstract: To describe the use of pain medications in patients with chronic low back pain (CLBP after initiating duloxetine or standard of care (SOC [muscle relaxants, gabapentin, pregabalin, venlafaxine, and tricyclic antidepressants] for pain management, pharmacy and medical claims from Surveillance Data, Inc (SDI Health were analyzed. Adult patients with CLBP who initiated duloxetine or SOC between November 2010 and April 2011 were identified. Treatment initiation was defined as no pill coverage for duloxetine or SOC in the previous 90 days. Included patients had no opioid use in the 90 days before initiation. Propensity score matching was used to select patients with similar baseline demographic and clinical characteristics for duloxetine and SOC cohorts. Compliance with index medication was assessed via medication possession ratio (MPR and proportion of days covered (PDC for 6 months after initiation. The proportion of patients receiving opioids and days on opioids after index date were assessed, and regression models were estimated to compare opioid use between cohorts. A total of 766 patients initiated duloxetine and 6,206 patients initiated SOC. After matching, 743 patients were selected for the duloxetine (mean age 57 years; female 74% and SOC (mean age 57 years; female 75% cohorts, respectively. Of the duloxetine cohort, 92% started on or below recommended daily dose (≤60 mg. The duloxetine cohort had significantly higher MPR (0.78 versus [vs] 0.60 and PDC (0.50 vs 0.31, were less likely to use opioids (45% vs 61%, and had fewer days on opioids (median 0 vs 7 days than the SOC cohort (all P < 0.001. After adjusting for demographic and clinical characteristics, the duloxetine cohort initiated opioids later than the SOC cohort (hazard ratio 0.77, 95

  20. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain

    NARCIS (Netherlands)

    M. van Middelkoop (Marienke); S.M. Rubinstein (Sidney); T. Kuijpers (Ton); A.P. Verhagen (Arianne); R.W.J.G. Ostelo (Raymond); B.W. Koes (Bart); M.W. van Tulder (Maurits)

    2010-01-01

    textabstractLow back pain (LBP) is a common and disabling disorder in western society. The management of LBP comprises a range of different intervention strategies including surgery, drug therapy, and non-medical interventions. The objective of the present study is to determine the effectiveness of

  1. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain

    NARCIS (Netherlands)

    M. van Middelkoop (Marienke); S.M. Rubinstein (Sidney); T. Kuijpers (Ton); A.P. Verhagen (Arianne); R.W.J.G. Ostelo (Raymond); B.W. Koes (Bart); M.W. van Tulder (Maurits)

    2011-01-01

    textabstractLow back pain (LBP) is a common and disabling disorder in western society. The management of LBP comprises a range of different intervention strategies including surgery, drug therapy, and non-medical interventions. The objective of the present study is to determine the effectiveness of

  2. Epidural injection with or without steroid in managing chronic low back and lower extremity pain: ameta-analysis of ten randomized controlled trials

    OpenAIRE

    Zhai, Jinshuai; Zhang, Long; Li, Mengya; Tian, Yiren; Zheng, Wang; Chen, Jia; Huang, Teng; Li, Xicheng; Tian, Zhi

    2015-01-01

    Background: Chronic low back and lower extremity pain is mainly caused by lumbar disc herniation (LDH) and radiculitis. Various surgery and nonsurgical modalities, including epidural injections, have been used to treat LDH or radiculitis. Therefore, we conducted this meta-analysis to assess the effects of the two interventions in managing various chronic low and lower extremity pain. Methods: A systematic literature search was conducted to identify randomized controlled trials (RCTs) which co...

  3. Use of an abbreviated neuroscience education approach in the treatment of chronic low back pain: a case report.

    Science.gov (United States)

    Louw, Adriaan; Puentedura, Emilio Louie; Mintken, Paul

    2012-01-01

    Chronic low back pain (CLBP) remains prevalent in society, and conservative treatment strategies appear to have little effect. It is proposed that patients with CLBP may have altered cognition and increased fear, which impacts their ability to move, perform exercise, and partake in activities of daily living. Neuroscience education (NE) aims to change a patient's cognition regarding their pain state, which may result in decreased fear, ultimately resulting in confrontation of pain barriers and a resumption of normal activities. A 64-year-old female with history of CLBP was the patient for this case report. A physical examination, the Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), Fear-Avoidance Beliefs Questionnaire (FABQ), and Zung Depression Scale were assessed during her initial physical therapy visit, immediately after her first physical therapy session, and at 7-month follow-up. Treatment consisted of an abbreviated NE approach, exercises (range of motion, stretches, and cardiovascular), and aquatic therapy. She attended twice a week for 4 weeks, or 8 visits total. Pre-NE, the patient reported NPRS = 9/10; ODI = 54%; FABQ-W = 25/42,; FABQ-PA = 20/24, and Zung = 58. Immediately following the 75-minute evaluation and NE session, the patient reported improvement in all four outcome measures, most notably a reduction in the FABQ-W score to 2/42 and the FABQ-PA to 1/24. At a 7-month follow-up, all outcome measures continued to be improved. NE aimed at decreasing fear associated with movement may be a valuable adjunct to movement-based therapy, such as exercise, for patients with CLBP.

  4. Coping with Low Back Pain.

    Science.gov (United States)

    Kindig, L. E.; Mrvos, S. R.

    Guidelines are offered for the prevention and relief of lower back pain. The structure of the spine is described, and the functions and composition of spinal disks are explained. A list is included of common causes of abnormalities of the spinal column, and injuries which may cause the fracture of the vertebrae are described. Factors causing low…

  5. Heart Coherence Training Combined with Back School in Patients with Chronic Non-specific Low Back Pain : First Pragmatic Clinical Results

    NARCIS (Netherlands)

    Soer, Remko; Vos, Dafne; Hofstra, Bert; Reneman, Michiel F.

    2014-01-01

    The aim of this study was to explore on which variables a stress reduction program based on heart coherence can enhance the effects of a back school (BS) in patients with chronic non-specific low back pain and to explore possible moderators for treatment success. A retrospective explorative design w

  6. A Systematic Review of Sociodemographic, Physical, and Psychological Predictors of Multidisciplinary Rehabilitation—or, Back School Treatment Outcome in Patients With Chronic Low Back Pain

    NARCIS (Netherlands)

    Hulst, van der Marije; Vollenbroek-Hutten, Miriam M.R.; IJzerman, Maarten J.

    2005-01-01

    Objective. To determine predictors of outcome of multidisciplinary rehabilitation–or back school treatment for patients with chronic low back pain. Summary of Background Data. Numerous reviews have been performed to gain insight into which patients benefit from which treatment. However, no revie

  7. Lumbar and abdominal muscle activity during walking in subjects with chronic low back pain: Support of the “guarding” hypothesis?

    NARCIS (Netherlands)

    Hulst, van der M.; Vollenbroek-Hutten, M.M.R.; Rietman, J.S.; Hermens, H.J.

    2010-01-01

    It has been hypothesized that changes in trunk muscle activity in chronic low back pain (CLBP) reflect an underlying “guarding” mechanism, which will manifest itself as increased superficial abdominal – and lumbar muscle activity. During a functional task like walking, it may be further provoked at

  8. A study on the Efficacy of Muscle Energy Technique as compared to Conventional Therapy on Lumbar Spine Range of Motion in Chronic Low Back Pain of Sacroiliac Origin

    Directory of Open Access Journals (Sweden)

    Supreet Bindra

    2013-10-01

    Full Text Available Sacroiliac joint dysfunction is a term often used to describe pain in and around the region of the joint that is presumed to be due to biomechanical disorders of the joint. Despite of high incidence, the contribution of sacroiliac joint to low back pain has been a matter of controversy. Physical therapists routinely assess spinal range of motion in patients with low back pain and believe that spinal range of motion and disability are closely linked. The present study was aimed to determine the relative efficacy of Muscle Energy Technique as compared to Conventional Therapy on lumbar spine range of motion in chronic low back pain of Sacroiliac origin. It was found that the subjects who were treated with Muscle Energy Technique showed greater improvements in lumbar spine range of motion as compared to Conventional Therapy Group. As far as reduction in pain and disability are concerned both the groups showed almost similar results. The study concluded that sacroiliac joint dysfunction affects lumbar spine range of motion and is a significant contributor to chronic low back pain.

  9. Spinal segmental stabilisation exercises for chronic low back pain: programme adherence and its influence on clinical outcome.

    Science.gov (United States)

    Mannion, Anne F; Helbling, Daniel; Pulkovski, Natascha; Sprott, Haiko

    2009-12-01

    Exercise rehabilitation is one of the few evidence-based treatments for chronic non-specific low back pain (cLBP), but individual success is notoriously variable and may depend on the patient's adherence to the prescribed exercise regime. This prospective study examined factors associated with adherence and the relationship between adherence and outcome after a programme of physiotherapeutic spine stabilisation exercises. A total of 32/37 patients with cLBP completed the study (mean age, 44.0 (SD = 12.3) years; 11/32 (34%) male). Adherence to the 9-week programme was documented as: percent attendance at therapy, percent adherence to daily home exercises (patient diary) and percent commitment to rehabilitation (Sports Injury Rehabilitation Adherence Scale (SIRAS)). The average of these three measures formed a multidimensional adherence index (MAI). Psychological disturbance, fear-avoidance beliefs, catastrophising, exercise self-efficacy and health locus of control were measured by questionnaire; disability in everyday activities was scored with the Roland-Morris disability scale and back pain intensity with a 0-10 graphic rating scale. Overall, adherence to therapy was very good (average MAI score, 85%; median (IQR), 89 (15)%). The only psychological/beliefs variable showing a unique significant association with MAI was exercise self-efficacy (Rho = 0.36, P = 0.045). Pain intensity and self-rated disability decreased significantly after therapy (each P success of their own therapy, perhaps by increasing exercise self-efficacy. Whether the "adherence-outcome" interaction was mediated by improvements in function related to the specific exercises, or by a more "global" effect of the programme, remains to be examined.

  10. Efficacy of dynamic muscular stabilization techniques (DMST) over conventional techniques in rehabilitation of chronic low back pain.

    Science.gov (United States)

    Kumar, Suraj; Sharma, Vijai P; Negi, Mahendra P S

    2009-12-01

    Low back pain (LBP) is a common health problems. Although it is multifactorial, its treatment varies considerably, including medication, physical therapy modalities, and exercise therapy, and each have several interventions. Despite their effectiveness, their head-to-head comparisons are limited. This study was aimed at 1 such comparison. A total of 30 hockey players, 18 to 28 years of age, with subacute or chronic LBP were randomly assigned equally in 2 groups. One group was treated with conventional treatment--a combination of 2 electrotherapies (ultrasound and short-wave diathermy) and 1 exercise therapy (lumbar strengthening exercises)--and the other group was treated with dynamic muscular stabilization techniques (DMST), an active approach of stabilizing training. The results showed that both the treatments are effective in the management of LBP, but DMST was found to be more effective than conventional treatment. The walking, stand ups, climbing, and pain improved 4.7, 2.0, 1.4, and 2.1 times, respectively, more with DMST than with conventional treatment. With time (days), walking, stand ups, climbing, and pain improved (correlation) significantly (p < 0.01) higher in DMST (r = 0.83 to 0.92) than in conventional treatment (r = 0.40 to 0.75), and their rate of improvement (regression beta coefficients) were also significantly (p < 0.01) higher in DMST (beta = -0.16 to 0.73) than in conventional treatment (beta = -0.07 to 0.15). Subjects matching were perfect (p < 0.01) and test-retest reliability of all dependent variables was significantly (p < 0.01) high (intraclass correlation coefficient approximately 1). No major adverse effects were recorded in any of the patients in either group. This study concluded that for early recovery, DMST is more suitable than conventional treatment.

  11. Percutaneous Nucleoplasty Using Coblation Technique for the Treatment of Chronic Nonspecific Low Back Pain: 5-year Follow-up Results

    Institute of Scientific and Technical Information of China (English)

    Da-Jiang Ren; Xiu-Mei Liu; Sui-Yong Du; Tian-Sheng Sun; Zhi-Cheng Zhang; Fang Li

    2015-01-01

    Background:This study evaluated the efficacy of percutaneous nucleoplasty using coblation technique for the treatment of chronic nonspecific low back pain (LBP),after 5 years of follow-up.Methods:From September 2004 to November 2006,172 patients underwent percutaneous nucleoplasty for chronic LBP in our department.Forty-one of these patients were followed up for a mean period of 67 months.Nucleoplasty was performed at L3/4 in 1 patient;L4/5 in 25 patients;L5/S1 in 2 patients;L3/4 and L4/5 in 2 patients;L4/5 and L5/S1 in 7 patients;and L3/4,L4/5,and L5/S1 in 4 patients.Patients were assessed preoperatively and at 1 week,1 year,3 years,and 5 years postoperatively.Pain was graded using a 10-cm Visual Analogue Scale (VAS) and the percentage reduction in pain score was calculated at each postoperative time point.The Oswestry Disability Index (ODI) was used to assess disability-related to lumbar spine degeneration,and patient satisfaction was assessed using the modified MacNab criteria.Results:There were significant differences among the preoperative,1-week postoperative,and 3-year postoperative VAS and ODI scores,but not between the 3-and 5-year postoperative scores.There were no significant differences in age,sex,or preoperative symptoms between patients with effective and ineffective treatment,but there were significant differences in the number of levels treated,Pfirrmann grade of intervertebral disc degeneration,and provocative discography findings between these two groups.Excellent or good patient satisfaction was achieved in 87.9% of patients after 1 week,72.4% after 1 year,67.7% after 3 years,and 63.4% at the last follow-up.Conclusions:Although previously published short-and medium-term outcomes after percutaneous nucleoplasty appeared to be satisfactory,our long-term follow-up results show a significant decline in patient satisfaction over time.Percutaneous nucleoplasty is a safe and simple technique,with therapeutic effectiveness for the treatment of

  12. Neurophysiologic effects of spinal manipulation in patients with chronic low back pain

    Directory of Open Access Journals (Sweden)

    Walkowski Stevan

    2011-07-01

    Full Text Available Abstract Background While there is growing evidence for the efficacy of SM to treat LBP, little is known on the mechanisms and physiologic effects of these treatments. Accordingly, the purpose of this study was to determine whether SM alters the amplitude of the motor evoked potential (MEP or the short-latency stretch reflex of the erector spinae muscles, and whether these physiologic responses depend on whether SM causes an audible joint sound. Methods We used transcranial magnetic stimulation to elicit MEPs and electromechanical tapping to elicit short-latency stretch reflexes in 10 patients with chronic LBP and 10 asymptomatic controls. Neurophysiologic outcomes were measured before and after SM. Changes in MEP and stretch reflex amplitude were examined based on patient grouping (LBP vs. controls, and whether SM caused an audible joint sound. Results SM did not alter the erector spinae MEP amplitude in patients with LBP (0.80 ± 0.33 vs. 0.80 ± 0.30 μV or in asymptomatic controls (0.56 ± 0.09 vs. 0.57 ± 0.06 μV. Similarly, SM did not alter the erector spinae stretch reflex amplitude in patients with LBP (0.66 ± 0.12 vs. 0.66 ± 0.15 μV or in asymptomatic controls (0.60 ± 0.09 vs. 0.55 ± 0.08 μV. Interestingly, study participants exhibiting an audible response exhibited a 20% decrease in the stretch reflex (p Conclusions These findings suggest that a single SM treatment does not systematically alter corticospinal or stretch reflex excitability of the erector spinae muscles (when assessed ~ 10-minutes following SM; however, they do indicate that the stretch reflex is attenuated when SM causes an audible response. This finding provides insight into the mechanisms of SM, and suggests that SM that produces an audible response may mechanistically act to decrease the sensitivity of the muscle spindles and/or the various segmental sites of the Ia reflex pathway.

  13. Individuals with chronic low back pain demonstrate delayed onset of the back muscle activity during prone hip extension.

    Science.gov (United States)

    Suehiro, Tadanobu; Mizutani, Masatoshi; Ishida, Hiroshi; Kobara, Kenichi; Osaka, Hiroshi; Watanabe, Susumu

    2015-08-01

    Prone hip extension (PHE) is commonly used in the evaluation of the stability of the lumbopelvic region. There is little evidence of difference in muscle activity onset timing between healthy individuals and individuals with chronic low back pain (CLBP) during PHE. The purpose of this study was to determine if individuals with and without CLBP differ in the onset time of the trunk and hip extensor muscles activity during PHE. The participants were 20 patients with CLBP and 20 healthy individuals. Electromyography data of the erector spinae, multifidus, gluteus maximus, and semitendinosus were collected during PHE using a surface electromyograph. Relative differences in the onset times between each muscle and the prime mover (i.e., the semitendinosus) were calculated. The onsets of the bilateral multifidus and contralateral erector spinae were significantly delayed in the CLBP group compared with the healthy group (pleg movement not being significantly different between the groups. The onset times of the gluteus maximus and ipsilateral erector spinae showed no significant differences between the groups. These results suggest that individuals with CLBP use an altered, and possibly inadequate, trunk muscle recruitment pattern.

  14. Are There Abnormalities in Peripheral and Central Components of Somatosensory Evoked Potentials in Non-Specific Chronic Low Back Pain?

    Science.gov (United States)

    Puta, Christian; Franz, Marcel; Blume, Kathrin R.; Gabriel, Holger H. W.; Miltner, Wolfgang H. R.; Weiss, Thomas

    2016-01-01

    Chronic low back pain (CLBP) was shown to be associated with longer reflex response latencies of trunk muscles during external upper limb perturbations. One theoretical, but rarely investigated possibility for longer reflex latencies might be related to modulated somatosensory information processing. Therefore, the present study investigated somatosensory evoked potentials (SEPs) to median nerve stimulation in CLBP patients and healthy controls (HC). Latencies of the peripheral N9 SEP component were used as the primary outcome. In addition, latencies and amplitudes of the central N20 SEP component, sensory thresholds, motor thresholds and nerve conduction velocity were also analyzed in CLBP patients and HC. There is a trend for the CLBP patients to exhibit longer N9 latencies at the ipsilateral Erb’s point compared to HC. This trend is substantiated by significantly longer N9 latencies in CLBP patients compared to normative data. None of the other parameters showed any significant difference between CLBP patients and HC. Overall, our data indicate small differences of the peripheral N9 SEP component; however, these differences cannot explain the reflex delay observed in CLBP patients. While it was important to rule out the contribution of early somatosensory processing and to elucidate its contribution to the delayed reflex responses in CLBP patients, further research is needed to find the primary source(s) of time-delayed reflexes in CLBP. PMID:27799904

  15. Imaging-guided hyperstimulation analgesia in low back pain.

    Science.gov (United States)

    Gorenberg, Miguel; Schwartz, Kobi

    2013-01-01

    Low back pain in patients with myofascial pain syndrome is characterized by painful active myofascial trigger points (ATPs) in muscles. This article reviews a novel, noninvasive modality that combines simultaneous imaging and treatment, thus taking advantage of the electrodermal information available from imaged ATPs to deliver localized neurostimulation, to stimulate peripheral nerve endings (Aδ fibers) and in turn, to release endogenous endorphins. "Hyperstimulation analgesia" with localized, intense, low-rate electrical pulses applied to painful ATPs was found to be effective in 95% patients with chronic nonspecific low back pain, in a clinical validation study.

  16. [The moderator role of family type in the relationship between functional disability and quality of life in patients with chronic low back pain].

    Science.gov (United States)

    Ferreira, Maria Salomé Martins; Pereira, Maria da Graça

    2016-01-01

    Chronic low back pain is a disease that interferes with quality of life and the patient's functional capability. This study aimed to identify the moderating effect of the "Type of Family" in the relationship between functional disability and quality of life in patients with chronic low back pain. Two hundred and three patients with low back pain for longer than 3 months participated in the study. The instruments used were: Medical Outcome Study (MOS 20); Roland Morris Disability Questionnaire (RMDO; Family Adaptability and Cohesion Evaluation Scales (FACES II). Regression analyses were performed in order to test the moderating effect of the type of family. The results showed that patients with lower levels of disability presented better quality of life in the intermediate and balanced families, and this relationship was even stronger in balanced families. According to the results, intervention programs in chronic low back pain, besides the patient, should include the family particularly in balanced families since they are the ones that feel the impact of the disease on their quality of life the most.

  17. Management of patients with low back pain

    DEFF Research Database (Denmark)

    Debarle, Michel; Aigron, Rémi; Depernet, Laure

    2014-01-01

    BACKGROUND: Little is known about the level of consensus within the French chiropractic profession regarding management of clinical issues. A previous Swedish study showed that chiropractors agreed relatively well on the management strategy for nine low back pain scenarios. We wished to investigate...... whether those findings could be reproduced among French chiropractors.Objectives: 1. To assess the level of consensus among French chiropractors regarding management strategies for nine different scenarios of low back pain. 2. To assess whether the management choices of the French chiropractors appeared...... reasonable for the low back pain scenarios. 3. To compare French management patterns with those described in the previous survey of Swedish chiropractors. METHOD: A postal questionnaire was sent to a randomly selected sample of 167 French chiropractors in 2009. The questionnaire described a 40-year old man...

  18. Do abnormal serum lipid levels increase the risk of chronic low back pain? The Nord-Trondelag Health Study.

    Directory of Open Access Journals (Sweden)

    Ingrid Heuch

    Full Text Available Cross-sectional studies suggest associations between abnormal lipid levels and prevalence of low back pain (LBP, but it is not known if there is any causal relationship.The objective was to determine, in a population-based prospective cohort study, whether there is any relation between levels of total cholesterol, high density lipoprotein (HDL cholesterol and triglycerides and the probability of experiencing subsequent chronic (LBP, both among individuals with and without LBP at baseline.Information was collected in the community-based HUNT 2 (1995-1997 and HUNT 3 (2006-2008 surveys of an entire Norwegian county. Participants were 10,151 women and 8731 men aged 30-69 years, not affected by chronic LBP at baseline, and 3902 women and 2666 men with LBP at baseline. Eleven years later the participants indicated whether they currently suffered from chronic LBP.Among women without LBP at baseline, HDL cholesterol levels were inversely associated and triglyceride levels positively associated with the risk of chronic LBP at end of follow-up in analyses adjusted for age only. Adjustment for the baseline factors education, work status, physical activity, smoking, blood pressure and in particular BMI largely removed these associations (RR: 0.96, 95% CI: 0.85-1.07 per mmol/l of HDL cholesterol; RR: 1.16, 95% CI: 0.94-1.42 per unit of lg(triglycerides. Total cholesterol levels showed no associations. In women with LBP at baseline and men without LBP at baseline weaker relationships were observed. In men with LBP at baseline, an inverse association with HDL cholesterol remained after complete adjustment (RR: 0.83, 95% CI: 0.72-0.95 per mmol/l.Crude associations between lipid levels and risk of subsequent LBP in individuals without current LBP are mainly caused by confounding with body mass. However, an association with low HDL levels may still remain in men who are already affected and possibly experience a higher pain intensity.

  19. Systematic review of patient history and physical examination to diagnose chronic low back pain originating from the facet joints.

    Science.gov (United States)

    Maas, E T; Juch, J N S; Ostelo, R W J G; Groeneweg, J G; Kallewaard, J W; Koes, B W; Verhagen, A P; Huygen, F J P M; van Tulder, M W

    2017-03-01

    Patient history and physical examination are frequently used procedures to diagnose chronic low back pain (CLBP) originating from the facet joints, although the diagnostic accuracy is controversial. The aim of this systematic review is to determine the diagnostic accuracy of patient history and/or physical examination to identify CLBP originating from the facet joints using diagnostic blocks as reference standard. We searched MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Collaboration database from inception until June 2016. Two review authors independently selected studies for inclusion, extracted data and assessed the risk of bias. We calculated sensitivity and specificity values, with 95% confidence intervals (95% CI). Twelve studies were included, in which 129 combinations of index tests and reference standards were presented. Most of these index tests have only been evaluated in single studies with a high risk of bias. Four studies evaluated the diagnostic accuracy of the Revel's criteria combination. Because of the clinical heterogeneity, results were not pooled. The published sensitivities ranged from 0.11 (95% CI 0.02-0.29) to 1.00 (95% CI 0.75-1.00), and the specificities ranged from 0.66 (95% CI 0.46-0.82) to 0.91 (95% CI 0.83-0.96). Due to clinical heterogeneity, the evidence for the diagnostic accuracy of patient history and/or physical examination to identify facet joint pain is inconclusive. Patient history and physical examination cannot be used to limit the need of a diagnostic block. The validity of the diagnostic facet joint block should be studied, and high quality studies are required to confirm the results of single studies.

  20. Course and prognosis of recovery for chronic non-specific low back pain: design, therapy program and baseline data of a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Verkerk Karin

    2011-11-01

    Full Text Available Abstract Background There has been increasing focus on factors predicting the development of chronic musculoskeletal disorders. For patients already experiencing chronic non-specific low back pain it is also relevant to investigate which prognostic factors predict recovery. We present the design of a cohort study that aims to determine the course and prognostic factors for recovery in patients with chronic non-specific low back pain. Methods/Design All participating patients were recruited (Jan 2003-Dec 2008 from the same rehabilitation centre and were evaluated by means of (postal questionnaires and physical examinations at baseline, during the 2-month therapy program, and at 5 and 12 months after start of therapy. The therapy protocol at the rehabilitation centre used a bio-psychosocial approach to stimulate patients to adopt adequate (movement behaviour aimed at physical and functional recovery. The program is part of regular care and consists of 16 sessions of 3 hours each, over an 8-week period (in total 48 hours, followed by a 3-month self-management program. The primary outcomes are low back pain intensity, disability, quality of life, patient's global perceived effect of recovery, and participation in work. Baseline characteristics include information on socio-demographics, low back pain, employment status, and additional clinical items status such as fatigue, duration of activities, and fear of kinesiophobia. Prognostic variables are determined for recovery at short-term (5 months and long-term (12 months follow-up after start of therapy. Discussion In a routine clinical setting it is important to provide patients suffering from chronic non-specific low back pain with adequate information about the prognosis of their complaint.

  1. Predictive factors for successful clinical outcome 1 year after an intensive combined physical and psychological programme for chronic low back pain

    OpenAIRE

    van Hooff, Miranda L; Spruit, Maarten; O’Dowd, John K.; van Lankveld, Wim; Fairbank, Jeremy C.T.; Van Limbeek, Jacques

    2013-01-01

    Purpose The aim of this longitudinal study is to determine the factors which predict a successful 1-year outcome from an intensive combined physical and psychological (CPP) programme in chronic low back pain (CLBP) patients. Methods A prospective cohort of 524 selected consecutive CLBP patients was followed. Potential predictive factors included demographic characteristics, disability, pain and cognitive behavioural factors as measured at pre-treatment assessment. The primary outcome measure ...

  2. Pregnancy-related low back pain.

    Science.gov (United States)

    Katonis, P; Kampouroglou, A; Aggelopoulos, A; Kakavelakis, K; Lykoudis, S; Makrigiannakis, A; Alpantaki, K

    2011-07-01

    Pregnancy related low back pain is a common complaint among pregnant women. It can potentially have a negative impact on their quality of life. The aim of this article is to present a current review of the literature concerning this issue.By using PubMed database and low back pain, pelvic girdle pain, pregnancy as keywords, abstracts and original articles in English investigating the diagnosis treatment of back pain during pregnancy were searched and analyzedLow back pain could present as either a pelvic girdle pain between the posterior iliac crest and the gluteal fold or as a lumbar pain over and around the lumbar spine. The source of the pain should be diagnosed and differentiated early.The appropriate treatment aims to reduce the discomfort and the impact on the pregnant womans quality of life. This article reveals the most common risk factors, as well as treatment methods, which may help to alleviate the pain. Some suggestions for additional research are also discussed.

  3. The Effect of Fatigue and Instability on Postural Control Parameters in Standing Posture in Healthy Adults and Patients with Chronic Low Back Pain

    Directory of Open Access Journals (Sweden)

    Amir Hosein Kahlaee

    2012-06-01

    Full Text Available Background: This study aims at analyzing the effect of fatigue and instability on postural control parameters in both healthy people and patients with the chronic nonspecific low-back pain.Materials and Methods: In this non-experimental case-control study, oscillations of center of pressure were statistically analyzed in 16 healthy people and 15 patients with the chronic nonspecific low back pain. The analysis was conducted through two stages: before and after fatigue and under both stable and unstable surfaces. Results: Under the pre-fatigue, stable condition, there was not any difference between the two groups. Both fatigue and unstable surface changed our variables (sway area, range, velocity, frequency and total power of the signal. All the changes in variables were significant in the low-back pain group; while changes in the healthy group only covered the time-domain variables. The effect of instability was higher than that of fatigue. Conclusion: The postural control system for patients with low-back pain before fatigue and under stable condition, revealed sufficient competence to provide postural stability and its function cannot be differentiated from that in healthy people. Meanwhile, different mechanisms were used by these patients to confront stability challenging factors and further neural activity was required to counteract such factors.

  4. External Validation of a Referral Rule for Axial Spondyloarthritis in Primary Care Patients with Chronic Low Back Pain

    Science.gov (United States)

    van Hoeven, Lonneke; Vergouwe, Yvonne; de Buck, P. D. M.; Luime, Jolanda J.; Hazes, Johanna M. W.; Weel, Angelique E. A. M.

    2015-01-01

    Objectives To validate and optimize a referral rule to identify primary care patients with chronic low back pain (CLBP) suspected for axial spondyloarthritis (axSpA). Design Cross-sectional study with data from 19 Dutch primary care practices for development and 38 for validation. Participants Primary care patients aged 18-45 years with CLBP existing more than three months and onset of back pain started before the age of 45 years. Main Outcome The number of axSpA patients according to the ASAS criteria. Methods The referral rule (CaFaSpA referral rule) was developed using 364 CLBP patients from 19 primary care practices and contains four easy to use variables; inflammatory back pain, good response to nonsteriodal anti-inflammatory drugs, family history of spondyloarthritis and a back pain duration longer than five years. This referral rule is positive when at least two variables are present. Validation of the CaFaSpA rule was accomplished in 579 primary care CLBP patients from 38 practices from other areas. Performance of the referral rule was assessed by c-statistic and calibration plot. To fit the final referral rule the development and validation datasets were pooled leading to a total study population of 943 primary care participants. Results The referral rule was validated in 579 patients (41% male, mean age 36 (sd7.0). The percentage of identified axSpA patients was 16% (n=95). External validation resulted in satisfactory calibration and reasonable discriminative ability (c-statistics 0.70 [95% CI, 0.64-0.75]). In the pooled dataset sensitivity and specificity of the referral rule were 75% and 58%. Conclusions The CaFaSpA referral rule for axSpA consists of four easy to use predictors for primary care physicians and has a good predictive value in this validation study. The referral rule has the potential to be a screening tool for primary care by identifying CLBP patients suspected for axSpA. PMID:26200904

  5. External Validation of a Referral Rule for Axial Spondyloarthritis in Primary Care Patients with Chronic Low Back Pain.

    Directory of Open Access Journals (Sweden)

    Lonneke van Hoeven

    Full Text Available To validate and optimize a referral rule to identify primary care patients with chronic low back pain (CLBP suspected for axial spondyloarthritis (axSpA.Cross-sectional study with data from 19 Dutch primary care practices for development and 38 for validation.Primary care patients aged 18-45 years with CLBP existing more than three months and onset of back pain started before the age of 45 years.The number of axSpA patients according to the ASAS criteria.The referral rule (CaFaSpA referral rule was developed using 364 CLBP patients from 19 primary care practices and contains four easy to use variables; inflammatory back pain, good response to nonsteriodal anti-inflammatory drugs, family history of spondyloarthritis and a back pain duration longer than five years. This referral rule is positive when at least two variables are present. Validation of the CaFaSpA rule was accomplished in 579 primary care CLBP patients from 38 practices from other areas. Performance of the referral rule was assessed by c-statistic and calibration plot. To fit the final referral rule the development and validation datasets were pooled leading to a total study population of 943 primary care participants.The referral rule was validated in 579 patients (41% male, mean age 36 (sd7.0. The percentage of identified axSpA patients was 16% (n=95. External validation resulted in satisfactory calibration and reasonable discriminative ability (c-statistics 0.70 [95% CI, 0.64-0.75]. In the pooled dataset sensitivity and specificity of the referral rule were 75% and 58%.The CaFaSpA referral rule for axSpA consists of four easy to use predictors for primary care physicians and has a good predictive value in this validation study. The referral rule has the potential to be a screening tool for primary care by identifying CLBP patients suspected for axSpA.

  6. Getting “Unstuck”: A Multi-Site Evaluation of the Efficacy of an Interdisciplinary Pain Intervention Program for Chronic Low Back Pain

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    Timothy Clark

    2016-06-01

    Full Text Available Chronic low back pain is one of the major health problems in the U.S., resulting in a large number of years of disability. To address the biopsychosocial nature of pain, interdisciplinary pain programs provide integrated interventions by an interdisciplinary team in a unified setting with unified goals. This study examined outcomes of an interdisciplinary program located at two sites with different staff, yet with a unified model of treatment and documentation. Efficacy at the combined sites was examined by comparing standard measures obtained upon admission to the program with measures at completion of a 3–4 week long program for 393 patients with chronic low back pain (CLBP. Repeated measures included pain severity, pain interference, efficacy of self-management strategies, hours of activity, depression, ability to do ADLs, and physical endurance. All repeated measures differed at the p < 0.001 level, with large effect sizes (0.66–0.85. Eighty-two percent of graduates reported being “very much improved” or “much improved”. A second analyses provided evidence that treatment effects were robust across sites with no differences (<0.001 found on five of seven selected outcome measures. A third analysis found that number of days of treatment was correlated on three of seven measures at the <0.01 level. However, the amount of variance explained by days of treatment was under 5% on even the most highly correlated measure. These finding are consistent with previous research and explore short-term effectiveness of treatment across treatment sites and with variable duration of treatment.

  7. Barriers and facilitators to yoga use in a population of individuals with self-reported chronic low back pain: a qualitative approach.

    Science.gov (United States)

    Combs, Martha A; Thorn, Beverly E

    2014-11-01

    Yoga has been found to be efficacious in treating chronic low back pain, yet biomedical treatments are most commonly used for pain. Promoting yoga as part of integrative care would reduce exclusive reliance on high-cost, higher-risk biomedical treatments. Attitudes toward yoga play a role in consideration of it as a treatment. The current study examined attitudes toward yoga in adults with chronic low back pain and compared these results to those found in a 2009 general population study. Participants completed a semi-structured interview where they responded to items about perceptions of potential barriers and facilitators to trying yoga. Participant responses were analyzed qualitatively and several common themes emerged. Themes identified by participants indicated there is mixed information about yoga in the public domain and that clarification of what yoga is, how it can be beneficial, and what it requires one to do physically may help promote its use.

  8. The chronic low back pain region of spine in athletes%运动员脊柱源慢性腰痛的述评

    Institute of Scientific and Technical Information of China (English)

    金晨; 李强; 张璐; 李婧

    2014-01-01

    Chronic back pain is one of the high incidence diseases,which has been plagued athletes. The majority of chronic low back pain is spine source. In this paper,the incidence and causes of chronic low back pain in athletes,and rehabilitation assessments were reviewed. The spinal stabilization system was used as a theoretical basis of damage,to analyze the current short-age of treatment for chronic low back pain,thus to provide the reference of rehabilitation and e-valuation more suitable for athletes.%慢性腰痛一直是困扰运动员的高发病之一,其中以脊柱源慢性腰痛占多数。本文对运动员慢性腰痛的发病率及原因,康复治疗评估进行综述。通过脊柱稳定系统作为损伤的理论基础来分析目前治疗的不足,为慢性腰痛的康复治疗与评估更加适合运动员群体提供参考。

  9. DIAGNOSTICS AND TREATMENT OF LOW BACK PAIN

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    Rashid Askhatovich Altunbaev

    2009-01-01

    Full Text Available The paper gives an update on the principles of diagnosis and medical and surgical treatments in patients with low back pain (LBP, by taking into account the clinical phenomenology of pain manifestations. It considers the use of nonsteroidal anti-inflammatory drugs, myorelaxants, anticonvulsants, antidepressants, and other agents. The data of clinical trials of meloxicam used in LBP are presented. The currently available surgical treatments for LBP are described.

  10. An economic analysis of usual care and acupuncture collaborative treatment on chronic low back pain: A Markov model decision analysis

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    Lee Taejin

    2010-11-01

    Full Text Available Abstract Background The collaborative treatment of acupuncture in addition to routine care as an approach for the management of low back pain (LBP is receiving increasing recognition from both public and professional arenas. In 2010, the Ministry of Health, Welfare and Family Affairs (MOHW of South Korea approved the practice of doctors and Oriental medical doctors (acupuncture qualified working together in the same facility and offering collaborative treatment at the same time for the same disease. However, there is little more than anecdotal evidence on the health and economic implications of this current practice. Therefore, the objective of this study is to examine the effectiveness and costs of acupuncture in addition to routine care in the treatment of chronic LBP patients in South Korea. Methods The Markov model was developed to synthesise evidence on both costs and outcomes for patients with chronic LBP. We conducted the base case analysis, univariate and probabilistic sensitivity analyses, and also performed the value of information analysis for future researches. Model parameters were sourced from systematic review of both alternatives, simple bibliographic reviews of relevant articles published in English or Korean, and statistical analyses of the 2005 and 2007 Korean National Health and Nutrition Survey (KNHNS data. The analyses were based on the societal perspective over a five year time horizon using a 5% discount rate. Results In the base case, collaborative treatment resulted in better outcomes, but at a relatively high cost. Overall, the incremental cost-effectiveness ratio of a collaborative practice was 3,421,394 KRW (Korean rate Won per QALY (Quality adjusted life year (2,895.80 USD per QALY. Univariate sensitivity analysis of indirect non-medical costs did not affect the preference order of the strategies. Probabilistic sensitivity analysis revealed that if the threshold was over 3,260,000 KRW per QALY (2,759.20 USD per QALY

  11. Amount of health care and self-care following a randomized clinical trial comparing flexion-distraction with exercise program for chronic low back pain

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    Keenum Michael

    2006-08-01

    Full Text Available Abstract Background Previous clinical trials have assessed the percentage of participants who utilized further health care after a period of conservative care for low back pain, however no chiropractic clinical trial has determined the total amount of care during this time and any differences based on assigned treatment group. The objective of this clinical trial follow-up was to assess if there was a difference in the total number of office visits for low back pain over one year after a four week clinical trial of either a form of physical therapy (Exercise Program or a form of chiropractic care (Flexion Distraction for chronic low back pain. Methods In this randomized clinical trial follow up study, 195 participants were followed for one year after a four-week period of either a form of chiropractic care (FD or a form of physical therapy (EP. Weekly structured telephone interview questions regarded visitation of various health care practitioners and the practice of self-care for low back pain. Results Participants in the physical therapy group demonstrated on average significantly more visits to any health care provider and to a general practitioner during the year after trial care (p Conclusion During a one-year follow-up, participants previously randomized to physical therapy attended significantly more health care visits than those participants who received chiropractic care.

  12. Differences in performance on the functional movement screen between chronic low back pain patients and healthy control subjects

    OpenAIRE

    Ko, Min-Joo; Noh, Kyung-Hee; Kang, Min-Hyeok; Oh, Jae-Seop

    2016-01-01

    [Purpose] Differences in scores on the Functional Movement Screen between patients with chronic lower back pain and healthy control subjects were investigated. [Subjects and Methods] In all, 20 chronic lower back pain patients and 20 healthy control subjects were recruited. Chronic lower back pain patients and healthy controls performed the Functional Movement Screen (deep squat, hurdle step, inline lunge, shoulder mobility, active straight leg raise, trunk stability pushup, and rotary stabil...

  13. Effectiveness of mat Pilates or equipment-based Pilates in patients with chronic non-specific low back pain: a protocol of a randomised controlled trial

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    da Luz Maurício Antônio

    2013-01-01

    Full Text Available Abstract Background Chronic low back pain is an expensive and difficult condition to treat. One of the interventions widely used by physiotherapists in the treatment of chronic non-specific low back pain is exercise therapy based upon the Pilates principles. Pilates exercises can be performed with or without specific equipment. These two types of Pilates exercises have never been compared on a high-quality randomised controlled trial. Methods/design This randomised controlled trial with a blinded assessor will evaluate eighty six patients of both genders with chronic low back pain, aged between 18 and 60 years, from one Brazilian private physiotherapy clinic. The patients will be randomly allocated into two groups: Mat Group will perform the exercises on the ground while the Equipment-based Group will perform the Pilates method exercises on the following equipment: Cadillac, Reformer, Ladder Barrel, and Step Chair. The general and specific disability of the patient, kinesiophobia, pain intensity and global perceived effect will be evaluated by a blinded assessor before randomisation and at six weeks and six months after randomisation. In addition, the expectation of the participants and their confidence with the treatment will be evaluated before randomisation and after the first treatment session, respectively. Discussion This will be the first study aiming to compare the effectiveness of Mat and Equipment-based Pilates exercises in patients with chronic non-specific low back pain. The results may help health-care professionals in clinical decision-making and could potentially reduce the treatment costs of this condition. Trial registration Brazilian Registry of Clinical Trials RBR-7tyg5j

  14. Challenges of the pregnant athlete and low back pain.

    Science.gov (United States)

    Noon, Megan L; Hoch, Anne Z

    2012-01-01

    Low back pain during pregnancy is a common problem with a high prevalence among pregnant athletes. The etiology of pregnancy-related low back pain remains unclear, although more evidence is supporting a biomechanical/musculoskeletal origin. This article will review the causes of low back pain in athletes and pregnant women, differentiate low back from pelvic girdle pain, and discuss the treatment and prevention of pregnancy-related low back and pelvic girdle pain.

  15. Bee venom acupuncture for the treatment of chronic low back pain: study protocol for a randomized, double-blinded, sham-controlled trial

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    Seo Byung-Kwan

    2013-01-01

    Full Text Available Abstract Background Chronic non-specific low back pain is the most common medical problem for which patients seek complementary and alternative medical treatment, including bee venom acupuncture. However, the effectiveness and safety of such treatments have not been fully established by randomized clinical trials. The aim of this study is to determine whether bee venom acupuncture is effective for improving pain intensity, functional status and quality of life of patients with chronic non-specific low back pain. Methods/design This study is a randomized, double-blinded, sham-controlled clinical trial with two parallel arms. Fifty-four patients between 18 and 65 years of age with non-radicular chronic low back pain experiencing low back pain lasting for at least the previous three months and ≥4 points on a 10-cm visual analog scale for bothersomeness at the time of screening will be included in the study. Participants will be randomly allocated into the real or sham bee venom acupuncture groups and treated by the same protocol to minimize non-specific and placebo effects. Patients, assessors, acupuncturists and researchers who prepare the real or sham bee venom acupuncture experiments will be blinded to group allocation. All procedures, including the bee venom acupuncture increment protocol administered into predefined acupoints, are designed by a process of consensus with experts and previous researchers according to the Standards for Reporting Interventions in Clinical Trials of Acupuncture. Bothersomeness measured using a visual analogue scale will be the primary outcome. Back pain-related dysfunction, pain, quality of life, depressive symptoms and adverse experiences will be measured using the visual analogue scale for pain intensity, the Oswestry Disability Index, the EuroQol 5-Dimension, and the Beck’s Depression Inventory. These measures will be recorded at baseline and 1, 2, 3, 4, 8 and 12 weeks. Discussion The results from this study

  16. The Use of Conservative and Alternative Therapy for Low Back Pain

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    Ping Chung Leung

    2015-09-01

    Full Text Available Low back pain may have complex patho-physiological causes leading to chronicity that resists conventional managements. Complementary and alternative treatment options have, therefore, gained popularity. In this chapter, acupuncture, manual therapy, and natural healing for low back pain will be discussed. Special emphasis is given on the role of the individual in the control and prevention of low back pain.

  17. Autonomic status and pain profile in patients of chronic low back pain and following electro acupuncture therapy: a randomized control trial.

    Science.gov (United States)

    Shankar, Nilima; Thakur, Manisha; Tandon, Om Prakash; Saxena, Ashok Kumar; Arora, Shobha; Bhattacharya, Neena

    2011-01-01

    Pain is a syndrome characterized by several neurophysiological changes including that of the autonomic nervous system. Chronic low back pain (LBP) is a major health problem and is a frequent reason for using unconventional therapies especially acupuncture. This study was conducted to evaluate the autonomic status and pain profile in chronic LBP patients and to observe the effect of electro acupuncture therapy. Chronic LBP patients (n=60) were recruited from the Department of Orthopaedics, GTB Hospital, Delhi. Age and sex matched healthy volunteers were selected as controls (n=30). Following a written consent, LBP patients were randomly allocated into two study groups - Group A received 10 sittings of electro acupuncture, on alternate days, at GB and UB points selected for back pain, while the Group B received a conventional drug therapy in the form of oral Valdecoxib together with supervised physiotherapy. Controls were assessed once while the patients were assessed twice, before and after completion of the treatment program (3 weeks). The autonomic status was studied with non-invasive cardiovascular autonomic function tests which included E: I ratio, 30:15 ratio, postural challenge test and sustained handgrip test. Pain intensity was measured with the visual analogue scale (VAS) and the global perceived effect (GPE). Statistical analysis was performed using repeated measure's ANOVA with Tukey's test. Pain patients showed a significantly reduced vagal tone and increased sympathetic activity as compared to the controls (Pacupuncture group showed a better response (PAcupuncture effectively relieves the pain and improves the autonomic status and hence can be used as an alternative/additive treatment modality in these cases.

  18. Socioeconomic inequalities in mobility decline in chronic disease groups (asthma/COPD, heart disease, diabetes mellitus, low back pain): only a minor role for disease severity and comorbidity

    OpenAIRE

    2004-01-01

    Objective: This study examined the association between socioeconomic status and mobility decline and whether this could be explained by disease severity and comorbidity in four different chronic disease groups (asthma/COPD, heart disease, diabetes mellitus, and low back pain). It is not clear, whether the adverse course of physical functioning in persons with a low socioeconomic status can be explained by a higher prevalence of more severe disease or comorbidity in these persons.

  19. Preference and Expectation for Treatment Assignment in a Randomized Controlled Trial of Once- vs Twice-weekly Yoga for Chronic Low Back Pain

    OpenAIRE

    Tran, Huong H.; Weinberg, Janice; Sherman, Karen J.; Saper, Robert B

    2015-01-01

    Background: In studies involving nonpharmacological complementary and alternative medicine interventions, participant blinding is very difficult. Participant expectations may affect perceived benefit of therapy. In studies of yoga as treatment for chronic low back pain, little is known about the relationship between patient expectations and preferences on outcomes. This study was designed to identify baseline predictors of preference and to determine if expectations and preferences for differ...

  20. Electrical stimulation for chronic non-specific low back pain in a working-age population: a 12-week double blinded randomized controlled trial

    OpenAIRE

    2013-01-01

    Background Non-invasive electrotherapy is commonly used for treatment of chronic low back pain. Evidence for efficacy of most electrotherapy modalities is weak or lacking. This study aims to execute a high-quality, double-blinded randomized controlled clinical trial comparing 1) H-Wave® Device stimulation plus usual care with 2) transcutaneous electrical nerve stimulation (TENS) plus usual care, and 3) Sham electrotherapy plus usual care to determine comparative efficacy for treatment of chro...

  1. [Low back pain in pregnant women].

    Science.gov (United States)

    Majchrzycki, Marian; Mrozikiewicz, Przemysław M; Kocur, Piotr; Bartkowiak-Wieczorek, Joanna; Hoffmann, Marcin; Stryła, Wanda; Seremak-Mrozikiewicz, Agnieszka; Grześkowiak, Edmund

    2010-11-01

    Pain of lumbosacral segment of the vertebral column and the pelvis concerns about 45% of all pregnant women. The change of the body posture during pregnancy is the result of gravity centre relocation, which affects the musculosceletal system. Development of the joint, ligament and myofascial dysfunctions, as well as the pain in the lumbosacral segment and the pelvis, are the most common reasons of spine pain. The aim of this review is to present the current state of knowledge about lumbar spine pain in pregnant women with special focus on the pain connected with muscular, joint and ligament disorders. Pregnancy is a serious burden for the female osteo-skeletal system. Lumbar pain with different location and intensification is the negative consequence of the position changes during pregnancy. Pharmacotherapy could be useful only in cases of intensive low back pain, with possible application of small spectrum of drugs that are safe during pregnancy. Physical therapy including manual therapy exercises, massage and techniques of local anesthesia are alternative methods in case of low back pain in pregnant women.

  2. Lombalgia ocupacional Occupational low back pain

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    Milton Helfenstein Junior

    2010-01-01

    Full Text Available A lombalgia ocupacional apresenta etiologia multifatorial, elevada prevalência e incidência. Caracterizada por quadro de dor de variada duração e intensidade, a dor lombar pode levar à incapacidade laborativa e à invalidez. A lombalgia acarreta sofrimento aos trabalhadores, custos às empresas, aos sistemas previdenciário e assistencial de saúde. Os autores, pela relevância do tema, elaboraram este artigo de revisão bibliográfica dando ênfase ao embasamento teorico-conceitual e à experiência de especialistas.The occupational low back pain presents multifactorial aetiology, important prevalence and incidence. Characterized by pain of varying duration and intensity, low back pain may lead to disability. Low back pain causes suffering to workers, implies costs to companies, to the social security and health assistance system. Because of the theme's relevance, the authors have elaborated this review of literature with emphasis on a theoretical and conceptual basis, as well as experience of experts.

  3. PROTOCOL OF TREATMENT IN LOW BACK PAIN

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    Alisson Guimbala dos Santos Araujo

    2013-09-01

    Full Text Available Low back pain can be considered as one of the main factors that lead to decreased functional capacity of the human being. Being a frequent dysfunction in people, causing a decrease in quality of life, productivity and functional disability and is associated with important social and economic impact. Therefore the objective of the research was to assess the treatment protocols in low back pain. The study is characterized by being a literature of scientific articles, based on data published in PubMed, SciELO, BIREME and Cochrane from 2000 to 2012. We found eight scientific articles that addressed physical therapy methods in the treatment of low back pain, including a literature review. Related Articles show variation from one to 55 patients in groups, with a total of 185 patients studied. It was concluded then that it hasn’t met a specific treatment that is placed as the most effective for this pathology, although all include electrotherapy, manual therapy, exercise and RPG they show significant results in pain relief, quality of life thereby increasing functionality.

  4. An observational retrospective/horizontal study to compare oxygen-ozone therapy and/or global postural re-education in complicated chronic low back pain.

    Science.gov (United States)

    Apuzzo, Dario; Giotti, Chiara; Pasqualetti, Patrizio; Ferrazza, Paolo; Soldati, Paola; Zucco, Gesualdo M

    2014-01-01

    Acute low back pain (LBP) is the fifth most common reason for physician visits and about nine out of ten adults experience back pain at some point in their life. In a large number of patients LBP is associated with disc herniation (DH). Recently, oxygen-ozone (O2O3) therapy has been used successfully in the treatment of LBP, reducing pain after the failure of other conservative treatments. The aim of this study was to assess the effects of O2O3 therapy in back pain rehabilitation, comparing three groups of patients suffering from chronic back pain associated with DH submitted to three different treatments: intramuscular O2O3 infiltrations, global postural An observational retrospective/horizontal study to compare oxygen-ozone therapy and/or global postural re-education in complicated chronic low back pain re-education (GPR), or a combination of the two (O2O3+GPR). The data show that pain severity before treatment was significantly lower in the patients treated with GPR alone (VAS score 7.4) than in the O2O3+GPR patients (VAS score 8.5) and the O2O3 patients (VAS score 8.6). At the end of treatment, pain severity was lower in the O2O3 patients than in the GPR-alone patients. After some years of follow-up only the difference between O2O3+GPR and GPR-alone remained significant.

  5. Research methods for subgrouping low back pain

    DEFF Research Database (Denmark)

    Kent, Peter; Keating, Jennifer L; Leboeuf-Yde, Charlotte

    2010-01-01

    There is considerable clinician and researcher interest in whether the outcomes for patients with low back pain, and the efficiency of the health systems that treat them, can be improved by 'subgrouping research'. Subgrouping research seeks to identify subgroups of people who have clinically impo...... the strengths and limitations of research methods suitable for the hypothesis-setting phase of subgroup studies.......There is considerable clinician and researcher interest in whether the outcomes for patients with low back pain, and the efficiency of the health systems that treat them, can be improved by 'subgrouping research'. Subgrouping research seeks to identify subgroups of people who have clinically...... important distinctions in their treatment needs or prognoses. Due to a proliferation of research methods and variability in how subgrouping results are interpreted, it is timely to open discussion regarding a conceptual framework for the research designs and statistical methods available for subgrouping...

  6. Stress is dominant in patients with depression and chronic low back pain. A qualitative study of psychotherapeutic interventions for patients with non-specific low back pain of 3–12 months’ duration

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    Ellegaard Hanne

    2012-09-01

    Full Text Available Abstract Background There is continuing uncertainty in back pain research as to which treatment is best suited to patients with non-specific chronic low back pain (CLBP. In this study, Gestalt therapy and the shock trauma method Somatic Experiencing® (SE were used as interventions in parallel with the usual cross-disciplinary approach. The aim was to investigate how these treatments influence a patient’s capacity to cope with CLBP when it is coupled with depression. Methods In this qualitative explorative study, a phenomenological–hermeneutic framework was adopted. Patients were recruited on the basis of following criteria: A moderate depression score of 23–30 according to the Beck Depression Inventory Scale and a pain score of 7–10 (Box scale from 0–10 and attendance at five- six psychotherapeutic sessions. Six patients participated in the study. The data was comprised of written field notes from each session, which were subsequently analysed and interpreted at three levels: naive reading, structural analysis and critical interpretation and discussion. Results Three areas of focus emerged: the significance of previous experiences, restrictions in everyday life and restoration of inner resources during the therapy period. The study revealed a diversity of psychological stressors that related to loss and sorrow, being let down, violations, traumatic events and reduced functioning, which led to displays of distress, powerlessness, reduced self-worth, anxiety and discomfort. Overall, the sum of the stressors together with pain and depression were shown to trigger stress symptoms. Stress was down-played in the psychotherapeutic treatment and inner resources were re-established, which manifested as increased relaxation, presence, self-worth, sense of responsibility and happiness. This, in turn, assisted the patients to better manage their CLBP. Conclusions CLBP is a stress factor in itself but when coupled with depression, they can be

  7. Effectiveness of anodal transcranial direct current stimulation in patients with chronic low back pain: Design, method and protocol for a randomised controlled trial

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    Luedtke Kerstin

    2011-12-01

    Full Text Available Abstract Background Electrical stimulation of central nervous system areas with surgically implanted stimulators has been shown to result in pain relief. To avoid the risks and side effects of surgery, transcranial direct current stimulation is an option to electrically stimulate the motor cortex through the skull. Previous research has shown that transcranial direct current stimulation relieves pain in patients with fibromyalgia, chronic neuropathic pain and chronic pelvic pain. Evidence indicates that the method is pain free, safe and inexpensive. Methods/Design A randomised controlled trial has been designed to evaluate the effect of transcranial direct current stimulation over the motor cortex for pain reduction in patients with chronic low back pain. It will also investigate whether transcranial direct current stimulation as a prior treatment enhances the symptom reduction achieved by a cognitive-behavioural group intervention. Participants will be randomised to receive a series of 5 days of transcranial direct current stimulation (2 mA, 20 mins or 20 mins of sham stimulation; followed by a cognitive-behavioural group programme. The primary outcome parameters will measure pain (Visual Analog Scale and disability (Oswestry Disability Index. Secondary outcome parameters will include the Fear Avoidance Beliefs Questionnaire, the Funktionsfragebogen Hannover (perceived function, Hospital Anxiety Depression Scale, bothersomeness and Health Related Quality of Life (SF 36, as well as Patient-Perceived Satisfactory Improvement. Assessments will take place immediately prior to the first application of transcranial direct current stimulation or sham, after 5 consecutive days of stimulation, immediately after the cognitive-behavioural group programme and at 4 weeks, 12 weeks and 24 weeks follow-up. Discussion This trial will help to determine, whether transcranial direct current stimulation is an effective treatment for patients with chronic low back

  8. Postural balance in low back pain patients

    DEFF Research Database (Denmark)

    Maribo, Thomas; Schiøttz-Christensen, Berit; Jensen, Lone Donbæk

    2012-01-01

    INTRODUCTION: Altered postural control has been observed in low back pain (LBP) patients. They seem to be more dependent on vision when standing. The objective of the study was to determine concurrent and predictive validity of measures of postural stability in LBP patients. MATERIALS AND METHODS......: Centre of Pressure (CoP) measurements were tested against pain, fear of pain, and physical function. Velocity, anterior-posterior displacement, and the Romberg Ratio obtained on a portable force platform were used as measures of postural stability. RESULTS: Baseline and 12-week follow-up results of 97....... CONCLUSION: This first study of concurrent and predictive validity of postural balance in LBP patients revealed no association between CoP measures and pain, fear of pain, and physical function....

  9. The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients.

    Science.gov (United States)

    Jeong, Ui-Cheol; Sim, Jae-Heon; Kim, Cheol-Yong; Hwang-Bo, Gak; Nam, Chan-Woo

    2015-12-01

    [Purpose] The aim of this study was to examine the effects of exercise to strengthen the muscles of the hip together with lumbar segmental stabilization exercise on the lumbar disability index, lumbar muscle strength, and balance. [Subjects and Methods] This study randomly and equally assigned 40 participants who provided written consent to participate in this study to a lumbar segmental stabilization exercise plus exercise to strengthen the muscles of the gluteus group (SMG + LES group) and a lumbar segmental stabilization exercise group. [Results] Each evaluation item showed a statistically significant effect. [Conclusion] Clinical application of exercise in this study showed that lumbar segmental stabilization exercise plus exercise to strengthen the muscles of the gluteus resulted in a greater decrease in low back pain disability index and increase in lumbar muscle strength and balance ability than lumbar segmental stabilization exercise in chronic low back pain patients receiving the exercise treatments during the same period.

  10. A prospective study predicting the outcome of chronic low back pain and physical therapy: the role of fear-avoidance beliefs and extraspinal pain

    Directory of Open Access Journals (Sweden)

    Aloma S.A. Feitosa

    Full Text Available ABSTRACT Objective: To identify the prognostic factors for conventional physical therapy in patients with chronic low back pain (CLBP. Methods: Prospective observational study. Participants: One hundred thirteen patients with CLBP selected at the Spinal Disease Outpatient Clinic. Main outcome measures: Pain intensity was scored using the Numeric Rating Scale (NRS, and function was measured using the Roland-Morris Disability Questionnaire (RMDQ. Results: The Fear-Avoidance Beliefs Questionnaire work subscale results (FABQ-work; odds ratio [OR] = 0.27, 95% confidence interval [CI] 0.13–0.56, p < 0.001 and extraspinal pain (OR = 0.35, 95% CI 0.17–0.74, p = 0.006 were independently associated with a decreased response to conventional physical therapy for CLBP. Conclusion: We identified high FABQ-work and extraspinal pain scores as key determinants of a worse response to physical therapy among CLBP patients, supporting the need for a special rehabilitation program for this subgroup.

  11. Effects in Short and Long Term of Global Postural Reeducation (GPR on Chronic Low Back Pain: A Controlled Study with One-Year Follow-Up

    Directory of Open Access Journals (Sweden)

    Chiara Castagnoli

    2015-01-01

    Full Text Available Objective. Comparing global postural reeducation (GPR to a standard physiotherapy treatment (PT based on active exercises, stretching, and massaging for improving pain and function in chronic low back pain (CLBP patients. Design. Prospective controlled study. Setting. Outpatient rehabilitation facility. Participants. Adult patients with diagnosis of nonspecific, chronic (>6 months low back pain. Interventions. Both treatments consisted of 15 sessions of one hour each, twice a week including patient education. Measures. Roland Morris Disability Questionnaire to evaluate disability, and Numeric Analog Scale for pain. A score change >30% was considered clinically significant. Past treatments, use of medications, smoking habits, height, weight, profession, and physical activity were also recorded on baseline, on discharge, and 1 year after discharge (resp., T0, T1, and T2. Results. At T0 103 patients with cLBP (51 cases and 52 controls were recruited. The treatment (T1 has been completed by 79 (T1 of which 60 then carried out the 1-year follow-up (T2. Both GPR and PT at T1 were associated with a significant statistical and clinical improvement in pain and function, compared to T0. At T2, only pain in GPR still registered a statistically significant improvement.

  12. Making Better Lives: Patient-Focused Care for Low Back Pain (LBP)

    Science.gov (United States)

    2017-01-13

    Chronic Low Back Pain; Hip Ostearthritis; Myofascial Pain Syndrome; Fibromyalgia; Depression; Maladaptive Coping; Lumbar Spinal Stenosis; Insomnia; Sacroiliac Joint Pain; Lateral Hip and Thigh Pain; Anxiety; Dementia; Recent Leg Length Discrepancy

  13. Differences in performance on the functional movement screen between chronic low back pain patients and healthy control subjects.

    Science.gov (United States)

    Ko, Min-Joo; Noh, Kyung-Hee; Kang, Min-Hyeok; Oh, Jae-Seop

    2016-07-01

    [Purpose] Differences in scores on the Functional Movement Screen between patients with chronic lower back pain and healthy control subjects were investigated. [Subjects and Methods] In all, 20 chronic lower back pain patients and 20 healthy control subjects were recruited. Chronic lower back pain patients and healthy controls performed the Functional Movement Screen (deep squat, hurdle step, inline lunge, shoulder mobility, active straight leg raise, trunk stability pushup, and rotary stability). The Mann-Whitney test was used to analyze differences in Functional Movement Screen scores between the two groups. [Results] Chronic lower back pain patients scored lower on the Functional Movement Screen total composite compared with healthy control subjects. Chronic lower back pain patients scored lower on Functional Movement Screen subtests including the deep squat, hurdle step, active straight leg raise, and rotary stability tests. [Conclusion] The deep squat, hurdle step, active straight leg raise, and rotary stability tasks of the Functional Movement Screen can be recommended as a functional assessment tools to identify functional deficits in chronic lower back pain patients.

  14. Low back pain and degenerative disc disease

    Directory of Open Access Journals (Sweden)

    Jandrić Slavica

    2006-01-01

    Full Text Available Introduction. Various clinical conditions can cause low back pain, and in most cases it is of a degenerative origin. Degenerative disc disease is a common condition which affects young to middle-aged men and women equally. Changes in the mechanical properties of the disc lead to degenerative arthritis in the intervertebral joints, osteophytes, and narrowing the intervertebral foramen or the spinal canal. Pathophysiology. Degenerative cascade, described by Kirkaldy-Willis, is the widely accepted pathophysiologic model describing the degenerative process as it affects the lumbar spine in 3 phases. Diagnosis. There are two forms of low back pain secondary to degenerative disc disease: a lumbalgia and b lumbar radiculopathy. Limitation of movement, problems with balance, pain, loss of reflexes in the extremities, muscle weakness, loss of sensation or other signs of neurological damage can be found on physical examination. For accurate diagnosis, it is often necessary to combine clinical examination and sophisticated technology. Treatment. Coservative treatment consists of rest, physical therapy, pharmacological therapy and injection therapy. Physical rehabilitation with active patient participation is a key approach to treatment of patients with discogenic pain. Physical therapy, occupational therapy and kinesitherapy are important for improving muscle strength, endurance, and flexibility. Disc surgery is performed if surgical intervention is required. .

  15. Intradiscal and intra-articular facet infiltrations with plasma rich in growth factors reduce pain in patients with chronic low back pain

    Science.gov (United States)

    Kirchner, Fernando; Anitua, Eduardo

    2016-01-01

    Context: Low back pain (LBP) is a complex and disabling condition, and its treatment becomes a challenge. Aims: The aim of our study was to assess the clinical outcome of plasma rich in growth factors (PRGF-Endoret) infiltrations (one intradiscal, one intra-articular facet, and one transforaminal epidural injection) under fluoroscopic guidance-control in patients with chronic LBP. PRGF-Endoret which has been shown to be an efficient treatment to reduce joint pain. Settings and Design: The study was designed as an observational retrospective pilot study. Eighty-six patients with a history of chronic LBP and degenerative disease of the lumbar spine who met inclusion and exclusion criteria were recruited between December 2010 and January 2012. Subjects and Methods: One intradiscal, one intra-articular facet, and one transforaminal epidural injection of PRGF-Endoret under fluoroscopic guidance-control were carried out in 86 patients with chronic LBP in the operating theater setting. Statistical Analysis Used: Descriptive statistics were performed using absolute and relative frequency distributions for qualitative variables and mean values and standard deviations for quantitative variables. The nonparametric Friedman statistical test was used to determine the possible differences between baseline and different follow-up time points on pain reduction after treatment. Results: Pain assessment was determined using a visual analog scale (VAS) at the first visit before (baseline) and after the procedure at 1, 3, and 6 months. The pain reduction after the PRGF-Endoret injections showed a statistically significant drop from 8.4 ± 1.1 before the treatment to 4 ± 2.6, 1.7 ± 2.3, and 0.8 ± 1.7 at 1, 3, and 6 months after the treatment, respectively, with respect to all the time evaluations (P < 0.0001) except for the pain reduction between the 3rd and 6th month whose signification was lower (P < 0.05). The analysis of the VAS over time showed that at the end point of the

  16. Comparing Once- versus Twice-Weekly Yoga Classes for Chronic Low Back Pain in Predominantly Low Income Minorities: A Randomized Dosing Trial.

    Science.gov (United States)

    Saper, Robert B; Boah, Ama R; Keosaian, Julia; Cerrada, Christian; Weinberg, Janice; Sherman, Karen J

    2013-01-01

    Background. Previous studies have demonstrated that once-weekly yoga classes are effective for chronic low back pain (cLBP) in white adults with high socioeconomic status. The comparative effectiveness of twice-weekly classes and generalizability to racially diverse low income populations are unknown. Methods. We conducted a 12-week randomized, parallel-group, dosing trial for 95 adults recruited from an urban safety-net hospital and five community health centers comparing once-weekly (n = 49) versus twice-weekly (n = 46) standardized yoga classes supplemented by home practice. Primary outcomes were change from baseline to 12 weeks in pain (11-point scale) and back-related function (23-point modified Roland-Morris Disability Questionnaire). Results. 82% of participants were nonwhite; 77% had annual household incomes back pain and impairment. Pain and back-related function improved within both groups (P yoga classes were similarly effective for predominantly low income minority adults with moderate to severe chronic low back pain. This trial is registered with ClinicalTrials.gov NCT01761617.

  17. Chronic Pain

    Science.gov (United States)

    ... a problem you need to take care of. Chronic pain is different. The pain signals go on ... there is no clear cause. Problems that cause chronic pain include Headache Low back strain Cancer Arthritis ...

  18. Postural balance in low back pain patients

    DEFF Research Database (Denmark)

    Maribo, Thomas; Stengaard-Pedersen, Kristian; Jensen, Lone Donbæk

    2011-01-01

    Low back pain (LBP) patients have poorer postural control compared to healthy controls, and the importance of assessing and addressing balance is a matter of debate. In the clinic, balance is often tested by means of the one leg stand test (OLST) while research often employs center of pressure (Co...... Ratio) might be of clinical interest. This study aimed to assess postural balance in LBP patients by analyzing intra-session reliability of CoP parameters on a portable force platform, the Romberg Ratio, and the OLST. Furthermore, we aimed to determine whether CoP parameters and OLST measure identical...

  19. Imaging-guided hyperstimulation analgesia in low back pain

    Directory of Open Access Journals (Sweden)

    Gorenberg M

    2013-06-01

    Full Text Available Miguel Gorenberg,1,2 Kobi Schwartz31Department of Nuclear Medicine, B'nai Zion Medical Center, Haifa, Israel; 2The Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; 3Department of Physical Therapy, B'nai Zion Medical Center, Haifa, IsraelAbstract: Low back pain in patients with myofascial pain syndrome is characterized by painful active myofascial trigger points (ATPs in muscles. This article reviews a novel, noninvasive modality that combines simultaneous imaging and treatment, thus taking advantage of the electrodermal information available from imaged ATPs to deliver localized neurostimulation, to stimulate peripheral nerve endings (Aδ fibers and in turn, to release endogenous endorphins. "Hyperstimulation analgesia" with localized, intense, low-rate electrical pulses applied to painful ATPs was found to be effective in 95% patients with chronic nonspecific low back pain, in a clinical validation study.Keywords: myofascial, noninvasive, electrical, impedance

  20. The course of low back pain from adolescence to adulthood

    DEFF Research Database (Denmark)

    Hestbaek, Lise; Leboeuf-Yde, Charlotte; Kyvik, Kirsten Ohm

    2006-01-01

    STUDY DESIGN: Prospective study with 8-year follow-up. OBJECTIVE: To describe the evolution of low back pain from adolescence into adulthood. SUMMARY OF BACKGROUND DATA: High prevalence rates of low back pain among children and adolescents have been demonstrated in several studies, and it has been...... questionnaires in 1994 and again in 2002. The questionnaires dealt with various aspects of general health, including the prevalence of low back pain, classified according to number of days affected (0, 1-7, 8-30, >30). RESULTS: Low back pain in adolescence was found to be a significant risk factor for low back...... than 30 days with low back pain during the follow-up year. This was true for only 9% of the rest of the sample. CONCLUSIONS: Our study clearly demonstrates correlations between low back pain in childhood/adolescence and low back pain in adulthood. This should lead to a change in focus from the adult...

  1. Translation, Adaptation, and Validation of Hindi Version of the Pain Catastrophizing Scale in Patients with Chronic Low Back Pain for Use in India.

    Science.gov (United States)

    Bansal, Dipika; Gudala, Kapil; Lavudiya, Sreenu; Ghai, Babita; Arora, Pooja

    2016-10-01

    OBJECTIVES : This study translates the Pain Catastrophizing Scale (PCS) into Hindi and examines the psychometric properties of the translated version (Hindi PCS [Hi-PCS]) in patients with chronic low back pain (CLBP). METHODS : Forward and backward translations were performed from English to Hindi according to standard methodology. A final version was evaluated by a committee of clinical experts and Hi-PCS was then pilot-tested in 10 patients with CLBP. Cross-cultural validation of the resulting adapted Hi-PCS was done by administering Hi-PCS at baseline to 100 patients with CLBP (≥ 12 weeks pain) who were able to read and write in Hindi, and re-administering Hi-PCS after 3 days. Construct validity was assessed using factor analysis. Psychometric properties including internal consistency; test-retest reliability; and convergent validity with pain severity, functional disability, and health-related quality of life (HRQoL) were also assessed. RESULTS : Principal component analysis observed a three-factor structure, which explained 58% of the variance. Confirmatory factor analysis elicited the best fit as judged by the model fit indices. Hi-PCS as a whole was deemed to be internally consistent (Cronbach's α = 0.76). Intraclass correlation coefficient for the Hi-PCS is 0.923 (95% CI: 0.875-0.953). Hi-PCS was moderately correlated with pain intensity (r = 0.651) and functional disability (r = 0.352), and negatively correlated with QoL (r = -0.380). CONCLUSIONS : PCS translation and cross-cultural adaptation to Hindi demonstrated good factor structure along adequate psychometric properties and could be recommended for use in CLBP research in India.

  2. Cost-effectiveness analysis of pregabalin for treatment of chronic low back pain in patients with accompanying lower limb pain (neuropathic component in Japan

    Directory of Open Access Journals (Sweden)

    Igarashi A

    2015-10-01

    Full Text Available Ataru Igarashi,1 Manabu Akazawa,2 Tatsunori Murata,3 Toshihiko Taguchi,4 Alesia Sadosky,5 Nozomi Ebata,6 Richard Willke,5 Koichi Fujii,6 Jim Doherty,5 Makoto Kobayashi3 1Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan; 2Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan; 3CRECON Medical Assessment Inc., Tokyo, Japan; 4Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan; 5Pfizer Inc., New York, NY, USA; 6Pfizer Japan, Inc., Tokyo, Japan Objective: To assess the cost-effectiveness of pregabalin for the treatment of chronic low back pain with accompanying neuropathic pain (CLBP-NeP from the health care payer and societal perspectives. Methods: The cost-effectiveness of pregabalin versus usual care for treatment of CLBP-NeP was evaluated over a 12-month time horizon using the incremental cost-effectiveness ratio (ICER. Quality-adjusted life years (QALYs, derived from the five-dimension, five-level EuroQol (EQ-5D-5L questionnaire, was the measure of effectiveness. Medical costs and productivity losses were both calculated. Expected costs and outcomes were estimated via cohort simulation using a state-transition model, which mimics pain state transitions among mild, moderate, and severe pain. Distributions of pain severity were obtained from an 8-week noninterventional study. Health care resource consumption for estimation of direct medical costs for pain severity levels was derived from a physician survey. The ICER per additional QALY gained was calculated and sensitivity analyses were performed to evaluate the robustness of the assumptions across a range of values. Results: Direct medical costs and hospitalization costs were both lower in the pregabalin arm compared with usual care. The estimated ICERs in the base case scenarios were approximately ¥2,025,000 and ¥1,435,000 per

  3. [Low back pain during pregnancy. Multidisciplinary approach].

    Science.gov (United States)

    Gallo-Padilla, D; Gallo-Padilla, C; Gallo-Vallejo, F J; Gallo-Vallejo, J L

    2016-09-01

    After explaining that low back pain is considered the most common pregnancy complication, its pathogenesis, risk factors and the clinical characteristics of the very painful symptoms of this condition are described. As for its approach, it is stressed that it must be multidisciplinary, introducing very important preventive measures, including proper postural hygiene. For its treatment, the methods may be based on non-surgical or pharmacological interventions of a conservative non-invasive nature. Thus, physiotherapy, osteopathic manipulation, multimodal intervention (exercise and education), exercises performed in water environment, acupuncture, etc., have proven to be effective. Finally, it is emphasised that given the significant impact on their quality of life, different health professionals must be proactive and treat the lumbar disease in pregnant women.

  4. Self-reported moderate-to-vigorous leisure time physical activity predicts less pain and disability over 12 months in chronic and persistent low back pain

    DEFF Research Database (Denmark)

    Pinto, R Z; Ferreira, P H; Kongsted, Alice

    2014-01-01

    Physical deconditioning in combination with societal and emotional factors has been hypothesized to compromise complete recovery from low back pain (LBP). However, there is a lack of longitudinal studies designed to specifically investigate physical activity as an independent prognostic factor. W...

  5. Physiotherapy in early phase of low back pain

    Directory of Open Access Journals (Sweden)

    Markku Paatelma

    2011-03-01

    Full Text Available Markku PaatelmaDepartment of Education, Auron – OMT Center, Helsinki, FinlandAbstract: Low back pain (LBP is a substantial health problem and has subsequently attracted a considerable amount of research both in the early and chronic phases. Chronic, nonspecific LBP indicates limited effectiveness from most commonly applied interventions and approaches, but it seems to be opposite in the early phase. Intervention is more effective than advice on staying active in acute LBP, leading to more rapid improvement in function, mood, quality of life, and general health. We compared physiotherapy (PT that involved 3–7 treatment sessions based on subclassification in early phase LBP (acute and subacute LBP lasting <3 months to one session of PT that advised staying active, in 134 LBP patients. Low back and leg pain, disability, and days of sick-leave were evaluated. After 12 months, all groups had only minimal pain and disability. In the advice-only group, those patients who had radiating pain had less improvement compared with other groups, and increasing days of sick-leave because of LBP after 12 months. Compared with the advice-only group, orthopedic manual therapy and McKenzie methods seemed to be slightly more effective than one session of assessment in pain and disability.Keywords: OMT, advice, low back pain 

  6. Hypnotic analgesia: 1. Somatosensory event-related potential changes to noxious stimuli and 2. Transfer learning to reduce chronic low back pain.

    Science.gov (United States)

    Crawford, H J; Knebel, T; Kaplan, L; Vendemia, J M; Xie, M; Jamison, S; Pribram, K H

    1998-01-01

    Fifteen adults with chronic low back pain (M = 4 years), age 18 to 43 years (M = 29 years), participated. All but one were moderately to highly hypnotizable (M = 7.87; modified 11-point Stanford Hypnotic Susceptibility Scale, Form C [Weitzenhoffer & Hilgard, 1962]), and significantly reduced pain perception following hypnotic analgesia instructions during cold-pressor pain training. In Part 1, somatosensory event-related potential correlates of noxious electrical stimulation were evaluated during attend and hypnotic analgesia (HA) conditions at anterior frontal (Fp1, Fp2), midfrontal (F3, F4), central (C3, C4), and parietal (P3, P4) regions. During HA, hypothesized inhibitory processing was evidenced by enhanced N140 in the anterior frontal region and by a prestimulus positive-ongoing contingent cortical potential at Fp1 only. During HA, decreased spatiotemporal perception was evidenced by reduced amplitudes of P200 (bilateral midfrontal and central, and left parietal) and P300 (right midfrontal and central). HA led to highly significant mean reductions in perceived sensory pain and distress. HA is an active process that requires inhibitory effort, dissociated from conscious awareness, where the anterior frontal cortex participates in a topographically specific inhibitory feedback circuit that cooperates in the allocation of thalamocortical activities. In Part 2, the authors document the development of self-efficacy through the successful transfer by participants of newly learned skills of experimental pain reduction to reduction of their own chronic pain. Over three experimental sessions, participants reported chronic pain reduction, increased psychological well-being, and increased sleep quality. The development of "neurosignatures of pain" can influence subsequent pain experiences (Coderre, Katz, Vaccarino, & Melzack, 1993; Melzack, 1993) and may be expanded in size and easily reactivated (Flor & Birbaumer, 1994; Melzack, 1991, 1993). Therefore, hypnosis and

  7. Cost-effectiveness analysis of pregabalin for treatment of chronic low back pain in patients with accompanying lower limb pain (neuropathic component) in Japan

    Science.gov (United States)

    Igarashi, Ataru; Akazawa, Manabu; Murata, Tatsunori; Taguchi, Toshihiko; Sadosky, Alesia; Ebata, Nozomi; Willke, Richard; Fujii, Koichi; Doherty, Jim; Kobayashi, Makoto

    2015-01-01

    Objective To assess the cost-effectiveness of pregabalin for the treatment of chronic low back pain with accompanying neuropathic pain (CLBP-NeP) from the health care payer and societal perspectives. Methods The cost-effectiveness of pregabalin versus usual care for treatment of CLBP-NeP was evaluated over a 12-month time horizon using the incremental cost-effectiveness ratio (ICER). Quality-adjusted life years (QALYs), derived from the five-dimension, five-level EuroQol (EQ-5D-5L) questionnaire, was the measure of effectiveness. Medical costs and productivity losses were both calculated. Expected costs and outcomes were estimated via cohort simulation using a state-transition model, which mimics pain state transitions among mild, moderate, and severe pain. Distributions of pain severity were obtained from an 8-week noninterventional study. Health care resource consumption for estimation of direct medical costs for pain severity levels was derived from a physician survey. The ICER per additional QALY gained was calculated and sensitivity analyses were performed to evaluate the robustness of the assumptions across a range of values. Results Direct medical costs and hospitalization costs were both lower in the pregabalin arm compared with usual care. The estimated ICERs in the base case scenarios were approximately ¥2,025,000 and ¥1,435,000 per QALY gained with pregabalin from the payer and societal perspectives, respectively; the latter included indirect costs related to lost productivity. Sensitivity analyses using alternate values for postsurgical pain scores (0 and 5), initial pain severity levels (either all moderate or all severe), and the actual EQ-5D-5L scores from the noninterventional study showed robustness of results, with ICERs that were similar to the base case. Development of a cost-effectiveness acceptability curve showed high probability (≥75%) of pregabalin being cost-effective. Conclusion Using data and assumptions from routine clinical

  8. A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component.

    Science.gov (United States)

    Yousef, A A; Al-deeb, A E

    2013-03-01

    Persistent mechanical irritation of the nerve root sets up a series of events mediating sensitisation of the dorsal roots and dorsal horns in the spinal cord. Current evidence supports the role of magnesium in blocking central sensitisation through its effect on N-methyl-d-aspartate receptors. We studied the role of sequential intravenous and oral magnesium infusion in patients with chronic low back pain with a neuropathic component. We recruited a cohort of 80 patients with chronic low back pain with a Leeds Assessment of Neuropathic Signs and Symptoms pain scale score ≥ 12, who were receiving a physical therapy programme. All patients were treated with anticonvulsants, antidepressants and simple analgesics; in addition 40 patients received placebo for 6 weeks (control group), while the other 40 patients received an intravenous magnesium infusion for 2 weeks followed by oral magnesium capsules for another 4 weeks (magnesium group). Patients were asked to rate their pain using a numerical rating scale. Lumbar spine range of motion was also determined using a long-arm goniometer. In the magnesium group, the patients' numerical rating scales revealed a significant reduction in pain intensity. The mean (SD) pre-treatment value was 7.5 (2.2) compared with 4.7 (1.8) at 6 months (p = 0.034). The reduction in pain intensity was accompanied by significant improvement in lumbar spine range of motion during the follow-up period. The mean (SD) values of flexion, extension and lateral flexion movements before treatment and at 6-month follow up were 22.2 (8.4) vs 34.7 (11.5) (p = 0.018), 11.8 (3.4) vs 16.9 (3.5) (p = 0.039), 11.4 (3.6) vs 17.2 (4.4) (p = 0.035), respectively. Our findings show that a 2-week intravenous magnesium infusion followed by 4 weeks of oral magnesium supplementation can reduce pain intensity and improve lumbar spine mobility during a 6-month period in patients with refractory chronic low back pain with a neuropathic component.

  9. Comparing Once- versus Twice-Weekly Yoga Classes for Chronic Low Back Pain in Predominantly Low Income Minorities: A Randomized Dosing Trial

    Directory of Open Access Journals (Sweden)

    Robert B. Saper

    2013-01-01

    Full Text Available Background. Previous studies have demonstrated that once-weekly yoga classes are effective for chronic low back pain (cLBP in white adults with high socioeconomic status. The comparative effectiveness of twice-weekly classes and generalizability to racially diverse low income populations are unknown. Methods. We conducted a 12-week randomized, parallel-group, dosing trial for 95 adults recruited from an urban safety-net hospital and five community health centers comparing once-weekly (n=49 versus twice-weekly (n=46 standardized yoga classes supplemented by home practice. Primary outcomes were change from baseline to 12 weeks in pain (11-point scale and back-related function (23-point modified Roland-Morris Disability Questionnaire. Results. 82% of participants were nonwhite; 77% had annual household incomes <$40,000. The sample’s baseline mean pain intensity [6.9 (SD 1.6] and function [13.7 (SD 5.0] reflected moderate to severe back pain and impairment. Pain and back-related function improved within both groups (P<0.001. However, there were no differences between once-weekly and twice-weekly groups for pain reduction [-2.1 (95% CI -2.9, -1.3 versus −2.4 (95% CI -3.1, -1.8, P=0.62] or back-related function [-5.1 (95% CI -7.0, -3.2 versus −4.9 (95% CI -6.5, -3.3, P=0.83]. Conclusions. Twelve weeks of once-weekly or twice-weekly yoga classes were similarly effective for predominantly low income minority adults with moderate to severe chronic low back pain. This trial is registered with ClinicalTrials.gov NCT01761617.

  10. Kinesio Taping to generate skin convolutions is not better than sham taping for people with chronic non-specific low back pain: a randomised trial

    Directory of Open Access Journals (Sweden)

    Patrícia do Carmo Silva Parreira

    2014-06-01

    Full Text Available Question: For people with chronic low back pain, does Kinesio Taping, applied according to the treatment manual to create skin convolutions, reduce pain and disability more than a simple application without convolutions? Design: Randomised trial with concealed allocation, intention-to-treat analysis and blinded assessment of some outcomes. Participants: 148 participants with chronic non-specific low back pain. Intervention: Experimental group participants received eight sessions (over four weeks of Kinesio Taping applied according to the Kinesio Taping Method treatment manual (ie, 10 to 15% tension applied in flexion to create skin convolutions in neutral. Control group participants received eight sessions (over four weeks of Kinesio Taping with no tension, creating no convolutions. Outcome measures: The primary outcome measures were pain intensity and disability after the four-week intervention. Secondary outcomes were pain intensity and disability 12 weeks after randomisation, and global perceived effect at both four and 12 weeks after randomisation. Results: Applying Kinesio Tape to create convolutions in the skin did not significantly change its effect on pain (MD–0.4 points, 95% CI–1.3 to 0.4 or disability (MD–0.3 points, 95% CI–1.9 to 1.3 at four weeks. There was a small difference in favour of the experimental group for the secondary outcome of global perceived effect (MD 1.4 points, 95% CI 0.3 to 2.5 at four weeks. No significant between-group differences were observed for the other secondary outcomes. Conclusion: Kinesio Taping applied with stretch to generate convolutions in the skin was no more effective than simple application of the tape without tension for the outcomes measured. These results challenge the proposed mechanism of action of this therapy. Trial registration: Brazilian Registry of Clinical Trials, RBR-7ggfkv. [Parreira PCS, Costa LCM, Takahashi R, Hespanhol Junior LC, da Luz Junior MA, da Silva TM, Costa LOP

  11. Attitudes towards complementary and alternative medicine in chronic pain syndromes: a questionnaire-based comparison between primary headache and low back pain

    Directory of Open Access Journals (Sweden)

    Czaja Eva

    2011-10-01

    Full Text Available Abstract Background Complementary and Alternative Medicine (CAM is widely used and popular among patients with primary headache or low back pain (LBP. Aim of the study was to analyze attitudes of headache and LBP patients towards the use of CAM. Methods Two questionnaire-based surveys were applied comparing 432 primary headache and 194 LBP patients. Results In total, 84.75% of all patients reported use of CAM; with significantly more LBP patients. The most frequently-used CAM therapies in headache were acupuncture (71.4%, massages (56.4%, and thermotherapy (29.2%, in LBP thermotherapy (77.4%, massages (62.7%, and acupuncture (51.4%. The most frequent attitudes towards CAM use in headache vs. LBP: "leave nothing undone" (62.5% vs. 52.1%; p = 0.006, "take action against the disease" (56.8% vs. 43.2%; p = 0.006. Nearly all patients with previous experience with CAM currently use CAM in both conditions (93.6% in headache; 100% in LBP. However, the majority of the patients had no previous experience. Conclusion Understanding motivations for CAM treatment is important, because attitudes derive from wishes for non-pharmacological treatment, to be more involved in treatment and avoid side effects. Despite higher age and more permanent pain in LBP, both groups show high use of CAM with only little specific difference in preferred methods and attitudes towards CAM use. This may reflect deficits and unfulfilled goals in conventional treatment. Maybe CAM can decrease the gap between patients' expectations about pain therapy and treatment reality, considering that both conditions are often chronic diseases, causing high burdens for daily life.

  12. MRI in patients with low back pain

    DEFF Research Database (Denmark)

    Jensen, Rikke Krüger; Manniche, Claus; Leboeuf-Yde, Charlotte

    MRI in LBP patients: good or bad? Background: The routine use of radiology is presently discouraged in patients with low back pain (LBP). MRI provides clinicians and patients with detailed knowledge of the spinal structures and has no known physical side effects. It is possible that detailed...... insight into the pathological changes in LBP patients may affect the management of patients. However, this has never been tested. Until June 2006, all patients at our specialized public out-patient clinic, were referred to MRI on the basis of clinical indications, economic constraints, and availability...... of MRI (the "old" group). As a new approach, all patients with certain criteria are now referred to MRI before the clinical examination (the "new" group).   Objectives: The aims of this study were to investigate if the two different MRI approaches, the "old" and "new", resulted in differences in relation...

  13. Expectation of recovery from low back pain

    DEFF Research Database (Denmark)

    Kongsted, Alice; Vach, Werner; Axø, Marie

    2014-01-01

    Study Design. A prospective cohort study conducted in general practice (GP) and chiropractic practice (CP).Objectives. To explore which patient characteristics were associated with recovery expectations in low back pain (LBP) patients, whether expectations predicted 3-month outcome, and to what...... extent expectations were associated with empirical prognostic factors.Summary of Background Data. Patients' recovery expectations have been associated with prognosis, but it is largely unknown why patients expect what they do, and how expectations relate to other prognostic factors.Methods. 1169...... participants completed questionnaires at their first consultation due to LBP and 78% were followed for 3 months. At baseline, recovery expectations were measured on a 0-10 scale. Outcome measures were LBP intensity and Global Perceived Effect (GPE). Associations were tested in regression models...

  14. Psychological Distress in Acute Low Back Pain

    DEFF Research Database (Denmark)

    Shaw, William S; Hartvigsen, Jan; Woiszwillo, Mary J

    2016-01-01

    OBJECTIVE: To characterize the measurement scales and levels of psychological distress reported among published studies of acute low back pain (LBP) in the scientific literature. DATA SOURCES: Peer-reviewed scientific literature found in 8 citation index search engines (CINAHL, Embase, MANTIS, Psyc......INFO, PubMed, Web of Science, AMED, and Academic Search Premier) for the period from January 1, 1966, to April 30, 2015, in English, Danish, Norwegian, and Swedish languages. STUDY SELECTION: Cross-sectional, case-control, cohort, or randomized controlled trials assessing psychological distress...... (study populations, definitions of LBP, distress measures) were systematically extracted and reviewed for risk of bias. Distress measures were described, and data were pooled in cases of identical measures. Reported levels of distress were contextualized using available population norms, clinical...

  15. Low Back Pain in Primary Care

    DEFF Research Database (Denmark)

    Hestbæk, Lise; Munck, Anders; Hartvigsen, Lisbeth;

    2014-01-01

    Study Design. Baseline description of a multicenter cohort study. Objective. To describe patients with low back pain (LBP) in both chiropractic and general practice in Denmark. Background. To optimize standards of care in the primary healthcare sector, detailed knowledge of the patient populations...... in different settings is needed. In Denmark, most LBP-patients access primary healthcare through chiropractic or general practice. Methods. Chiropractors and general practitioners recruited adult patients seeking care for LBP. Extensive baseline questionnaires were obtained and descriptive analyses presented...... separately for general and chiropractic practice patients, Mann-Whitney rank sum test and Pearson's chi-square test, were used to test for differences between the two populations. Results. Questionnaires were returned from 934 patients in chiropractic practice and 319 patients from general practice. Four out...

  16. How is trunk muscle activity during forward bending in standing in chronic non-specific low back pain patients presenting with psychosocial characteristics such as fear avoidance beliefs, pain catastrophizing or kinesiophobia? A systematic review of the literature

    DEFF Research Database (Denmark)

    Sørensen, Brian Østergaard

    2016-01-01

    Low back pain (LBP) is the most common single reason for addressing the health care system due to musculoskeletal pain. More than 80% will experience LBP at some point in life; 6 - 10% of those experiencing LBP will develop persistent and chronic pain with great variance in level of disability...... and pain. Research indicates that LBP is multifactorial and calls for a biopsychosocial model when approaching the patient experiencing LBP. Despite this recognition LBP is poorly understood. A factor for debate has been the contribution of pain-related fear regarding maintenance of chronicity. Recently...

  17. Diagnosis and management of low back pain and sciatica.

    Science.gov (United States)

    Wheeler, A H

    1995-10-01

    Acute low back pain with associated sciatica is usually a benign, self-limited disorder. Appropriate medical treatment may include passive forms of physical therapy, including McKenzie exercises, manipulation, medication and therapeutic injections. After pain is controlled, the patient should be taught self-management techniques, including exercises and ergonomic protection of the spine. Evidence is increasing that exercise programs are effective, although the optimal regimen has yet to be defined and may vary from patient to patient. Chronic low back pain is a complex disorder that must be managed aggressively with a multidisciplinary approach that addresses physical, psychologic and socioeconomic aspects of the illness. Self-administered traction, corsets, medications and other treatment methods may prove to be useful adjuncts to an active program of exercise and education that promotes functional restoration.

  18. Yoga and pilates in the management of low back pain.

    Science.gov (United States)

    Sorosky, Susan; Stilp, Sonja; Akuthota, Venu

    2008-03-01

    Many interventions for the management of low back pain exist, however most have modest efficacy at best, and there are few with clearly demonstrated benefits once pain becomes chronic. Therapeutic exercise, on the other hand, does appear to have significant benefits for managing patients with chronic low back pain (CLBP) in terms of decreasing pain and improving function. In addition, because chronic pain is complex and does not fit a simple model, there have also been numerous trials investigating and demonstrating the efficacy of multidisciplinary pain programs for CLBP. It follows that interventions that treat more than one aspect of LBP would have significant benefits for this patient population. Yoga and Pilates which have, both been gaining in popularity over the last decade are two mind-body exercise interventions that address both the physical and mental aspects of pain with core strengthening, flexibility, and relaxation. There has been a slow evolution of these nontraditional exercise regimens into treatment paradigms for LBP, although few studies examining their effects have been published. The following article will focus on the scientific and theoretical basis of using yoga and Pilates in the management of CLBP.

  19. Epidural injections with or without steroids in managing chronic low back pain secondary to lumbar spinal stenosis: a meta-analysis of 13 randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Meng H

    2015-08-01

    Full Text Available Hai Meng, Qi Fei, Bingqiang Wang, Yong Yang, Dong Li, Jinjun Li, Nan Su Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China Background: Epidural injections of anesthetic with or without steroids are widely used for treating lumbar spinal stenosis, a common cause of chronic low back pain, but there is a lack of rigorous data comparing the effectiveness of epidural injections of anesthetic with and without steroids. This meta-analysis presents a current, comprehensive picture of how epidural injections of anesthetic with steroids compare with those using local anesthetic alone.Methods: PubMed, Embase, Web of Science, and Cochrane Library databases were searched from their inception through February 5, 2015. Weight mean difference, risk ratio, and 95% confidence intervals were calculated. A random effects model or fixed effects model was used to pool the estimates, according to the heterogeneity between the included studies.Results: We included 13 randomized controlled trials, involving 1,465 patients. Significant pain relief (≥50% was demonstrated in 53.7% of patients administered with epidural injections of anesthetic with steroids (group 1 and in 56.4% of those administered with local anesthetic alone (group 2. Patients showed a reduction in numeric rating scale pain score of 3.7 and 3.6 in the two groups, respectively. Significant functional improvement was achieved in 65.2% of patients in group 1 and 63.1% of patients in group 2, with Oswestry Disability Index reductions of 13.8 and 14.5 points, respectively. The overall number of injections per year was 3.2±1.3 and 3.4±1.2 with average total relief per year of 29.3±19.7 and 33.8±19.3 weeks, respectively. The opioid intakes decreased from baseline by 12.4 and 7.8 mg, respectively. Among the outcomes listed, only total relief time differed significantly between the two groups.Conclusion: Both epidural injections with

  20. Improvements in tissue blood flow and lumbopelvic stability after lumbopelvic core stabilization training in patients with chronic non-specific low back pain.

    Science.gov (United States)

    Paungmali, Aatit; Henry, Leonard Joseph; Sitilertpisan, Patraporn; Pirunsan, Ubon; Uthaikhup, Sureeporn

    2016-01-01

    [Purpose] This study investigated the effects of lumbopelvic stabilization training on tissue blood flow changes in the lumbopelvic region and lumbopelvic stability compared to placebo treatment and controlled intervention among patients with chronic non-specific low back pain. [Subjects and Methods] A total of 25 participants (7 males, 18 females; mean age, 33.3 ± 14.4 years) participated in this within-subject, repeated-measures, double-blind, placebo-controlled comparison trial. The participants randomly underwent three types of interventions that included lumbopelvic stabilization training, placebo treatment, and controlled intervention with 48 hours between sessions. Lumbopelvic stability and tissue blood flow were measured using a pressure biofeedback device and a laser Doppler flow meter before and after the interventions. [Results] The repeated-measures analysis of variance results demonstrated a significant increase in tissue blood flow over the lumbopelvic region tissues for post- versus pre-lumbopelvic stabilization training and compared to placebo and control interventions. A significant increase in lumbopelvic stability before and after lumbopelvic stabilization training was noted, as well as upon comparison to placebo and control interventions. [Conclusion] The current study supports an increase in tissue blood flow in the lumbopelvic region and improved lumbopelvic stability after core training among patients with chronic non-specific low back pain.

  1. Cumulative mechanical low-back load at work is a determinant of low-back pain

    NARCIS (Netherlands)

    Coenen, P.; Kingma, I.; Boot, C.R.L.; Bongers, P.M.; Dieën, J.H. van

    2014-01-01

    Objectives: Reported associations of physical exposures during work (eg, lifting, trunk flexion or rotation) and low-back pain (LBP) are rather inconsistent. Mechanical back loads (eg, moments on the low back) as a result of exposure to abovementioned risk factors have been suggested to be important

  2. Dor lombar crônica: intensidade de dor, incapacidade e qualidade de vida Chronic low back pain: pain intensity, disability and quality of life

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    Thais Stefane

    2013-01-01

    Full Text Available OBJETIVO: Avaliar a percepção da dor, a incapacidade e qualidade de vida em indivíduos com dor lombar crônica. MÉTODOS: Estudo transversal. Utilizou-se uma escala numérica de 11 pontos para mensurar a intensidade de dor, o questionário de Roland-Morris para incapacidade e WHOQOL-Bref para mensurar a qualidade de vida. Realizou-se análise exploratória, coeficiente de correlação de Spearman e ajustados modelos de regressão linear. RESULTADOS: Amostra de 97 participantes, sendo que a média da incapacidade foi 14,4; da intensidade de dor no momento da entrevista, 5,4; e da qualidade de vida 48,1 pontos. O domínio físico da qualidade de vida foi o mais prejudicado, com 44,1 pontos. CONCLUSÃO: A dor percebida foi considerada de alta intensidade, o nível de incapacidade encontrado foi considerado grave e o domínio físico da qualidade de vida o mais prejudicado e fortemente associado ao nível de incapacidade.OBJECTIVE: To assess perceived pain, disability and quality of life in individuals with chronic low back pain. METHODS: Cross-sectional study. An 11-point numerical scale was used to measure pain intensity, the Roland-Morris questionnaire for disability and the WHOQOL-Bref to measure quality of life. Exploratory analysis and Spearman's correlation coefficient were applied and linear regression models were adjusted. RESULTS: In the sample of 97 participants, the mean disability score was 14.4; mean pain intensity score at the moment of the interview 5.4; and mean quality of life score 48.1 points. The physical quality of life domain was the most impaired, with a score of 44.1 points. CONCLUSION: The perceived pain intensity was considered high, the disability level found was considered severe and the physical quality of life domain appeared as the most impaired and strongly associated with the disability level.

  3. Myofascial low back pain: a review.

    Science.gov (United States)

    Malanga, Gerard A; Cruz Colon, Eduardo J

    2010-11-01

    Myofascial pain syndrome is a common nonarticular local musculoskeletal pain syndrome caused by myofascial trigger points located at muscle, fascia, or tendinous insertions, affecting up to 95% of people with chronic pain disorders. Clinically, myofascial pain syndrome can present as painful restricted range of motion, stiffness, referred pain patterns, and autonomic dysfunction. The underlying cause is often related to muscular imbalances, and following a thorough physical examination the condition should be treated with a comprehensive rehabilitation program. Additional treatment options include pharmacologic, needling with or without anesthetic agents or nerve stimulation, and alternative medicine treatments such as massage or herbal medicines. Repeated trigger point injections should be avoided, and corticosteroids should not be injected into trigger points.

  4. Kinesio Taping Does Not Provide Additional Benefits in Patients With Chronic Low Back Pain Who Receive Exercise and Manual Therapy: A Randomized Controlled Trial.

    Science.gov (United States)

    Added, Marco Aurélio Nemitalla; Costa, Leonardo Oliveira Pena; de Freitas, Diego Galace; Fukuda, Thiago Yukio; Monteiro, Renan Lima; Salomão, Evelyn Cassia; de Medeiros, Flávia Cordeiro; Costa, Lucíola da Cunha Menezes

    2016-07-01

    Study Design Randomized controlled trial. Background Many clinical practice guidelines endorse both manual therapy and exercise as effective treatment options for patients with low back pain. To optimize the effects of the treatments recommended by the guidelines, a new intervention known as Kinesio Taping is being widely used in these patients. Objectives To determine the effectiveness of Kinesio Taping in patients with chronic nonspecific low back pain when added to a physical therapy program consisting of exercise and manual therapy. Methods One hundred forty-eight patients with chronic nonspecific low back pain were randomly allocated to receive 10 (twice weekly) sessions of physical therapy, consisting of exercise and manual therapy, or the same treatment with the addition of Kinesio Taping applied to the lower back. The primary outcomes were pain intensity and disability (5 weeks after randomization) and the secondary outcomes were pain intensity, disability (3 months and 6 months after randomization), global perceived effect, and satisfaction with care (5 weeks after treatment). Data were collected by a blinded assessor. Results No between-group differences were observed in the primary outcomes of pain intensity (mean difference, -0.01 points; 95% confidence interval [CI]: -0.88, 0.85) or disability (mean difference, 1.14 points; 95% CI: -0.85, 3.13) at 5 weeks' follow-up. In addition, no between-group differences were observed for any of the other outcomes evaluated, except for disability 6 months after randomization (mean difference, 2.01 points; 95% CI: 0.03, 4.00) in favor of the control group. Conclusion Patients who received a physical therapy program consisting of exercise and manual therapy did not get additional benefit from the use of Kinesio Taping. Level of Evidence Therapy, level 1b. Prospectively registered May 28, 2013 at www.ClinicalTrials.gov (NCT01866332). J Orthop Sports Phys Ther 2016;46(7):506-513. Epub 6 Jun 2016. doi:10.2519/jospt.2016.6590.

  5. Long-term effect of high-intensity laser therapy in the treatment of patients with chronic low back pain: a randomized blinded placebo-controlled trial.

    Science.gov (United States)

    Alayat, Mohamed Salaheldien Mohamed; Atya, Azza Mohamed; Ali, Mohamed Mohamed Ebrahim; Shosha, Tamer Mohamed

    2014-05-01

    The aim of this study was to compare the effect of high-intensity laser therapy (HILT), alone or combined with exercise, in the treatment of chronic low back pain (CLBP). A total of 72 male patients participated in this study, with a mean (SD) age of 32.81 (4.48) years. Patients were randomly assigned into three groups and treated with HILT plus exercise (HILT + EX), placebo laser plus exercise (PL + EX), and HILT alone in groups 1, 2, and 3, respectively. The outcomes measured were lumbar range of motion (ROM), pain level by visual analog scale (VAS), and functional disability by both the Roland Disability Questionnaire (RDQ) and the Modified Oswestry Disability Questionnaire (MODQ). Statistical analyses were performed to compare the differences between baseline and post-treatment measurements. The level of statistical significance was set as P laser with exercise.

  6. [Episacral lipoma: a treatable cause of low back pain].

    Science.gov (United States)

    Erdem, Hatice Rana; Nacır, Barış; Özeri, Zuhal; Karagöz, Aynur

    2013-01-01

    Episacral lipoma is a small, tender subcutaneous nodule primarily occurring over the posterior iliac crest. Episacral lipoma is a significant and treatable cause of acute and chronic low back pain. Episacral lipoma occurs as a result of tears in the thoracodorsal fascia and subsequent herniation of a portion of the underlying dorsal fat pad through the tear. This clinical entity is common, and recognition is simple. The presence of a painful nodule with disappearance of pain after injection with anaesthetic, is diagnostic. Medication and physical therapy may not be effective. Local injection of the nodule with a solution of anaesthetic and steroid is effective in treating the episacral lipoma. Here we describe 2 patients with painful nodules over the posterior iliac crest. One patient complained of severe lower back pain radiating to the left lower extremity and this patient subsequently underwent disc operation. The other patient had been treated for greater trochanteric pain syndrome. In both patients, symptoms appeared to be relieved by local injection of anaesthetic and steroid. Episacral lipoma should be considered during diagnostic workup and in differential diagnosis of acute and chronic low back pain.

  7. Tratamiento multidisciplinar para el dolor lumbar crónico: Programa de musicoterapia Multimodal treatmaent of chronic low back pain: A music therapy program

    Directory of Open Access Journals (Sweden)

    A. Alonso-Cardaño

    2008-05-01

    . Objective. To examine the influence of a musictherapy program on chronic low back pain patients related to coping strategies. Material an method. 14 patients from the Pain Unit in the San Pedro Hospital of Logroño were included in a music-therapy program during six weeks with a dignosis of chronic low back pain. Subjects were weekly visited by a music therapist, 60 min per sesión. All the patients answered a questionnarie to evalúate the used coping strategies to pain (CAD, in the first and the end visits. In adittion, a severity pain scale (VAS was answered twice in each interventional session. Results. The pain coping strategy more frecuently used was information seeking. All strategies shown better results at the end of the program, but only two of them had significant results: information seeking, catarsis, and distraction. Conclusión. The music-therapy program increased the more active pain coping estrategies that are possitively associated to a better degree of adjustment of the patient with chronic low back pain.

  8. Low Back Pain - Management Perspective Of A commonly Encountered Problem

    Directory of Open Access Journals (Sweden)

    Parharaj S S

    2004-01-01

    Full Text Available Low Back pain is a very common symptom affecting the general population, incurring a huge annual societal cost. In spite of this, it remains very commonly misdiagnosed and maltreated. The majority of benign chronic low back pain patients suffer from a combination of myofascial frozen back syndrome with or without an overly of psychosocioeconomic factors. Neural compression causes are less frequent. A though evaluation of the patient to select the most rational therapeutic approach is necessary. In majority of the patients, a well planned out rehabilitation programme is useful. Surgery is indicated in a minority with neural compression or spinal instability, motivation is essential as rehabilitation and surgery have a high failure rate in inadequately motivated patients with psychosocioeconomic dysfunction.

  9. Trunk coordination in healthy and chronic nonspecific low back pain subjects during repetitive flexion-extension tasks: Effects of movement asymmetry, velocity and load.

    Science.gov (United States)

    Mokhtarinia, Hamid Reza; Sanjari, Mohammad Ali; Chehrehrazi, Mahshid; Kahrizi, Sedigheh; Parnianpour, Mohamad

    2016-02-01

    Multiple joint interactions are critical to produce stable coordinated movements and can be influenced by low back pain and task conditions. Inter-segmental coordination pattern and variability were assessed in subjects with and without chronic nonspecific low back pain (CNSLBP). Kinematic data were collected from 22 CNSLBP and 22 healthy volunteers during repeated trunk flexion-extension in various conditions of symmetry, velocity, and loading; each at two levels. Sagittal plane angular data were time normalized and used to calculate continuous relative phase for each data point. Mean absolute relative phase (MARP) and deviation phase (DP) were derived to quantify lumbar-pelvis and pelvis-thigh coordination patterns and variability. Statistical analysis revealed more in-phase coordination pattern in CNSLBP (p=0.005). There was less adaptation in the DP for the CNSLBP group, as shown by interactions of Group by Load (p=.008) and Group by Symmetry by Velocity (p=.03) for the DP of pelvis-thigh and lumbar-pelvis couplings, respectively. Asymmetric (pvelocity conditions (p<0.001). In conclusion, coordination pattern and variability could be influenced by trunk flexion-extension conditions. CNSLBP subjects demonstrated less adaptability of movement pattern to the demands of the flexion-extension task.

  10. Low back pain during labor and related factors.

    Science.gov (United States)

    Tzeng, Ya-Ling; Su, Tsann-Juu

    2008-09-01

    A substantial proportion of women in labor suffer from low back pain, yet this issue has only been specifically evaluated in a few Western studies. The purpose of this research was to (1) describe the following characteristics of low back pain during labor: prevalence, anatomic region(s) affected, type, pattern, intensity trend, effective interventions, and exacerbating factors; (2) identify the factors relating to intrapartum low back pain in Taiwan women. A correlational design with repeated measures was used to conduct this investigation. Ninety-three low-risk women in labor were recruited from a medical center in central Taiwan. Low back pain was repeatedly measured during the latent phase (cervix dilated 2-4 cm), early active phase (cervix dilated 5-7 cm), and late active phase (cervix dilated 8-10 cm) of labor. Data were analyzed using descriptive statistics, repeated measurement ANOVA, and logistic regression. The results showed as many as 75.3% of the participants suffered episodes of low back pain during labor. The mean pain scores were 36.66-76.20 in the various stages of labor. Pain intensified as labor progressed. The location of the pain also changed with the progression of labor. The type of low back pain in 54.29% of women in labor was "muscle soreness and pain"; The pattern of pain in 45.71% women was continuous. Massage was chosen as the most effective intervention to alleviate low back pain by 65.3% of women. The women in labor who suffered from low back pain during pregnancy (OR = 3.23; p low back pain group. In conclusion, our study demonstrates low back pain intensified with the progression of labor, suggesting early prevention is necessary, especially in the case of women who had low back pain during pregnancy and heavier body weight when hospitalized.

  11. Low back pain and lumbar angles in Turkish coal miners

    Energy Technology Data Exchange (ETDEWEB)

    Sarikaya, S.; Ozdolap, S.; Gumustas, S.; Koc, U. [Zonguldak Karaelmas University, Zonguldak (Turkey). Faculty of Medicine

    2007-02-15

    This study was designed to assess the incidence of low back pain among Turkish coal miners and to investigate the relationship between angles of the lumbar spine and low back pain in coal miners. Fifty underground workers (Group I) and 38 age-matched surface workers (Group II) were included in the study. All the subjects were asked about low back pain in the past 5 years. The prevalence of low back pain was higher in Group I than in Group II (78.0%, 32.4%, respectively, P {lt} 0.001). The results of the study showed that low back pain occurred in 78.0% of Turkish coal miners. Although the nature of the occupation may have influenced coal miners' lumbar spinal curvature, lumbar angles are not a determinant for low back pain in this population. Further extensive studies involving ergonomic measurements are needed to validate our results for Turkish coal mining industry.

  12. Atypical low back pain: stiff-person syndrome.

    Science.gov (United States)

    Gallien, Philippe; Durufle, Aurélie; Petrilli, Sabine; Verin, Marc; Brissot, Régine; Robineau, Sandrine

    2002-03-01

    Stiff-person syndrome was diagnosed in a patient with chronic low back pain. The diagnosis of this rare neurological condition rests mainly on the clinical findings of axial and proximal limb rigidity, increased lumbar lordosis often accompanied with pain, and normal neurological findings apart from brisk deep tendon reflexes. Electromyography of the lumbar paraspinal muscles shows motor unit firing at rest with normal appearance of the motor unit potentials. Titers of antibody to glutamic acid decarboxylase are elevated. Diazepam is the treatment of reference. Physical therapy can substantially improve quality of life.

  13. Prognosis and Course of Disability in Patients With Chronic Nonspecific Low Back Pain: A 5- and 12-Month Follow-up Cohort Study

    NARCIS (Netherlands)

    Verkerk, K.; Luijsterburg, P.A.J.; Heymans, M.W.; Ronchetti, I.; Pool-Goudzwaard, A.L.; Miedema, H.S.; Koes, B.W.

    2013-01-01

    There is no strong evidence to support the claim that 80% to 90% of patients with low back pain (LBP) become pain-free within 1 month; on average, 62% (range42%–75%) of the patients still experienced back pain after 12 months.1 Studies following patients over a 12-month period have shown that LBP is

  14. Psychopathology predicts the outcome of medial branch blocks with corticosteroid for chronic axial low back or cervical pain: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Tipirneni Naveen

    2009-02-01

    Full Text Available Abstract Background Comorbid psychopathology is an important predictor of poor outcome for many types of treatments for back or neck pain. But it is unknown if this applies to the results of medial branch blocks (MBBs for chronic low back or neck pain, which involves injecting the medial branch of the dorsal ramus nerves that innervate the facet joints. The objective of this study was to determine whether high levels of psychopathology are predictive of pain relief after MBB injections in the lumbar or cervical spine. Methods This was a prospective cohort study. Consecutive patients in a pain medicine practice undergoing MBBs of the lumbar or cervical facets with corticosteroids were recruited to participate. Subjects were selected for a MBB based on operationalized selection criteria and the procedure was performed in a standardized manner. Subjects completed the Brief Pain Inventory (BPI and the Hospital Anxiety and Depression Scale (HADS just prior to the procedure and at one-month follow up. Scores on the HADS classified the subjects into three groups based on psychiatric symptoms, which formed the primary predictor variable: Low, Moderate, or High levels of psychopathology. The primary outcome measure was the percent improvement in average daily pain rating one-month following an injection. Analysis of variance and chi-square were used to analyze the analgesia and functional rating differences between groups, and to perform a responder analysis. Results Eighty six (86 subjects completed the study. The Low psychopathology group (n = 37 reported a mean of 23% improvement in pain at one-month while the High psychopathology group (n = 29 reported a mean worsening of -5.8% in pain (p Low group had at least 30% improvement in pain versus 10% in the High group (p Conclusion Psychiatric comorbidity is associated with diminished pain relief after a MBB injection performed with steroid at one-month follow-up. These findings illustrate the importance

  15. Use of yoga and zhen-jiu (acupuncture therapy in the combination treatment of patients with chronic nonspecific low back pain

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    I. A. Vyshlova

    2015-01-01

    Full Text Available Back pain is encountered in nearly 80–90% of the population; patient management is not only a medical, but also important socioeconomic problem.Objective: to comparatively evaluate the efficiency of yoga and zhen-jiu (acupuncture therapy in the combination treatment of patients with chronic nonspecific low back pain (LBP.Patients and methods. Sixty patients with chronic nonspecific LBP were examined and randomized in groups: 20 patients received symptomatic therapy only (a control group, 20 patients used yoga (Group 1 and 20 more patients had zhen-jiu therapy in addition to symptomatic therapy (Group 2.Results. As compared to the controls, Groups 1 and 2 patients showed a significant increase in the scope of lumbar spine movements and a decrease in the degree of pain syndrome. The investigation demonstrated the efficiency of yoga and zhen-jiu therapy versus symptomatic therapy in the combination treatment of chronic nonspecific LBP, by simultaneously reducing the number of side effects.Conclusion. It is necessary to conduct large controlled randomized studies evaluating the efficiency of yoga and zhen-jiu therapy in these patients.

  16. Effects of transcutaneous electrical nerve stimulation (TENS and interferential currents (IFC in patients with nonspecific chronic low back pain: randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Ligia Maria Facci

    Full Text Available CONTEXT AND OBJECTIVE: Transcutaneous electrical nerve stimulation (TENS and interferential current are the most used electrotherapy methods, although there is little scientific evidence to support their use. The aim of this study was to compare the effects of TENS and interferential current among patients with nonspecific chronic low back pain. DESIGN AND SETTING: Single-blind randomized controlled trial in the Department of Physiotherapy, Centro Universitário de Maringá. METHODS: One hundred and fifty patients were randomly divided into three groups: TENS (group 1, interferential current (group 2 and controls (group 3. The patients designated for electrotherapy received ten 30-minute sessions, while the control group remained untreated. All patients and controls were evaluated before and after treatment using a visual analog scale and the McGill Pain and Roland Morris questionnaires, and regarding their use of additional medications. RESULTS: There was a mean reduction on the visual analog scale of 39.18 mm with TENS, 44.86 mm with interferential current and 8.53 mm among the controls. In the Roland Morris questionnaire, group 1 had a mean reduction of 6.59; group 2, 7.20; and group 3, 0.70 points. In group 1, 84% of the patients stopped using medications after the treatment; in group 2, 75%; and in group 3, 34%. There was no statistically significant difference between the TENS and interferential current groups (P > 0.05; a difference was only found between these groups and the controls (P < 0.0001. CONCLUSION: There was no difference between TENS and interferential current for chronic low back pain treatment. CLINICAL TRIAL REGISTRATION: NCT01017913.

  17. The Back 2 Activity Trial: education and advice versus education and advice plus a structured walking programme for chronic low back pain

    Directory of Open Access Journals (Sweden)

    Bradbury Ian

    2010-07-01

    Full Text Available Abstract Background Current evidence supports the use of exercise-based treatment for chronic low back pain that encourages the patient to assume an active role in their recovery. Walking has been shown it to be an acceptable type of exercise with a low risk of injury. However, it is not known whether structured physical activity programmes are any more effective than giving advice to remain active. Methods/Design The proposed study will test the feasibility of using a pedometer-driven walking programme, as an adjunct to a standard education and advice session in participants with chronic low back pain. Fifty adult participants will be recruited via a number of different sources. Baseline outcome measures including self reported function; objective physical activity levels; fear-avoidance beliefs and health-related quality of life will be recorded. Eligible participants will be randomly allocated under strict, double blind conditions to one of two treatments groups. Participants in group A will receive a single education and advice session with a physiotherapist based on the content of the 'Back Book'. Participants in group B will receive the same education and advice session. In addition, they will also receive a graded pedometer-driven walking programme prescribed by the physiotherapist. Follow up outcomes will be recorded by the same researcher, who will remain blinded to group allocation, at eight weeks and six months post randomisation. A qualitative exploration of participants' perception of walking will also be examined by use of focus groups at the end of the intervention. As a feasibility study, treatment effects will be represented by point estimates and confidence intervals. The assessment of participant satisfaction will be tabulated, as will adherence levels and any recorded difficulties or adverse events experienced by the participants or therapists. This information will be used to modify the planned interventions to be used in a

  18. [The specificity and limitations of sacroiliac joint magnetic resonance imaging in the diagnosis of axial spondyloarthritis in patients with chronic low back pain].

    Science.gov (United States)

    Wang, Y Y; Zhao, Z; Luo, G; Li, Y; Zhang, J L; Huang, F

    2016-11-01

    Objective: To evaluate the specificity and limitations of sacroiliac joint magnetic resonance imaging (MRI) in the diagnosis of axial spondyloarthritis (SpA)in patients with chronic low back pain. Methods: We retrospectively analyzed clinical data of 390 patients with chronic low back pain in Department of Rheumatology, the PLA General Hospital from January 2013 to December 2015, including clinical manifestations, laboratory examinations and MRI data of sacroiliac joints. Results: There were 238 men and 152 women recruited. A total of 326 cases were diagnosed as axial SpA, including 216 men and 110 women with mean age (27.10±8.64) years and mean duration (7.64±3.50) months. Among these 326 patients, 243 (74.5%) were HLA-B27 positive. The other 64 patients were considered as diagnoses rather than SpA (non-SpA), consisting of 22 men and 42 women with mean age (31.29±7.76) years and mean duration (5.75±2.90)months. Non-SpA group had 10 (15.6%) patients with HLA-B27 positive. There were 68.1% and 65.0% SpA patients showing bone marrow edema and bone erosion of sacroiliac joint in MRI imaging respectively. Although there were 25.0% non-SpA patients with bone marrow edema and 7.8% with bone erosion in MRI of sacroiliac joint, the scores of bone marrow edema 0.00(0.00, 0.75) and bone erosion [0.00(0.00, 0.00)] were significantly lower compared with those in axial SpA group [bone marrow edema scores 2.00(0.00, 4.00), bone erosion scores 1.00(0.00, 3.00); PSacroiliac joint MRI is a valuable method to diagnose axial SpA in patients with chronic low back pain. Yet it still has some limitations. Clinical presentations and spinal MRI would be helpful in some patients.

  19. Risk of Chronic Low Back Pain Among Parturients Who Undergo Cesarean Delivery With Neuraxial Anesthesia: A Nationwide Population-Based Retrospective Cohort Study.

    Science.gov (United States)

    Chia, Yuan-Yi; Lo, Yuan; Chen, Yan-Bo; Liu, Chun-Peng; Huang, Wei-Chun; Wen, Chun-Hsien

    2016-04-01

    To investigate the risk of chronic low back pain (LBP) in parturients undergoing cesarean delivery (CD) with neuraxial anesthesia (NA). LBP is common during pregnancy and also after delivery, but its etiology is poorly understood. Previous studies that investigated the correlation between epidural labor analgesia and chronic low back pain were inconclusive. These studies lacked objective diagnostic criteria for LBP and did not exclude possible confounders. We performed this nationwide population-based retrospective cohort study to explore the relationship between CD with NA and subsequent LBP. From the Taiwan National Health Insurance Research Database (NHIRD), we identified all primiparas who had given birth between January 1, 2000 and December 31, 2013. Using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes, we identified the women who had vaginal delivery (VD) and those who had CD. The mode of anesthesia was ascertained by the NHI codes. Multivariable logistic regression was used to estimate the odds of postpartum LBP in women undergoing CD with NA compared with those having VD. The outcome was a diagnosis of LBP according to the first ICD-9-CM diagnosis code. The patients were observed for 3 years after delivery or until diagnosis of postpartum LBP, withdrawal from the NHI system, death, or December 31, 2013. Of the 61,027 primiparas who underwent delivery during the observation period, 40,057 were eligible for inclusion in the study. Of these women, 27,097 (67.6%) received VD, 8662 (21.6%) received CD with spinal anesthesia, and 4298 (10.7%) received CD with epidural anesthesia (EA). Women who received CD with EA were found to have higher risk of LBP than did women who received VD, with the adjusted OR being 1.26 (95% CI: 1.17-1.34). CD with EA might increase the risk of subsequent chronic LBP.

  20. Fascial Manipulation® for chronic aspecific low back pain: a single blinded randomized controlled trial [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Mirco Branchini

    2015-11-01

    Full Text Available Background: The therapeutic approach to chronic aspecific low back pain (CALBP has to consider the multifactorial aetiology of the disorder. International guidelines do not agree on unequivocal treatment indications. Recommendations for fascial therapy are few and of low level evidence but several studies indicate strong correlations between fascial thickness and low back pain. This study aims at comparing the effectiveness of Fascial Manipulation® associated with a physiotherapy program following guidelines for CALBP compared to a physiotherapy program alone. Methods: 24 subjects were randomized into two groups, both received eight treatments over 4 weeks. Outcomes were measured at baseline, at the end of therapy and at a 1 month and a 3 months follow-up. Pain was measured with the visual analogue scale (VAS and the brief pain inventory (BPI, function with the Rolland-Morris disability questionnaire (RMDQ, state of well-being with the short-form 36 health-survey (SF-36. The mean clinical important difference (MCID was also measured. Results: Patients receiving Fascial Manipulation® showed statistically and clinically significant improvements at the end of care for all outcomes, in the short (RMDQ, VAS, BPI and medium term for VAS and BPI compared to manual therapy. The MCID show significant improvements in the means and percentage of subjects in groups in all outcomes post-treatment, in the short and medium term. Conclusion: Fascial tissues were implicated in the aetiology of CALBP and treatment led to decreased symptomatic, improved functional and perceived well-being outcomes that were of greater amplitude compared to manual therapy alone.

  1. Fascial Manipulation® for chronic aspecific low back pain: a single blinded randomized controlled trial [version 2; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Mirco Branchini

    2016-01-01

    Full Text Available Background: The therapeutic approach to chronic aspecific low back pain (CALBP has to consider the multifactorial aetiology of the disorder. International guidelines do not agree on unequivocal treatment indications. Recommendations for fascial therapy are few and of low level evidence but several studies indicate strong correlations between fascial thickness and low back pain. This study aims at comparing the effectiveness of Fascial Manipulation® associated with a physiotherapy program following guidelines for CALBP compared to a physiotherapy program alone. Methods: 24 subjects were randomized into two groups, both received eight treatments over 4 weeks. Outcomes were measured at baseline, at the end of therapy and at a 1 month and a 3 months follow-up. Pain was measured with the visual analogue scale (VAS and the brief pain inventory (BPI, function with the Rolland-Morris disability questionnaire (RMDQ, state of well-being with the short-form 36 health-survey (SF-36. The mean clinical important difference (MCID was also measured. Results: Patients receiving Fascial Manipulation® showed statistically and clinically significant improvements at the end of care for all outcomes, in the short (RMDQ, VAS, BPI and medium term for VAS and BPI compared to manual therapy. The MCID show significant improvements in the means and percentage of subjects in groups in all outcomes post-treatment, in the short and medium term. Conclusion: Fascial tissues were implicated in the aetiology of CALBP and treatment led to decreased symptomatic, improved functional and perceived well-being outcomes that were of greater amplitude compared to manual therapy alone.

  2. The Nijmegen decision tool for chronic low back pain. Development of a clinical decision tool for secondary or tertiary spine care specialists.

    Directory of Open Access Journals (Sweden)

    Miranda L van Hooff

    Full Text Available BACKGROUND: In Western Europe, low back pain has the greatest burden of all diseases. When back pain persists, different medical specialists are involved and a lack of consensus exists among these specialists for medical decision-making in Chronic Low Back Pain (CLBP. OBJECTIVE: To develop a decision tool for secondary or tertiary spine care specialists to decide which patients with CLBP should be seen by a spine surgeon or by other non-surgical medical specialists. METHODS: A Delphi study was performed to identify indicators predicting the outcome of interventions. In the preparatory stage evidence from international guidelines and literature were summarized. Eligible studies were reviews and longitudinal studies. Inclusion criteria: surgical or non-surgical interventions and persistence of complaints, CLBP-patients aged 18-65 years, reported baseline measures of predictive indicators, and one or more reported outcomes had to assess functional status, quality of life, pain intensity, employment status or a composite score. Subsequently, a three-round Delphi procedure, to reach consensus on candidate indicators, was performed among a multidisciplinary panel of 29 CLBP-professionals (>five years CLBP-experience. The pre-set threshold for general agreement was ≥70%. The final indicator set was used to develop a clinical decision tool. RESULTS: A draft list with 53 candidate indicators (38 with conclusive evidence and 15 with inconclusive evidence was included for the Delphi study. Consensus was reached to include 47 indicators. A first version of the decision tool was developed, consisting of a web-based screening questionnaire and a provisional decision algorithm. CONCLUSIONS: This is the first clinical decision tool based on current scientific evidence and formal multidisciplinary consensus that helps referring the patient for consultation to a spine surgeon or a non-surgical spine care specialist. We expect that this tool considerably helps

  3. Effects of Mindfulness-Based Stress Reduction vs Cognitive-Behavioral Therapy and Usual Care on Back Pain and Functional Limitations among Adults with Chronic Low Back Pain: A Randomized Clinical Trial

    Science.gov (United States)

    Cherkin, Daniel C.; Sherman, Karen J.; Balderson, Benjamin H.; Cook, Andrea J.; Anderson, Melissa L.; Hawkes, Rene J.; Hansen, Kelly E.; Turner, Judith A.

    2016-01-01

    Importance Mindfulness-based stress reduction (MBSR) has not been rigorously evaluated for young and middle-aged adults with chronic low back pain. Objective To evaluate the effectiveness for chronic low back pain of MBSR versus usual care (UC) and cognitive-behavioral therapy (CBT). Design, Setting, and Participants Randomized, interviewer-blind, controlled trial in integrated healthcare system in Washington State of 342 adults aged 20–70 years with CLBP enrolled between September 2012 and April 2014 and randomly assigned to MBSR (n = 116), CBT (n = 113), or UC (n = 113). Interventions CBT (training to change pain-related thoughts and behaviors) and MBSR (training in mindfulness meditation and yoga) were delivered in 8 weekly 2-hour groups. UC included whatever care participants received. Main Outcomes and Measures Co-primary outcomes were the percentages of participants with clinically meaningful (≥30%) improvement from baseline in functional limitations (modified Roland Disability Questionnaire [RDQ]; range 0 to 23) and in self-reported back pain bothersomeness (0 to 10 scale) at 26 weeks. Outcomes were also assessed at 4, 8, and 52 weeks. Results Among 342 randomized participants (mean age, 49 (range, 20–70); 225 (66%) women; mean duration of back pain, 7.3 years (range 3 months to 50 years), low back pain, treatment with MBSR and CBT, compared with UC, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT. These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain. PMID:27002445

  4. Cross sectional study of low back pain among merchant seafarers at a medical centre in Singapore

    DEFF Research Database (Denmark)

    Nair, Ravindran; Jensen, Olaf Chresten; Gómez Muñiz, Fernando

    2011-01-01

    Background: Low back pain [LBP] either acute or chronic is the most common musculoskeletal complaint seen in a clinic. Majority of them are involved with manual handling of heavy objects. Objectives: To explore prevalence characteristics of low back pain syndrome among seafarers from merchant shi...

  5. Effect of exercise therapy on displacement of the center of rotation of lumbar vertebrae in patients with non-specific chronic low back pain

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    Y. Javadian

    2015-06-01

    Full Text Available Background: The center of rotation (COR of the lumbar vertebrae is one of the important characteristics in evaluation of lumbar spine kinematics. Objective: The aim of this study was to investigate the effect of exercise therapy on displacement of the COR of lumbar vertebrae in patients with non-specific chronic low back pain. Methods: This interventional study was conducted in 30 patients with non-specific chronic low back pain referred to Shahid Beheshti hospital in Babol, 2012. The patients were randomly assigned to two equal groups. For 8 weeks, the patients in the intervention group performed routine plus stabilization exercises while the patients in the control group performed only routine exercises. Radiographic examination was performed in flexion, extension, and neutral views before and after the treatment and the followings were compared: the COR of each lumbar vertebra in global state (rotation of each vertebra relative to the sacrum and relative state (rotation of each vertebra relative to the lower vertebra and in full flexion-extension, flexion, and extension arcs. Data were analyzed using paired T-test and independent sample T-test. Findings: After treatment, the mean difference of the COR of the lumbar vertebrae was only significantly different between the two groups for relative measurement in L3 on y-axis in full flexion-extension arc. In flexion arc, the mean difference of the displacement of the COR was significantly different between the two groups for global measurement in L3 and L5 on y-axis and for relative measurement in L5 on y-axis. In extension arc, the mean difference of the COR of the lumbar vertebrae was not significantly different between the two groups for both global and relative measurements. Conclusion: With regards to the results, it is suggested to consider the displacement of the COR as an objective index in order to evaluate the effect of stabilization exercises.

  6. Relationship between psychological factors and performance-based and self-reported disability in chronic low back pain

    NARCIS (Netherlands)

    Schiphorst Preuper, H.R.; Reneman, M.F.; Boonstra, Antje; Dijkstra, P.U.; Versteegen, G.J.; Geertzen, J.H.; Brouwer, S.

    2008-01-01

    Cross sectional study, performed in an outpatient university based pain rehabilitation setting. To analyze the relationship between psychological factors (psychosocial distress, depression, self efficacy, self-esteem, fear of movement, pain cognitions and coping reactions) and performance-based and

  7. "Low back pain"--下腰痛?腰痛?

    Institute of Scientific and Technical Information of China (English)

    苗军; 夏群

    2005-01-01

    @@ "Low back pain"一词在国内绝大多数译文或译著中被译为"下腰痛",也有作者将其译为"下背痛".笔者认为这些译法不妥,曲解了"low back pain"的原意.此词翻译的关键在于对"low back"一词解剖部位的理解上.

  8. A study on the Efficacy of Muscle Energy Technique as compared to Conventional Therapy on Lumbar Spine Range of Motion in Chronic Low Back Pain of Sacroiliac Origin

    OpenAIRE

    Supreet Bindra

    2013-01-01

    Sacroiliac joint dysfunction is a term often used to describe pain in and around the region of the joint that is presumed to be due to biomechanical disorders of the joint. Despite of high incidence, the contribution of sacroiliac joint to low back pain has been a matter of controversy. Physical therapists routinely assess spinal range of motion in patients with low back pain and believe that spinal range of motion and disability are closely linked. The present study was aimed to determine th...

  9. Differences in pain perception, health-related quality of life, disability, mood, and sleep between Brazilian and Spanish people with chronic non-specific low back pain

    Directory of Open Access Journals (Sweden)

    Daiana P. Rodrigues-De-Souza

    2016-01-01

    Full Text Available ABSTRACT Background Cultural and social factors play an important role in the development and persistence of Low Back Pain (LBP. Nevertheless, there are few studies investigating differences in LBP features between countries. Objective To determine differences in pain perception between individuals with LBP living in Brazil and Spain. Method Thirty Spanish individuals and 30 age- and sex-comparable Brazilian individuals with LBP were recruited from the Public Health Services of both countries. The Numerical Pain Rating Scale and the pain rating index (PRI, the number of words chosen (NWC, and the present pain index (PPI extracted from the McGill Pain Questionnaire were used to assess pain. The Oswestry Disability Index, the Short Form-36, Beck Depression Inventory-II, and Pittsburgh Sleep Quality Index were also applied. Differences between countries and the correlation between demographic and clinical variables in each country were assessed with parametric and the nonparametric tests. Results A significant Country by Gender interaction was found for the PRI total score (P=0.038, but not for intensity of pain, disability, PPI, or NWC, in which Spanish women exhibited greater pain ratio than Spanish men (P=0.014, and no gender differences were identified in Brazilians. The Spanish group showed a consistent pattern of correlations for clinical data. Within Brazilian patients, fewer correlations were found and all of the coefficients were lower than those in the Spanish group. Conclusion The pain perception in patients with LBP is different depending on the country. Within Spanish patients, LBP is considered a more global entity affecting multidimensional contexts.

  10. Complementary and Alternative Medical Therapies for Chronic Low Back Pain: What Treatments are Patients Willing to Try?

    OpenAIRE

    Erro Janet; Connelly Maureen T; Cherkin Daniel C; Sherman Karen J; Savetsky Jacqueline B; Davis Roger B; Eisenberg David M

    2004-01-01

    Abstract Background Although back pain is the most common reason patients use complementary and alternative medical (CAM) therapies, little is known about the willingness of primary care back pain patients to try these therapies. As part of an effort to refine recruitment strategies for clinical trials, we sought to determine if back pain patients are willing to try acupuncture, chiropractic, massage, meditation, and t'ai chi and to learn about their knowledge of, experience with, and percept...

  11. Development of a screening tool predicting the transition from acute to chronic low back pain for patients in a GP setting: Protocol of a multinational prospective cohort study

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    Bajracharya Suraj

    2008-12-01

    Full Text Available Abstract Background Low back pain (LBP is by far the most prevalent and costly musculoskeletal problem in our society today. Following the recommendations of the Multinational Musculoskeletal Inception Cohort Study (MMICS Statement, our study aims to define outcome assessment tools for patients with acute LBP and the time point at which chronic LBP becomes manifest and to identify patient characteristics which increase the risk of chronicity. Methods Patients with acute LBP will be recruited from clinics of general practitioners (GPs in New Zealand (NZ and Switzerland (CH. They will be assessed by postal survey at baseline and at 3, 6, 12 weeks and 6 months follow-up. Primary outcome will be disability as measured by the Oswestry Disability Index (ODI; key secondary endpoints will be general health as measured by the acute SF-12 and pain as measured on the Visual Analogue Scale (VAS. A subgroup analysis of different assessment instruments and baseline characteristics will be performed using multiple linear regression models. This study aims to examine 1. Which biomedical, psychological, social, and occupational outcome assessment tools are identifiers for the transition from acute to chronic LBP and at which time point this transition becomes manifest 2. Which psychosocial and occupational baseline characteristics like work status and period of work absenteeism influence the course from acute to chronic LBP 3. Differences in outcome assessment tools and baseline characteristics of patients in NZ compared with CH. Discussion This study will develop a screening tool for patients with acute LBP to be used in GP clinics to access the risk of developing chronic LBP. In addition, biomedical, psychological, social, and occupational patient characteristics which influence the course from acute to chronic LBP will be identified. Furthermore, an appropriate time point for follow-ups will be given to detect this transition. The generalizability of our

  12. Fear-avoidance beliefs and pain avoidance in low back pain--translating research into clinical practice

    DEFF Research Database (Denmark)

    Rainville, James; Smeets, Rob J E M; Bendix, Tom;

    2011-01-01

    For patients with low back pain, fear-avoidance beliefs (FABs) represent cognitions and emotions that underpin concerns and fears about the potential for physical activities to produce pain and further harm to the spine. Excessive FABs result in heightened disability and are an obstacle...... for recovery from acute, subacute, and chronic low back pain....

  13. Effectiveness and gastrointestinal tolerability during conversion and titration with once-daily OROS® hydromorphone extended release in opioid-tolerant patients with chronic low back pain

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    Hale ME

    2013-05-01

    Full Text Available Martin E Hale,1 Srinivas R Nalamachu,2 Arif Khan,3 Michael Kutch4,* 1Gold Coast Research, LLC, Weston, FL, USA; 2International Clinical Research Institute, Overland Park, KS, USA; 3MedNorthwest Clinical Research Center, Bellevue, WA, USA; Duke University Medical Center, Durham, NC, USA; 4Applied Clinical Intelligence, LLC, Bala Cynwyd, PA, USA *Affiliation at the time this work was completed. Michael Kutch is currently affiliated with Cytel Inc, Chesterbrook, PA, USA Purpose: To describe the efficacy and safety of hydromorphone extended-release tablets (OROS hydromorphone ER during dose conversion and titration. Patients and methods: A total of 459 opioid-tolerant adults with chronic moderate to severe low back pain participated in an open-label, 2- to 4-week conversion/titration phase of a double-blind, placebo-controlled, randomized withdrawal trial, conducted at 70 centers in the United States. Patients were converted to once-daily OROS hydromorphone ER at 75% of the equianalgesic dose of their prior total daily opioid dose (5:1 conversion ratio, and titrated as frequently as every 3 days to a maximum dose of 64 mg/day. The primary outcome measure was change in pain intensity numeric rating scale; additional assessments included the Patient Global Assessment and the Roland–Morris Disability Questionnaire scores. Safety assessments were performed at each visit and consisted of recording and monitoring all adverse events (AEs and serious AEs. Results: Mean (standard deviation final daily dose of OROS hydromorphone ER was 37.5 (17.8 mg. Mean (standard error of the mean [SEM] numeric rating scale scores decreased from 6.6 (0.1 at screening to 4.3 (0.1 at the final titration visit (mean [SEM] change, -2.3 [0.1], representing a 34.8% reduction. Mean (SEM change in Patient Global Assessment was -0.6 (0.1, and mean change (SEM in the Roland–Morris Disability Questionnaire was -2.8 (0.3. Patients achieving a stable dose showed greater improvement

  14. The Effects of Spiral Taping Treatment on Low Back Pain

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    Hwang Jae-Ok

    2006-02-01

    Full Text Available Objective : The purpose of this study is to estimate the effects of spiral taping treatment on low back pain. Methods : 420 low back pain patients were treated with spiral taping or spiral taping plus herbal medicine, and no other treatments such as acupuncture, herbal acupuncture, and chiropractic therapy were added. We evaluated the improvement by physical examination and pain. Results : 364 patients felt no pain or inconvenience of daily life and 43 patients showed improvement of pain or symptom after 1 month of treatment. 13 patients showed same pain with before treatment. Conclusions : These results suggest spiral taping treatments contribute to the improvement of low back pain. Further study is needed for the confirmation of this effect of spiral taping treatments on low back pain.

  15. Effect of a single session of ear acupuncture on pain intensity and postural control in individuals with chronic low back pain: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Andrea Ushinohama

    2016-01-01

    Full Text Available ABSTRACT Background Ear Acupuncture (EA is a form of acupuncture in which needles are applied to the external ear and has been used in multiple painful conditions. Low back pain (LBP is highly prevalent in active individuals and causes high economic burden to health systems worldwide. LBP affects the person’s ability to keep balance, especially in challenging conditions. Objective The aim of the study was to examine the effects of a single session of EA on pain intensity and body sway during postural tasks. Method Eighty adults with LBP and pain intensity equal to or greater than 4 (0-10 scale were randomly allocated (1:1 to EA group (EAG or placebo group (PG. Initially, the level of pain intensity was assessed. Next, participants stood still on a force plate either with feet in parallel or in semi-tandem and with eyes open or closed. Then, the EAG was treated with EA for 20 min and the PG was treated with detuned ultrasound. After the treatment, pain intensity was assessed again and the postural test was repeated. Pain intensity was the primary outcome and center of pressure sway area and speed were the secondary outcomes measured. Results Results revealed that pain intensity decreased in both groups after treatment, but decreased more in the EAG. For postural control, no effect of treatment and no interaction between treatment and postural condition on body sway were found. Conclusion Those findings indicate that EA is better than placebo to reduce pain, but neither treatment has any effect on postural control.

  16. E-learning module on chronic low back pain in older adults: evidence of effect on medical student objective structured clinical examination performance.

    Science.gov (United States)

    Weiner, Debra K; Morone, Natalia E; Spallek, Heiko; Karp, Jordan F; Schneider, Michael; Washburn, Carol; Dziabiak, Michael P; Hennon, John G; Elnicki, D Michael

    2014-06-01

    The Institute of Medicine has highlighted the urgent need to close undergraduate and graduate educational gaps in treating pain. Chronic low back pain (CLBP) is one of the most common pain conditions, and older adults are particularly vulnerable to potential morbidities associated with misinformed treatment. An e-learning case-based interactive module was developed at the University of Pittsburgh Center of Excellence in Pain Education, one of 12 National Institutes of Health-designated centers, to teach students important principles for evaluating and managing CLBP in older adults. A team of six experts in education, information technology, pain management, and geriatrics developed the module. Teaching focused on common errors, interactivity, and expert modeling and feedback. The module mimicked a patient encounter using a standardized patient (the older adult with CLBP) and a pain expert (the patient provider). Twenty-eight medical students were not exposed to the module (Group 1) and 27 were exposed (Group 2). Their clinical skills in evaluating CLBP were assessed using an objective structured clinical examination (OSCE). Mean scores were 62.0 ± 8.6 for Group 1 and 79.5 ± 10.4 for Group 2 (P students (60.7%) and 26 of 27 Group 2 students (96.3%) passed. The CLBP OSCE was one of 10 OSCE stations in which students were tested at the end of a Combined Ambulatory Medicine and Pediatrics Clerkship. There were no between-group differences in performance on eight of the other nine OSCE stations. This module significantly improved medical student clinical skills in evaluating CLBP. Additional research is needed to ascertain the effect of e-learning modules on more-advanced learners and on improving the care of older adults with CLBP.

  17. A Randomized Controlled Trial Comparing the McKenzie Method to Motor Control Exercises in People With Chronic Low Back Pain and a Directional Preference.

    Science.gov (United States)

    Halliday, Mark H; Pappas, Evangelos; Hancock, Mark J; Clare, Helen A; Pinto, Rafael Z; Robertson, Gavin; Ferreira, Paulo H

    2016-07-01

    Study Design Randomized clinical trial. Background Motor control exercises are believed to improve coordination of the trunk muscles. It is unclear whether increases in trunk muscle thickness can be facilitated by approaches such as the McKenzie method. Furthermore, it is unclear which approach may have superior clinical outcomes. Objectives The primary aim was to compare the effects of the McKenzie method and motor control exercises on trunk muscle recruitment in people with chronic low back pain classified with a directional preference. The secondary aim was to conduct a between-group comparison of outcomes for pain, function, and global perceived effect. Methods Seventy people with chronic low back pain who demonstrated a directional preference using the McKenzie assessment were randomized to receive 12 treatments over 8 weeks with the McKenzie method or with motor control approaches. All outcomes were collected at baseline and at 8-week follow-up by blinded assessors. Results No significant between-group difference was found for trunk muscle thickness of the transversus abdominis (-5.8%; 95% confidence interval [CI]: -15.2%, 3.7%), obliquus internus (-0.7%; 95% CI: -6.6%, 5.2%), and obliquus externus (1.2%; 95% CI: -4.3%, 6.8%). Perceived recovery was slightly superior in the McKenzie group (-0.8; 95% CI: -1.5, -0.1) on a -5 to +5 scale. No significant between-group differences were found for pain or function (P = .99 and P = .26, respectively). Conclusion We found no significant effect of treatment group for trunk muscle thickness. Participants reported a slightly greater sense of perceived recovery with the McKenzie method than with the motor control approach. Level of Evidence Therapy, level 1b-. Registered September 7, 2011 at www.anzctr.org.au (ACTRN12611000971932). J Orthop Sports Phys Ther 2016;46(7):514-522. Epub 12 May 2016. doi:10.2519/jospt.2016.6379.

  18. Is Chronic Low Back Pain Associated with the Prevalence of Coronary Heart Disease when Genetic Susceptibility Is Considered? A Co-Twin Control Study of Spanish Twins

    Science.gov (United States)

    Fernandez, Matt; Ordoñana, Juan R.; Hartvigsen, Jan; Ferreira, Manuela L.; Refshauge, Kathryn M.; Sánchez-Romera, Juan F.; Pinheiro, Marina B.; Simpson, Stephen J.; Hopper, John L.; Ferreira, Paulo H.

    2016-01-01

    Objective To investigate the chronic low back pain and coronary heart disease relationship, after adjusting for relevant confounders, including genetics. Methods In a cross-sectional design, 2148 twins were recruited from the Murcia Twin Registry, Spain. The exposure was chronic LBP and the outcomes were myocardial infarction and other coronary heart diseases—lifetime and in the last 2 years–based on standardized health-related questionnaires. First, logistic regression analysis investigated associations of the total sample followed by a matched co-twin control analyses, with all complete twin pairs discordant for chronic LBP utilised, separated for zygosity—dizygotic (DZ) and monozygotic (MZ) pairs, which adjusted for shared familial factors, including genetics. Results Chronic LBP pain is associated with lifetime myocardial infarction [odds ratio (OR) = 2.69, 95% confidence interval (CI) = 1.35–5.36], other coronary heart diseases over a lifetime (OR = 2.58, 95% CI: 1.69–3.93) and in the last two years (OR = 2.19, 95% CI: 1.33–3.60), while there was a borderline association with myocardial infarction in the last 2 years (OR = 2.64, 95% CI: 0.98–7.12). Although the magnitude of the association remained or increased in the co-twin control analyses, none reached statistical significance. Conclusion Chronic LBP is associated with a higher prevalence of myocardial infarction and coronary heart disease. It is possible that this association remains even when controlling for genetics and early shared environment, although this should be investigated with larger samples of twins discordant for LBP. PMID:27171210

  19. Lumbar CT findings of patients with low back pain

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yong Chul; Kim, Yang Soo; Kim, Kyun Sang [Chung-Ang University, Seoul (Korea, Republic of)

    1986-04-15

    Low back pain is probably the second most common disease entity to upper respiratory infection in developed country. We were missing at least 50% of the pathologic conditions by using conventional diagnostic modalities in low back pain. They did tell us nothing or little about facet abnormalities, lateral recesses, vertebral canal and soft tissue surrounding lumbar spines. High resolutional CT has been the biggest turning point in the diagnosis and management of low back pain. CT make a contribution to reducing the morbidity and probably the cost of evaluating patients with low back pain, and to increasing diagnostic accuracy. We observed 100 cases of lumbar CT using TCT 80A scanner for the evaluation of low back pain during the period from Apr. 1985 to Sept. 1985 at Chung-Ang University Hospital. Lumbar CT scan reveals high-positive findings (98%) in low back pain patients. Common low back disorders in CT are disc bulging (53%), herniated nucleus pulposus (32%), degenerative arthritis in posterior facet joints (27%), spinal stenosis (20%) and postoperative spines (15%). Uncommon low back disorders in CT are compression fracture of vertebral bodies, spondylolysis or spondylolisthesis, tropism, transitional vertebra, Scheueman's disease, limbic fracture, transverse process or articular process fracture, sacroiliac joint subluxation, conjoined nerve root and meningocele.

  20. Psychopathology predicts the outcome of medial branch blocks with corticosteroid for chronic axial low back or cervical pain: a prospective cohort study

    Science.gov (United States)

    Wasan, Ajay D; Jamison, Robert N; Pham, Loc; Tipirneni, Naveen; Nedeljkovic, Srdjan S; Katz, Jeffrey N

    2009-01-01

    Background Comorbid psychopathology is an important predictor of poor outcome for many types of treatments for back or neck pain. But it is unknown if this applies to the results of medial branch blocks (MBBs) for chronic low back or neck pain, which involves injecting the medial branch of the dorsal ramus nerves that innervate the facet joints. The objective of this study was to determine whether high levels of psychopathology are predictive of pain relief after MBB injections in the lumbar or cervical spine. Methods This was a prospective cohort study. Consecutive patients in a pain medicine practice undergoing MBBs of the lumbar or cervical facets with corticosteroids were recruited to participate. Subjects were selected for a MBB based on operationalized selection criteria and the procedure was performed in a standardized manner. Subjects completed the Brief Pain Inventory (BPI) and the Hospital Anxiety and Depression Scale (HADS) just prior to the procedure and at one-month follow up. Scores on the HADS classified the subjects into three groups based on psychiatric symptoms, which formed the primary predictor variable: Low, Moderate, or High levels of psychopathology. The primary outcome measure was the percent improvement in average daily pain rating one-month following an injection. Analysis of variance and chi-square were used to analyze the analgesia and functional rating differences between groups, and to perform a responder analysis. Results Eighty six (86) subjects completed the study. The Low psychopathology group (n = 37) reported a mean of 23% improvement in pain at one-month while the High psychopathology group (n = 29) reported a mean worsening of -5.8% in pain (p < .001). Forty five percent (45%) of the Low group had at least 30% improvement in pain versus 10% in the High group (p < .001). Using an analysis of covariance, no baseline demographic, social, or medical variables were significant predictors of pain improvement, nor did they mitigate

  1. Spine school for patients with low back pain: interdisciplinary approach

    Directory of Open Access Journals (Sweden)

    Janaina Moreno Garcia

    2015-06-01

    Full Text Available OBJECTIVE: To analyze and evaluate an interdisciplinary educational treatment - Spine School.METHODS: This study is a non-controlled clinical trial. Twenty one individuals (19 women aged 27-74 years diagnosed with chronic low back pain were enrolled and followed-up by a rheumatologist and an orthopedist. The evaluations used were SF36, Roland Morris, canadian occupational performance measure (COPM and visual analogue scale (VAS of pain that were performed before and after seven weeks of treatment.RESULTS: We found statistically significant improvements in vitality (mean 48.10 vs. 81.25 p=0.009 and limitations caused by physical aspects (mean 48.81 vs. 81.25 p=0.038 and perception of pain (mean 6.88 vs. 5.38 p=0.005. Although the results were suggestive of improvement, there were no statistical significant differences in the domains social aspects (average 70.82 vs. 92.86 p=0.078, emotional aspects (average 52.38 vs. 88.95 p=0.078, and the performance satisfaction (mean 4.94 vs. 8.24 p=0.074.CONCLUSION: The Interdisciplinary Spine School was useful for improvement in some domains of quality of life of people with low back pain.

  2. Low back pain: considerations for rotary-wing aircrew.

    Science.gov (United States)

    Gaydos, Steven John

    2012-09-01

    Low back pain remains a significant issue among helicopter aircrew. There is a considerable body of scientific literature devoted to the problem, including epidemiologic and experimental studies addressing prevalence, characteristics, primary etiology, and contributing factors. It is endemic and multinational, with a prevalence ranging from 50-92%. Archetypal pain begins with flight or within hours of flight, is mostly targeted in the low back/lumbar region and/or buttocks, is transient, and is commonly described as dull and achy. A minority develop chronic, persistent pain that is variously described with dissimilar characteristics. The pernicious effects of back pain or discomfort while piloting may affect flight performance and safety, including reduced operational effectiveness and lost duty time, occupational attrition, curtailed or cancelled missions, compromised emergency egress, and performance deficits during critical phases of flight. The majority of etiologic studies have focused on the pathophysical posture adopted by pilots for aircraft control and exposure to whole body vibration. With more evidence for the former, it remains likely that both, as well as other factors, may have a contributory and perhaps integrative or concerted role. Corrective and mitigation strategies have addressed lumbar support, seat and cockpit ergonomic redesign, and improved aircrew health. Flight surgeons should be familiar with this prevalent issue and future research must address longitudinal cohort studies with clear definitions, relevant and valid exposure data, dose-response detail, and control for contributing factors and confounders.

  3. Ultrasound versus fluoroscopy-guided caudal epidural steroid injection for the treatment of chronic low back pain with radiculopathy: A randomised, controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Arindam Kumar Hazra

    2016-01-01

    Full Text Available Background and Aims: Caudal epidural steroid administration is an effective treatment for chronic low back pain (LBP. Fluoroscopy guidance is the gold standard for pain procedures. Ultrasound guidance is recently being used in pain clinic procedures. We compared the fluoroscopy guidance and ultrasound guidance for caudal epidural steroid injection with respect to the time needed for correct placement of the needle and clinical effectiveness in patients with chronic LBP. Methods: Fifty patients with chronic LBP with radiculopathy, not responding to conventional medical management, were randomly allocated to receive injection depot methyl prednisolone (40 mg through caudal route either using ultrasound guidance (Group U, n = 25 or fluoroscopy guidance (Group F, n = 25. Pre-procedural visual analogue scale (VAS score and Oswestry Disability Index (ODI were noted. During the procedure, the time needed for correct placement of needle was observed. Adverse events, if any, were also noted. All patients were followed up for next 2 months to evaluate Visual Analogue Scale (VAS score and ODI at the 2nd week and again at the end of 1st and 2nd month. Results: The needle-placement time was less using ultrasound guidance as compared to fluoroscopy guidance (119 ± 7.66 vs. 222.28 ± 29.65 s, respectively,P< 0.001. Significant reduction in VAS score and ODI (clinical improvement was noted in the follow-up time points and comparable between the groups at all time points. Conclusion: Ultrasound guidance can be a safe alternative tool for achieving faster needle placement in caudal epidural space. Clinical effectiveness (reduction of VAS and ODI scores remains comparable between both the techniques.

  4. Disc degeneration and chronic low back pain: an association which becomes nonsignificant when endplate changes and disc contour are taken into account

    Energy Technology Data Exchange (ETDEWEB)

    Kovacs, Francisco M. [Fundacion Kovacs, Departamento Cientifico, Palma de Mallorca (Spain); Fundacion Kovacs, Spanish Back Pain Research Network, Palma de Mallorca (Spain); Arana, Estanislao [Fundacion Kovacs, Spanish Back Pain Research Network, Palma de Mallorca (Spain); Fundacion Instituto Valenciano de Oncologia, Servicio de Radiologia, Valencia (Spain); Royuela, Ana [CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid (Spain); Hospital Ramon y Cajal, Unidad de Bioestadistica Clinica, IRYCIS, Madrid (Spain); Estremera, Ana; Amengual, Guillermo; Sarasibar, Helena; Martinez, Carmen [Fundacion Kovacs, Spanish Back Pain Research Network, Palma de Mallorca (Spain); Hospital Son Llatzer, Palma de Mallorca (Spain); Asenjo, Beatriz [Fundacion Kovacs, Spanish Back Pain Research Network, Palma de Mallorca (Spain); Hospital Carlos Haya, Malaga (Spain); Galarraga, Isabel [Fundacion Kovacs, Spanish Back Pain Research Network, Palma de Mallorca (Spain); Hospital de Manacor, Manacor, Mallorca (Spain); Alonso, Ana [Fundacion Kovacs, Spanish Back Pain Research Network, Palma de Mallorca (Spain); Fundacion Jimenez Diaz, Madrid (Spain); Casillas, Carlos [Fundacion Kovacs, Spanish Back Pain Research Network, Palma de Mallorca (Spain); Instituto de Traumatologia Union de Mutuas, Castellon (Spain); Muriel, Alfonso; Abraira, Victor [Hospital Ramon y Cajal, Unidad de Bioestadistica Clinica, IRYCIS, Madrid (Spain); CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid (Spain)

    2014-01-15

    The objective of this study was to assess the association between severe disc degeneration (DD) and low back pain (LBP). A case-control study was conducted with 304 subjects, aged 35-50, recruited in routine clinical practice across six hospitals; 240 cases (chronic LBP patients with a median pain duration of 46 months) and 64 controls (asymptomatic subjects without any lifetime history of significant LBP). The following variables were assessed once, using previously validated methods: gender, age, body mass index (BMI), lifetime smoking exposure, degree of physical activity, severity of LBP, disability, and findings on magnetic resonance (MRI) (disc degeneration, Modic changes (MC), disc protrusion/hernia, annular tears, spinal stenosis, and spondylolisthesis). Radiologists who interpreted MRI were blinded to the subjects' characteristics. A multivariate logistic regression model assessed the association between severe DD and chronic LBP, adjusting for gender, age, BMI, physical activity, MC, disc protrusion/hernia, and spinal stenosis. Severe DD at ≥1 level was found in 46.9 % of the controls and 65.8 % of the cases. Crude odds ratio (95 % CI), for suffering chronic LBP when having severe DD, was 2.06 (1.05; 4.06). After adjusting for ''MC'' and ''disc protrusion/hernia,'' it was 1.81 (0.81; 4.05). The association between severe DD and LBP ceases to be significant when adjusted for MC and disc protrusion/hernia. These results do not support that DD as a major cause of chronic LBP. (orig.)

  5. Percutaneous Nucleoplasty Using Coblation Technique for the Treatment of Chronic Nonspecific Low Back Pain: 5-year Follow-up Results

    Directory of Open Access Journals (Sweden)

    Da-Jiang Ren

    2015-01-01

    Conclusions: Although previously published short- and medium-term outcomes after percutaneous nucleoplasty appeared to be satisfactory, our long-term follow-up results show a significant decline in patient satisfaction over time. Percutaneous nucleoplasty is a safe and simple technique, with therapeutic effectiveness for the treatment of chronic LBP in selected patients. The technique is minimally invasive and can be used as part of a stepwise treatment plan for chronic LBP.

  6. Low Back Pain and Pelvic Girdle Pain in Pregnancy.

    Science.gov (United States)

    Casagrande, Danielle; Gugala, Zbigniew; Clark, Shannon M; Lindsey, Ronald W

    2015-09-01

    Pregnancy has a profound effect on the human body, particularly the musculoskeletal system. Hormonal changes cause ligamentous joint laxity, weight gain, and a shift in the center of gravity that leads to lumbar spine hyperlordosis and anterior tilting of the pelvis. In addition, vascular changes may lead to compromised metabolic supply in the low back. The most common musculoskeletal complaints in pregnancy are low back pain and/or pelvic girdle pain. They can be diagnosed and differentiated from each other by history taking, clinical examination, provocative test maneuvers, and imaging. Management ranges from conservative and pharmacologic measures to surgical treatment. Depending on the situation, and given the unique challenges pregnancy places on the human body and the special consideration that must be given to the fetus, an orthopaedic surgeon and the obstetrician may have to develop a plan of care together regarding labor and delivery or when surgical interventions are indicated.

  7. Spinal manipulative therapy for acute low-back pain (Review)

    OpenAIRE

    Rubinstein, S.M.; Terwee, C. B.; Assendelft, W J J; Boer, M.R.M. de; van Tulder, M. W.

    2012-01-01

    BACKGROUND: Many therapies exist for the treatment of low-back pain including spinal manipulative therapy (SMT), which is a worldwide, extensively practised intervention. This report is an update of the earlier Cochrane review, first published in January 2004 with the last search for studies up to January 2000. OBJECTIVES: To examine the effects of SMT for acute low-back pain, which is defined as pain of less than six weeks duration. SEARCH METHODS: A comprehensive search was conducted on 31 ...

  8. Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part VII: Insomnia.

    Science.gov (United States)

    Bramoweth, Adam D; Renqvist, Jenna G; Germain, Anne; Buysse, Daniel J; Gentili, Angela; Kochersberger, Gary; Rodriguez, Eric; Rossi, Michelle I; Weiner, Debra K

    2016-05-01

    OBJECTIVE : To present the seventh in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. This article focuses on insomnia and presents a treatment algorithm for managing insomnia in older adults, along with a representative clinical case. METHODS : A modified Delphi process was used to develop the algorithm and supportive materials. A multidisciplinary expert panel representing expertise in health psychology and sleep medicine developed the algorithm and supporting documents that were subsequently refined through an iterative process of input from a primary care provider panel. RESULTS : We present an illustrative clinical case and an algorithm to help guide the care of older adults with insomnia, an important contributor to CLBP and disability. Multicomponent cognitive behavioral therapy for insomnia (CBTI) and similar treatments (e.g., brief behavioral treatment for insomnia [BBTI]) are the recommended first-line treatment. Medications should be considered only if BBTI/CBTI is suboptimal or not effective and should be prescribed at the lowest effective dose for short periods of time (Insomnia is commonly comorbid with CLBP in older adults and should be routinely evaluated and treated because it is an important contributor to pain and disability. The algorithm presented was structured to assist primary care providers in planning treatment for older adults with CLBP and insomnia.

  9. Longer-term clinical and economic benefits of offering acupuncture to patients with chronic low back pain assessed as suitable for primary care management.

    Science.gov (United States)

    Thomas, K J; Fitter, M; Brazier, J; MacPherson, H; Campbell, M; Nicholl, J P; Roman, M

    1999-06-01

    This paper presents the research protocol for a pragmatic study of the benefits of providing an acupuncture service to patients in primary care with chronic low back pain. The proposal was written in response to a call for bids from the NHS Executive's centrally funded research programme for Health Technology Assessment (HTA). The research question posed was 'Does acupuncture have long-term effectiveness in the management of pain in primary care?' The present study was designed as a collaboration between an interdisciplinary team drawn from health services researchers at the University of Sheffield, acupuncture researchers from the Foundation for Traditional Chinese Medicine in York, and practitioners from general practice and acupuncture in York. The proposal presented here was submitted in response to an invitation from the Commissioning Board following a successful outline bid. It is reproduced here, largely as submitted in January 1998, using the headings under which information was requested. We also present an appendix describing methodological alterations made to the design in response the Commissioning Board's comments on the proposal. We present it in this format to give an idea of the evolution of the design and the process by which the research proposal was shaped. The final working protocol comprises a combination of these two elements.

  10. Investigation of sleep disturbance in chronic low back pain: an age- and gender-matched case-control study over a 7-night period.

    LENUS (Irish Health Repository)

    van de Water, Alexander T M

    2011-12-01

    Sleep disturbance is frequently reported by people with chronic low back pain (>12 weeks; CLBP), but few studies have comprehensively investigated sleep in this population. This study investigated differences in subjectively and objectively measured sleep patterns of people with CLBP, and compared this to age- and gender matched controls. Thirty-two consenting participants (n = 16 with CLBP, n = 16 matched controls), aged 24-65 years (43.8% male) underwent an interview regarding sleep influencing variables, completed the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Pittsburgh Sleep Diary, SF36-v2, Hospital Anxiety and Depression Scale, Oswestry Disability Index, Numerical Pain Rating Scales, and underwent seven consecutive nights of actigraphic measurement in the home environment. Compared to controls, people with CLBP had, on self-report measures, significantly poorer sleep quality [Pittsburgh Sleep Quality Index (range 0-21) mean (SD) 10.9 (4.2)], clinical insomnia [Insomnia Severity Index mean (range 0-28) 13.7 (7.6)], lower sleep efficiency, longer sleep onset latency, more time awake after sleep onset, and more awakenings during sleep (p < 0.05). However, no significant differences between groups were found on objective actigraphy (p > 0.05). The findings provide some evidence to support self-reported sleep assessment as an outcome measure in CLBP research, while further research is needed to determine the validity of objective sleep measurement in this population.

  11. Observation on Therapeutic Effect of Electro-acupuncture in the Treatment of Chronic Low Back Pain: A Report of 30 Cases

    Institute of Scientific and Technical Information of China (English)

    XIN Bao-yu; ZHU Zhong-chun

    2005-01-01

    Fifty-six cases of chronic low back pain were randomly divided into electroacupuncture group (n= 30) and control group (n= 26). Patients in electro-acupuncture group were treated with electro-acupuncture plus physical therapy, and patients in control group were treated with single physical therapy. The results showed that Electro-acupuncture plus physical therapy could obviously relieve pain, improve the patients' life quality, and its therapeutic effect was superior to that of the single physical therapy.%56例慢性腰背痛患者随机分为电针治疗组(n=30)和对照组(n=26).电针治疗组在常规物理疗法的基础上加用电针治疗,对照组采用常规物理疗法治疗.以疼痛等级量表为评价疼痛的指标.电针在物理治疗的基础上,能明显提高腰背痛的镇痛效果,改善患者的生活质量,其疗效明显优于单纯物理疗法.

  12. A systematic review on the effectiveness of complementary and alternative medicine for chronic non-specific low-back pain

    NARCIS (Netherlands)

    S.M. Rubinstein (Sidney); M. van Middelkoop (Marienke); T. Kuijpers (Ton); R.W.J.G. Ostelo (Raymond); A.P. Verhagen (Arianne); M.R. de Boer (Michiel Robert); B.W. Koes (Bart); M.W. van Tulder (Maurits)

    2010-01-01

    textabstractThe purpose of this systematic review was to assess the effects of spinal manipulative therapy (SMT), acupuncture and herbal medicine for chronic non-specific LBP. A comprehensive search was conducted by an experienced librarian from the Cochrane Back Review Group (CBRG) in multiple data

  13. Supervised and non-supervised Nordic walking in the treatment of chronic low back pain: a single blind randomized clinical trial

    DEFF Research Database (Denmark)

    Hartvigsen, Jan; Morsø, Lars; Bendix, Tom;

    2010-01-01

    further assessed using the Patient Specific Function Scale. Furthermore, information on time off work, use of medication, and concurrent treatment for their low back pain was collected. Objective measurements of physical activity levels for the supervised and unsupervised Nordic walking groups were...

  14. Manipulation does not add to the effect of extension exercises in chronic low-back pain (LBP). A randomized, controlled, double blind study

    DEFF Research Database (Denmark)

    Rasmussen, J.; Laetgaard, J.; Lindecrona, A.L.;

    2008-01-01

    by a visual analogue scale. RESULTS: Pain in both back and leg decreased without differences between groups. Segmental binding of the low-back was associated with persisting clinical symptoms at four weeks. CONCLUSION: No additional effect was demonstrated of manipulation, when extension exercises were used...

  15. How do persons with chronic low back pain speed up and slow down? Trunk-pelvis coordination and lumbar erector spinae activity during gait

    NARCIS (Netherlands)

    Lamoth, Claudine J.C.; Daffertshofer, Andreas; Meijer, Onno G.; Beek, Peter J.

    2006-01-01

    In healthy walking, the timing between trunk and pelvic rotations, as well as erector spinae (ES) activity varies systematically with walking velocity, whereas a comparable velocity-dependent adaptation of trunk-pelvis coordination is often reduced or absent in persons with low back pain (LBP). Base

  16. Core Muscle Activity during TRX Suspension Exercises with and without Kinesiology Taping in Adults with Chronic Low Back Pain: Implications for Rehabilitation

    Directory of Open Access Journals (Sweden)

    Shirley S. M. Fong

    2015-01-01

    Full Text Available This study aimed to examine the effects of kinesiology taping (KT and different TRX suspension workouts on the amplitude of electromyographic (EMG activity in the core muscles among people with chronic low back pain (LBP. Each participant (total n=21 was exposed to two KT conditions: no taping and taping, while performing four TRX suspension exercises: (1 hamstring curl, (2 hip abduction in plank, (3 chest press, and (4 45-degree row. Right transversus abdominis/internal oblique (TrAIO, rectus abdominis (RA, external oblique (EO, and superficial lumbar multifidus (LMF activity was recorded with surface EMG and expressed as a percentage of the EMG amplitude recorded during a maximal voluntary isometric contraction of the respective muscles. Hip abduction in plank increased TrAIO, RA, and LMF EMG amplitude compared with other TRX positions (P0.05. Hip abduction in plank most effectively activated abdominal muscles, whereas the hamstring curl most effectively activated the paraspinal muscles. Applying KT conferred no immediate benefits in improving the core muscle activation during TRX training in adults with chronic LBP.

  17. Deconstructing Chronic Low Back Pain in the Older Adult – Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part III: Fibromyalgia Syndrome

    Science.gov (United States)

    Fatemi, Gita; Fang, Meika A.; Breuer, Paula; Cherniak, Paul E.; Gentili, Angela; Hanlon, Joseph T.; Karp, Jordan F.; Morone, Natalia E.; Rodriguez, Eric; Rossi, Michelle I.; Schmader, Kenneth; Weiner, Debra K.

    2016-01-01

    Objective To present the third in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of twelve important contributors to pain and disability in older adults with CLBP. This article focuses on fibromyalgia syndrome (FMS). Methods A modified Delphi approach was used to create the evaluation and treatment algorithm, the table discussing the rationale behind each of the algorithm components, and the stepped-care drug recommendations. The team involved in the creation of these materials consisted of a principal investigator, a 5-member content expert panel, and a 9-member primary care panel. The evaluation and treatment recommendations were based on availability of medications and other resources within the Veterans Health Administration (VHA) facilities. However, non-VHA panelists were also involved in the development of these materials, which can be applied to both VA and civilian settings. The illustrative clinical case was taken from the clinical practice of the principal investigator. Results Following expert consultations and a review of the literature, we developed an evaluation and treatment algorithm with supporting materials to aid in the care of older adults with CLBP who have concomitant FMS. A case is presented that demonstrates the complexity of pain evaluation and management in older patients with CLBP and concomitant FMS Conclusions Recognition of FMS as a common contributor to CLBP in older adults and initiating treatment targeting both FMS and CLBP will lead to improved outcomes in pain and disability. PMID:26272644

  18. Auricular Point Acupressure to Manage Chronic Low Back Pain in Older Adults: A Randomized Controlled Pilot Study

    Directory of Open Access Journals (Sweden)

    Chao Hsing Yeh

    2014-01-01

    Full Text Available This prospective, randomized clinical trial (RCT pilot study was designed to (1 assess the feasibility and tolerability of an easily administered, auricular point acupressure (APA intervention and (2 provide an initial assessment of effect size as compared to a sham treatment. Thirty-seven subjects were randomized to receive either the real or sham APA treatment. All participants were treated once a week for 4 weeks. Self-report measures were obtained at baseline, weekly during treatment, at end-of-intervention (EOI, and at a 1-month follow-up. A dropout rate of 26% in the real APA group and 50% in the sham group was observed. The reduction in worst pain from baseline to EOI was 41% for the real and 5% for the sham group with a Cohen’s effect size of 1.22 P<0.00. Disability scores on the Roland Morris Disability Questionnaire (RMDQ decreased in the real group by 29% and were unchanged in the sham group (+3% P<0.00. Given the high dropout rate, results must be interpreted with caution; nevertheless, our results suggest that APA may provide an inexpensive and effective complementary approach for the management of back pain in older adults, and further study is warranted.

  19. Low back pain across the life course

    DEFF Research Database (Denmark)

    Dunn, Kate M; Hestbæk, Lise; Cassidy, J David

    2013-01-01

    Back pain episodes are traditionally regarded as individual events, but this model is currently being challenged in favour of treating back pain as a long-term or lifelong condition. Back pain can be present throughout life, from childhood to older age, and evidence is mounting that pain experience...... is maintained over long periods: for example, people with pain continue to have it on and off for years, and people without pain do not suddenly develop long-term pain. A number of factors predict back pain presence in epidemiological studies, and these are often present, and predictive, at different life...... stages. There are also factors present at particular life stages, such as childhood or adolescence, which predict back pain in adulthood. However, there are little published data on long-term pain patterns or predictors over the life course. Such studies could improve our understanding of the development...

  20. Multidisciplinary outpatient care program for patients with chronic low back pain: design of a randomized controlled trial and cost-effectiveness study [ISRCTN28478651

    Directory of Open Access Journals (Sweden)

    Anema Johannes R

    2007-09-01

    Full Text Available Abstract Background Chronic low back pain (LBP is a major public and occupational health problem, which is associated with very high costs. Although medical costs for chronic LBP are high, most costs are related to productivity losses due to sick leave. In general, the prognosis for return to work (RTW is good but a minority of patients will be absent long-term from work. Research shows that work related problems are associated with an increase in seeking medical care and sick leave. Usual medical care of patients is however, not specifically aimed at RTW. The objective is to present the design of a randomized controlled trial, i.e. the BRIDGE-study, evaluating the effectiveness in improving RTW and cost-effectiveness of a multidisciplinary outpatient care program situated in both primary and outpatient care setting compared with usual clinical medical care for patients with chronic LBP. Methods/Design The design is a randomized controlled trial with an economic evaluation alongside. The study population consists of patients with chronic LBP who are completely or partially sick listed and visit an outpatient clinic of one of the participating hospitals in Amsterdam (the Netherlands. Two interventions will be compared. 1. a multidisciplinary outpatient care program consisting of a workplace intervention based on participatory ergonomics, and a graded activity program using cognitive behavioural principles. 2. usual care provided by the medical specialist, the occupational physician, the patient's general practitioner and allied health professionals. The primary outcome measure is sick leave duration until full RTW. Sick leave duration is measured monthly by self-report during one year. Data on sick leave during one-year follow-up are also requested form the employers. Secondary outcome measures are pain intensity, functional status, pain coping, patient satisfaction and quality of life. Outcome measures are assessed before randomization and 3, 6

  1. Lumbar stimulation belt for therapy of low-back pain.

    Science.gov (United States)

    Popović, Dejan B; Bijelić, Goran; Miler, Vera; Dosen, Strahinja; Popović, Mirjana B; Schwirtlich, Laszlo

    2009-01-01

    We developed the STIMBELT, an electrical stimulation system that comprises a lumbar belt with up to eight pairs of embedded electrodes and an eight-channel electronic stimulator. The STIMBELT is an assistive system for the treatment of low-back pain (LBP). We describe here technical details of the system and summarize the results of its application in individuals with subacute and chronic LBP. The direct goals of the treatment were to relieve pain, reduce muscle spasms, increase strength and range of motion, and educate individuals with LBP in reducing the chances of its reoccurrence. The outcome measures include: a Visual Analogue Scale (VAS), the Oswestry LBP Disability Questionnaire, the Short Form (SF)-12 health survey, and the Manual Muscle Test. The results indicate significant benefits for individuals who use the STIMBELT in addition to the conventional therapy as opposed to only the conventional therapy.

  2. Prognostic factors and course for successful clinical outcome quality of life and patients' perceived effect after a cognitive behavior therapy for chronic non-specific low back pain: A 12-months prospective study

    NARCIS (Netherlands)

    Verkerk, K.; Luijsterburg, P.A.J.; Heymans, M.W.; Ronchetti, I.; Miedema, H.S.; Koes, B.W.; Pool-Goudzwaard, A.

    2015-01-01

    This study investigates the clinical course of and prognostic factors for quality of life (Short Form 36 items Health survey (SF-36)) and global perceived effect (GPE) in patients treated for chronic nonspecific low back pain at 5 and 12-months follow-up. Data from a prospective cohort (n ¼ 1760) of

  3. Alkaptonuria, a rare cause for low back pain

    Directory of Open Access Journals (Sweden)

    Vikram Muralidhar Haridas

    2013-09-01

    Full Text Available Alkaptonuria is a very rare disease that can cause premature degenerative arthritis of the spine and peripheral large joints. I present here a case of middle-aged woman who developed low back pain secondary to alkaptonuria.

  4. Development and validation of a questionnaire assessing volitional competencies to enhance the performance of physical activities in chronic low back pain patients

    Directory of Open Access Journals (Sweden)

    Duplan Bernard

    2011-05-01

    Full Text Available Abstract Background Motivation has long been emphasized as the most important determinant of action. However, there is a substantial gap between people's goals and their attainment. Patients may be motivated and yet unable to take action if their volitional competencies are insufficient. One of the important tasks of volition is goal-maintenance. Research has stressed the importance of a volitional tool, the implementation intentions. Implementation intentions indicate where, when, and how the action leading to the goal will be performed. Forming implementation intentions favours the execution of goal-directed efforts, and reinforces the relationship between intentions and behaviours. Results from various studies clearly suggest that volitional competencies and implementation intentions could play a role in low back pain (LBP patients. However, there is at present no questionnaire allowing assessing the capacity of implementation intentions of physical activities in LBP patients. Methods/Design This study will develop such a questionnaire, using a 3-step approach. A first qualitative step to build categories and generate items; 30 patients suffering chronic LBP will be invited to participate in semi-structured interviews; verbatim and derived items will then be submitted to a panel of experts, using a Delphi method; a second quantitative step to examine the properties of items, and determine the factorial structure of the questionnaire; 100 patients suffering chronic LBP will be recruited to respond to this phase; and third, preliminary psychometric analyses (item-scale correlations, construct validity, reliability; 180 chronic LBP patients will be recruited for this phase of the study. The relationships between implementation intentions and variables affecting physical activity on chronic LBP patients, i.e. pain, physical capacities, fear-avoidance beliefs, kinesiophobia, work status, and level of physical activity will be considered

  5. The effect of continuous ultrasound on chronic non-specific low back pain: a single blind placebo-controlled randomized trial

    Directory of Open Access Journals (Sweden)

    Ebadi Safoora

    2012-10-01

    Full Text Available Abstract Background Non-specific chronic low back pain (NSCLBP is one of the most common musculoskeletal disorders around the world including Iran. One of the most widely used modalities in the field of physiotherapy is therapeutic ultrasound (US. Despite its common use, there is still inconclusive evidence to support its effectiveness in patients with NSCLBP. The objective of this study was to evaluate the effect of continuous US compared with placebo US additional to exercise therapy for patients with NSCLBP. Methods In this single blind placebo controlled study, 50 patients with NSCLBP were randomized into two treatment groups: 1 continuous US (1 MHz &1.5 W/cm2 plus exercise 2 placebo US plus exercise. Patients received treatments for 4 weeks, 10 treatment sessions, 3 times per week, every other day. Treatment effects were assessed in terms of primary outcome measures: 1 functional disability, measured by Functional Rating Index, and 2 global pain, measured by a visual analog scale. Secondary outcome measures were lumbar flexion and extension range of motion (ROM, endurance time and rate of decline in median frequency of electromyography spectrum during a Biering Sorensen test. All outcome variables were measured before, after treatment, and after one-month follow-up. An intention to treat analysis was performed. Main effects of Time and Group as well as their interaction effect on outcome measures were investigated using repeated measure ANOVA. Results Analysis showed that both groups had improved regarding function (FRI and global pain (VAS (P .05. Improvement in function and lumbar ROM as well as endurance time were significantly greater in the group receiving continuous US (P Conclusions The study showed that adding continuous US to a semi supervised exercise program significantly improved function, lumbar ROM and endurance time. Further studies including a third group of only exercise and no US can establish the possible effects of

  6. Trunk flexion measurement for the assessment of low back pain

    OpenAIRE

    MILJKOVIC NADICA S.; BIJELIC GORAN S.; DJORDJEVIC OLIVERA C.; KONSTANTINOVIC LJUBICA M.; ZABALETA HARITZ R.; SEKARA TOMISLAV B.

    2015-01-01

    Low Back Pain (LBP) is one of the most common incidences all over the world. For the assessment of LBP, descriptive medical scores are widely used. Nevertheless, there is a need for the quantitative assessment of LBP by appropriate physiological and kinematic measurements. Quantitative assessment methods are of interest since they might provide reliable and repeatable measures related to low back pain in both everyday clinical practice and at home or work. In this paper, we proposed simple me...

  7. Does going to an amusement park alleviate low back pain? A preliminary study

    Directory of Open Access Journals (Sweden)

    Sakakibara T

    2012-10-01

    Full Text Available Toshihiko Sakakibara, Zhuo Wang, Yuichi KasaiDepartment of Spinal Surgery and Medical Engineering, Mie University Graduate School of Medicine, Tsu City, Mie Prefecture, JapanBackground: Low back pain is often called nonspecific pain. In this type of low back pain, various emotions and stress are known to strongly affect pain perception. The purpose of this study is to investigate how the degree of low back pain changes in people with chronic mild low back pain when they are inside and outside of an amusement park where people are supposed to have physical and psychological enjoyment.Methods: The subjects were 23 volunteers (13 males and 10 females aged 18 to 46 years old with a mean age of 24.0 years who had chronic low back pain. Visual analog scale (VAS scores of low back pain and salivary amylase levels (kIU/L of all subjects were measured at five time points: immediately after getting on the bus heading for the amusement park; 10 minutes, 1 hour (immediately after boarding the roller coaster, and 3 hours (immediately after exiting the haunted house after arriving at the amusement park; and immediately before getting off the bus returning from the park.Results: The three VAS values in the amusement park (10 minutes, 1 hour, and 3 hours after arriving at the amusement park measured were significantly lower (P < 0.05 when compared with the other two values measured immediately after getting on the bus heading for the amusement park and immediately before getting off the return bus. In salivary amylase levels, there were no statistically significant differences among the values measured at the five time points.Conclusion: Low back pain was significantly alleviated when the subjects were in the amusement park, which demonstrated that enjoyable activities, though temporarily, alleviated their low back pain.Keywords: low back pain, emotion, salivary alpha-amylase activity, enjoyment activities, psychological stress

  8. The effect of motor control exercises versus back muscle endurance training with kinesio taping on the balance indices in patients with nonspecific chronic low back Pain

    Directory of Open Access Journals (Sweden)

    Noorollahzadeh Karim

    2016-03-01

    Full Text Available Aims and Background: In patients with low back pain, postural sway is more than normal people. The aim of this study was to compare the effect of motor control exercises (MCE and back muscle endurance training with kinesio taping (BMET&KT on the on the balance indices in patients with nonspecific chronic low back Pain (NCLBP. Methods and Materials: For this single-blind randomized controlled trial, 33 patients with NCLBP were selected through convenience sampling and randomly divided into two groups of the MCE and BMET&KT. Exercises of the both groups were performed 3 times per week for 5 weeks. Before and after the treatment, overall, Anteroposterior and lateral stability indices were measured by Biodex Balance System in both static and dynamic conditions with the eyes open and closed on both legs. Paired t-test and independent sample t–tests were used for analyzing the data. Results: In the MCE group, the overall stability index(OSI and anteroposteriorior stability index(APSI in static condition with eyes closed and lateral stability index(LSI in static condition with open eyes reduced from 1.01 ±0.35 to 0.71 ± 0.36 (P = 0.003, 0.84 ± 0.35 to 0.57 ± 0.32 ( P = 0.008 and 0.14 ± 0.07 to 0.10 ± .04 (P = 0.020 respectively. In the BMET&KT group, the OSI and APSI in static condition with eyes open and LSI in dynamic condition with eyes open reduced from 0.35 ± 0.15 to 0.24 ± 0.10 (P = 0.009, 0.25 ± 0.09 to 0.18 ± 0.08 (P = 0.003 and from 0.63± 0.28 to 0.44± 0.20 (P = 0.008 respectively. Except APSI in static condition with eyes open, there wasn’t significant difference between the two groups (P > 0.05. Conclusion: The MCE were more effective on the static balance in eyes closed condition. While, BMET&KT were more effective on the static balance in the eyes open condition. But there wasn’t any difference between the two treatment methods in terms of the improvement of the postural stability

  9. Determining the reliability of a custom built seated stadiometry set-up for measuring spinal height in participants with chronic low back pain.

    Science.gov (United States)

    Steele, James; Bruce-Low, Stewart; Smith, Dave; Jessop, David; Osborne, Neil

    2016-03-01

    Indirect measurement of disc hydration can be obtained through measures of spinal height using stadiometry. However, specialised stadiometers for this are often custom-built and expensive. Generic wall-mounted stadiometers alternatively are common in clinics and laboratories. This study examined the reliability of a custom set-up utilising a wall-mounted stadiometer for measurement of spinal height using custom built wall mounted postural rods. Twelve participants with non-specific chronic low back pain (CLBP; females n = 5, males n = 7) underwent measurement of spinal height on three separate consecutive days at the same time of day where 10 measurements were taken at 20 s intervals. Comparisons were made using repeated measures analysis of variance for 'trial' and 'gender'. There were no significant effects by trial or interaction effects of trial x gender. Intra-individual absolute standard error of measurement (SEM) was calculated for spinal height using the first of the 10 measures, the average of 10 measures, the total shrinkage, and the rate of shrinkage across the 10 measures examined as the slope of the curve when a linear regression was fitted. SEMs were 3.1 mm, 2.8 mm, 2.6 mm and 0.212, respectively. Absence of significant differences between trials and the reported SEMs suggests this custom set-up for measuring spinal height changes is suitable use as an outcome measure in either research or clinical practice in participants with CLBP.

  10. [Treatment of low back pain (pain of locomotive organs)].

    Science.gov (United States)

    Tanikawa, Hirotaka

    2009-09-01

    Several diseases, including the functional somatic syndromes (FSS), are characterized by pain involving locomotive structures. These disorders include low back pain, neck-shoulder-arm syndrome and fibromyalgia. FSS patients are convinced that their illness is not a psychosomatic disorder, being instead a bodily disease. Therefore, physicians such as orthopedic surgeons play an important role in supporting patients suffering from FSS with locomotive pain, because these patients expect their physicians to treat them for a physical, rather than a psychological disorder. The author investigated the patient-doctor relationship in the examination room of a hospital, and designated pain combined with a depressive state characterized by agitation and helplessness, a common complaint made by FSS and psychosomatic disorder patients, 'painful depression'. Pain and depression influence each other and trigger a vicious downward spiral termed the 'pain-depression deflation spiral'. Generally, orthopedic surgeons can achieve good relationships with FSS patients with locomotive structure pain, despite suspicion of psycho-social factors. It is concluded that physical examinations and treatments by orthopedic surgeons, conducting physical examinations only, can serve as a very good psychosomatic approach to painful depression/FSS patients.

  11. Trunk Muscle Characteristics of the Multifidi, Erector Spinae, Psoas, and Quadratus Lumborum in Older Adults With and Without Chronic Low Back Pain.

    Science.gov (United States)

    Sions, J Megan; Elliott, James M; Pohlig, Ryan T; Hicks, Gregory E

    2017-03-01

    Study Design Cross-sectional study. Objective To determine whether there are differences in trunk muscle characteristics between older adults with and without chronic low back pain (LBP), while controlling for age, sex, and body mass index. Background Muscle support for the trunk is provided by the multifidi, erector spinae, psoas, and quadratus lumborum. Trunk muscle characteristics may be altered with aging and/or chronic LBP. To date, most trunk muscle research has been conducted among younger adults. Given age-related muscle changes, such as reduced size and increased intramuscular fat, studies are needed in older adults, including those comparing older adults with and without LBP. Methods One hundred two older adults with (n = 53) and without (n = 49) chronic LBP were included. Cross-sectional area (CSA) measurements were taken by tracing inside the fascial borders on magnetic resonance images. Pixel intensity summaries were obtained to compute muscle-to-fat indices and relative muscle CSA, that is, CSA void of fat. Right/left averages for levels L2 through L5 were determined. Mixed-design analyses of covariance were used to test for differences between groups, based on LBP presence and sex, across levels (P≤.05). Results Older adults with LBP had a greater average multifidus muscle-to-fat index (0.51 versus 0.49) and smaller average erector spinae relative muscle CSA (8.56 cm(2) versus 9.26 cm(2)) when compared to control participants without LBP. No interactions between LBP status and average muscle characteristics were found for the psoas or quadratus lumborum (P>.05). Conclusion Up to 54% of older adult trunk muscle CSA may be fat. Women have smaller muscles and greater intramuscular fat (at lower spinal levels) than men. J Orthop Sports Phys Ther 2017;47(3):173-179. Epub 3 Feb 2017. doi:10.2519/jospt.2017.7002.

  12. [Low Back Pain in Pregnancy: Diagnosis, Treatment Options and Outcomes].

    Science.gov (United States)

    Mühlemann, Daniel; Mühlemann, Malin B

    2015-05-20

    Low back pain in pregnancy is a common occurrence and is mainly caused by hormonal and biomechanical changes. Patients with pregnancy-induced low back pain (PILBP) frequently complain of moderate to severe and disabling pain often restricting their daily activities. In these cases, a “watch and wait” approach cannot be the best solution. On the basis of anamnesis and examination PILBP can be divided into three subgroups: pregnancy-related low back pain (PLBP), pelvic girdle pain (PGP) and the combination of PLBP and PGP. The three entities ask for different diagnostic workups and therapeutic modalities. There are many possible treatments for PLBP, however, only a few are based on sound evidence. Information and advice, exercise and training programs, acupuncture, stabilizing belts and analgesic medication can have a positive impact on pain and disability. PGP und PLBP respond well to chiropractic interventions.

  13. Objective Measures for Pregnancy Related Low Back and Pelvic Pain

    NARCIS (Netherlands)

    M. de Groot (Mirthe)

    2005-01-01

    textabstractPain in the lumbar spine and pelvic region is a frequent complication of pregnancy and delivery. The prevalence of pregnancy related low back and pelvic pain (PLBP) varies between 14.2 and 56%. In 6 to 15% the pain is so severe that it impedes daily life activities. The symptoms of PL

  14. Pregnancy Related Low Back and Pelvic Pain: a surgical approach

    NARCIS (Netherlands)

    C.M.A. Zwienen

    2005-01-01

    textabstractMore than half of all pregnant women experience low back and/or pelvic pain of whom one-third has severe complaints. In most cases the pelvic pain disap­pears within a few months after delivery, either spontaneously or after con­servative treatment. In a minority of patients the pain per

  15. Acupuncture for Low Back Pain: An Overview of Systematic Reviews

    Directory of Open Access Journals (Sweden)

    Lizhou Liu

    2015-01-01

    Full Text Available Objective. As evidence of the effectiveness of acupuncture for low back pain (LBP is inconsistent, we aimed to critically appraise the evidence from relevant systematic reviews. Methods. Systematic reviews of randomized controlled trials (RCTs concerning acupuncture and LBP were searched in seven databases. Internal validity and external validity of systematic reviews were assessed. Systematic reviews were categorized and high quality reviews assigned greater weightings. Conclusions were generated from a narrative synthesis of the outcomes of subgroup comparisons. Results. Sixteen systematic reviews were appraised. Overall, the methodological quality was low and external validity weak. For acute LBP, evidence that acupuncture has a more favorable effect than sham acupuncture in relieving pain was inconsistent; it had a similar effect on improving function. For chronic LBP, evidence consistently demonstrated that acupuncture provides short-term clinically relevant benefits for pain relief and functional improvement compared with no treatment or acupuncture plus another conventional intervention. Conclusion. Systematic reviews of variable quality showed that acupuncture, either used in isolation or as an adjunct to conventional therapy, provides short-term improvements in pain and function for chronic LBP. More efforts are needed to improve both internal and external validity of systematic reviews and RCTs in this area.

  16. Acupuncture for low back pain: an overview of systematic reviews.

    Science.gov (United States)

    Liu, Lizhou; Skinner, Margot; McDonough, Suzanne; Mabire, Leon; Baxter, George David

    2015-01-01

    Objective. As evidence of the effectiveness of acupuncture for low back pain (LBP) is inconsistent, we aimed to critically appraise the evidence from relevant systematic reviews. Methods. Systematic reviews of randomized controlled trials (RCTs) concerning acupuncture and LBP were searched in seven databases. Internal validity and external validity of systematic reviews were assessed. Systematic reviews were categorized and high quality reviews assigned greater weightings. Conclusions were generated from a narrative synthesis of the outcomes of subgroup comparisons. Results. Sixteen systematic reviews were appraised. Overall, the methodological quality was low and external validity weak. For acute LBP, evidence that acupuncture has a more favorable effect than sham acupuncture in relieving pain was inconsistent; it had a similar effect on improving function. For chronic LBP, evidence consistently demonstrated that acupuncture provides short-term clinically relevant benefits for pain relief and functional improvement compared with no treatment or acupuncture plus another conventional intervention. Conclusion. Systematic reviews of variable quality showed that acupuncture, either used in isolation or as an adjunct to conventional therapy, provides short-term improvements in pain and function for chronic LBP. More efforts are needed to improve both internal and external validity of systematic reviews and RCTs in this area.

  17. Study protocol: Transition from localized low back pain to chronic widespread pain in general practice: Identification of risk factors, preventive factors and key elements for treatment – A cohort study

    Directory of Open Access Journals (Sweden)

    Viniol Annika

    2012-05-01

    Full Text Available Abstract Background Chronic localized pain syndromes, especially chronic low back pain (CLBP, are common reasons for consultation in general practice. In some cases chronic localized pain syndromes can appear in combination with chronic widespread pain (CWP. Numerous studies have shown a strong association between CWP and several physical and psychological factors. These studies are population-based cross-sectional and do not allow for assessing chronology. There are very few prospective studies that explore the predictors for the onset of CWP, where the main focus is identifying risk factors for the CWP incidence. Until now there have been no studies focusing on preventive factors keeping patients from developing CWP. Our aim is to perform a cross sectional study on the epidemiology of CLBP and CWP in general practice and to look for distinctive features regarding resources like resilience, self-efficacy and coping strategies. A subsequent cohort study is designed to identify the risk and protective factors of pain generalization (development of CWP in primary care for CLBP patients. Methods/Design Fifty-nine general practitioners recruit consecutively, during a 5 month period, all patients who are consulting their family doctor because of chronic low back pain (where the pain is lasted for 3 months. Patients are asked to fill out a questionnaire on pain anamnesis, pain-perception, co-morbidities, therapy course, medication, socio demographic data and psychosomatic symptoms. We assess resilience, coping resources, stress management and self-efficacy as potential protective factors for pain generalization. Furthermore, we raise risk factors for pain generalization like anxiety, depression, trauma and critical life events. During a twelve months follow up period a cohort of CLBP patients without CWP will be screened on a regular basis (3 monthly for pain generalization (outcome: incident CWP. Discussion This cohort study will be the largest

  18. Does habituation differ in chronic low back pain subjects compared to pain-free controls? A cross-sectional pain rating ERP study reanalyzed with the ERFIA multilevel method.

    Science.gov (United States)

    Vossen, Catherine J; Vossen, Helen G M; Joosten, Engelbert A; van Os, Jim; Lousberg, Richel

    2015-05-01

    The objective of the present study was to investigate cortical differences between chronic low back pain (CLBP) subjects and pain-free controls with respect to habituation and processing of stimulus intensity. The use of a novel event-related fixed-interval areas (ERFIA) multilevel technique enables the analysis of event-related electroencephalogram (EEG) of the whole post stimulus range at a single trial level. This technique makes it possible to disentangle the cortical processes of habituation and stimulus intensity.In a cross-sectional study, 78 individuals with CLBP and 85 pain-free controls underwent a rating paradigm of 150 nonpainful and painful somatosensory electrical stimuli. For each trial, the entire epoch was partitioned into 20-ms ERFIAs, which acted as dependent variables in a multilevel analysis. The variability of each consecutive ERFIA period was modeled with a set of predictor variables, including 3 forms of habituation and stimulus intensity.Seventy-six pain-free controls and 65 CLBP subjects were eligible for analysis. CLBP subjects showed a significantly decreased linear habituation at 340 to 460 ms in the midline electrodes and C3 (Ps Future studies with a longitudinal design are required to solve this issue.

  19. Approach to low back pain. Chiropractic.

    Science.gov (United States)

    French, Simon; Werth, Peter; Walker, Bruce

    2014-01-01

    Case study. A man aged 42 years, who works as a police officer, presented with severe lower back pain, which he had experienced for 24 hours after spending the previous day helping his brother to move house. He had difficulty ambulating and most movements aggravated the pain. There were no lower limb symptoms and no red flags present on history or examination. He was otherwise well and was not taking any regular medications.

  20. Associations between Trunk Extension Endurance and Isolated Lumbar Extension Strength in Both Asymptomatic Participants and Those with Chronic Low Back Pain

    Directory of Open Access Journals (Sweden)

    Rebecca Conway

    2016-09-01

    Full Text Available Background: Strength and endurance tests are important for both clinical practice and research due to the key role they play in musculoskeletal function. In particular, deconditioning of the lumbar extensor musculature has been associated with low back pain (LBP. Due to the relationship between strength and absolute endurance, it is possible that trunk extension (TEX endurance tests could provide a proxy measure of isolated lumbar extension (ILEX strength and thus represent a simple, practical alternative to ILEX measurements. Though, the comparability of TEX endurance and ILEX strength is presently unclear and so the aim of the present study was to examine this relationship. Methods: Thirty eight healthy participants and nineteen participants with non-specific chronic LBP and no previous lumbar surgery participated in this cross-sectional study design. TEX endurance was measured using the Biering–Sorensen test. A maximal ILEX strength test was performed on the MedX lumbar-extension machine. Results: A Pearson’s correlation revealed no relationship between TEX endurance and ILEX strength in the combined group (r = 0.035, p = 0.793, the chronic LBP group (r = 0.120, p = 0.623 or the asymptomatic group (r = −0.060, p = 0.720. Conclusions: The results suggest that TEX is not a good indicator of ILEX and cannot be used to infer results regarding ILEX strength. However, a combination of TEX and ILEX interpreted together likely offers the greatest and most comprehensive information regarding lumbo-pelvic function during extension.

  1. Long-term effects of interprofessional biopsychosocial rehabilitation for adults with chronic non-specific low back pain: a multicentre, quasi-experimental study.

    Directory of Open Access Journals (Sweden)

    Jana Semrau

    Full Text Available Improvement of the long-term effectiveness of multidisciplinary ortho-paedic rehabilitation (MOR in the management of chronic non-specific low back pain (CLBP remains a central issue for health care in Germany. We developed an interprofessional and interdisciplinary, biopsychosocial rehabilitation concept named "PASTOR" to promote self-management in adults with CLBP and compared its effectiveness with the current model of MOR.A multicentre quasi-experimental study with three measurement time points was implemented. 680 adults aged 18 to 65 with CLBP were assed for eligibil-ity in three inpatient rehabilitation centres in Germany. At first the effects of the MOR, with a total extent of 48 hours (control group, were assessed. Thereafter, PASTOR was implemented and evaluated in the same centres (intervention group. It consisted of six interprofessional modules, which were provided on 12 days in fixed groups, with a total extent of 48 hours. Participants were assessed with self-report measures at baseline, discharge, and 12 months for functional ability (primary outcome using the Hannover Functional Ability Questionnaire (FFbH-R and vari-ous secondary outcomes (e.g. pain, health status, physical activity, pain coping, pain-related cognitions.In total 536 participants were consecutively assigned to PASTOR (n=266 or MOR (n=270. At 12 months, complete data of 368 participants was available. The adjusted between-group difference in the FFbH-R at 12 months was 6.58 (95% CI 3.38 to 9.78 using complete data and 3.56 (95% CI 0.45 to 6.67 using available da-ta, corresponding to significant small-to-medium effect sizes of d=0.42 (p<0.001 and d=0.10 (p=0.025 in favour of PASTOR. Further improvements in secondary out-comes were also observed in favour of PASTOR.The interprofessional and interdisciplinary, biopsychosocial rehabilita-tion program PASTOR shows some improvements of the long-term effectiveness of inpatient rehabilitation in the management of adults

  2. Spinal cord stimulation with hybrid lead relieves pain in low back and legs

    NARCIS (Netherlands)

    Vos, de Cecile C.; Dijkstra, Cindy; Lenders, Mathieu W.P.M.; Holsheimer, Jan; Levy, R.M.

    2012-01-01

    Objective: The failed back surgery syndrome (FBSS) is the most common chronic pain syndrome. Whereas it is relatively easy to achieve pain relief in the lower limbs of FBSS patients with spinal cord stimulation (SCS), it is difficult to manage low back pain with SCS. The performance of a paddle-shap

  3. Low back pain post partum - A case report.

    LENUS (Irish Health Repository)

    2012-02-23

    Sacral stress fracture is an unusual source of low back pain and can be easily confused with a number of other clinical conditions seen in physiotherapy clinics. The purpose of this case report is to describe the case of a patient presenting with low back pain post partum illustrating pertinent aspects of differential diagnosis and issues of management. A 31 year old female presented complaining of low back pain since the birth of her second child 11 months earlier. Subjective and objective examination led the Therapist to consider a diagnosis of sacral stress fracture. This diagnosis was confirmed by MRI. Three months after presenting to physiotherapy the patient was pain free and had returned to all aspects of her daily life without any difficulties. Clinicians must be aware of the less common pathologies in any hypotheses development. A careful history and physical examination and broad hypotheses generation will ensure that patients are accurately diagnosed and receive appropriate and effective treatments.

  4. Medial branch neurotomy in low back pain

    Energy Technology Data Exchange (ETDEWEB)

    Masala, Salvatore; Mammucari, Matteo; Simonetti, Giovanni [Interventional Radiology and Radiotherapy University ' ' Tor Vergata' ' , Department of Diagnostic and Molecular Imaging, Rome (Italy); Nano, Giovanni [Interventional Radiology and Radiotherapy University ' ' Tor Vergata' ' , Department of Diagnostic and Molecular Imaging, Rome (Italy); University ' ' Tor Vergata' ' , Department of Radiology, Rome (Italy); Marcia, Stefano [S. Giovanni di Dio Hospital, Department of Diagnostic and Molecular Imaging, Cagliari (Italy)

    2012-07-15

    This study aimed to assess the effectiveness of pulsed radiofrequency medial branch dorsal ramus neurotomy in patients with facet joint syndrome. From January 2008 to April 2010, 92 patients with facet joint syndrome diagnosed by strict inclusion criteria and controlled diagnostic blocks undergone medial branch neurotomy. We did not exclude patients with failed back surgery syndrome (FBSS). Electrodes (20G) with 5-mm active tip were placed under fluoroscopy guide parallel to medial branch. Patients were followed up by physical examination and by Visual Analog Scale and Oswestry Disability Index at 1, 6, and 12 months. In all cases, pain improvement was statistically significant and so quality of life. Three non-FBSS patients had to undergo a second neurotomy because of non-satisfactory pain decrease. Complications were reported in no case. Medial branch radiofrequency neurotomy has confirmed its well-established effectiveness in pain and quality of life improvement as long as strict inclusion criteria be fulfilled and nerve ablation be accomplished by parallel electrode positioning. This statement can be extended also to FBSS patients. (orig.)

  5. Does going to an amusement park alleviate low back pain? A preliminary study

    Science.gov (United States)

    Sakakibara, Toshihiko; Wang, Zhuo; Kasai, Yuichi

    2012-01-01

    Background Low back pain is often called nonspecific pain. In this type of low back pain, various emotions and stress are known to strongly affect pain perception. The purpose of this study is to investigate how the degree of low back pain changes in people with chronic mild low back pain when they are inside and outside of an amusement park where people are supposed to have physical and psychological enjoyment. Methods The subjects were 23 volunteers (13 males and 10 females) aged 18 to 46 years old with a mean age of 24.0 years who had chronic low back pain. Visual analog scale (VAS) scores of low back pain and salivary amylase levels (kIU/L) of all subjects were measured at five time points: immediately after getting on the bus heading for the amusement park; 10 minutes, 1 hour (immediately after boarding the roller coaster), and 3 hours (immediately after exiting the haunted house) after arriving at the amusement park; and immediately before getting off the bus returning from the park. Results The three VAS values in the amusement park (10 minutes, 1 hour, and 3 hours after arriving at the amusement park) measured were significantly lower (P amusement park and immediately before getting off the return bus. In salivary amylase levels, there were no statistically significant differences among the values measured at the five time points. Conclusion Low back pain was significantly alleviated when the subjects were in the amusement park, which demonstrated that enjoyable activities, though temporarily, alleviated their low back pain. PMID:23118550

  6. Comparing propensity score methods for creating comparable cohorts of chiropractic users and non-users in older, multiply comorbid Medicare patients with chronic low back pain

    Science.gov (United States)

    Weeks, William B; Tosteson, Tor D; Whedon, James M; Leininger, Brent; Lurie, Jon D; Swenson, Rand; Goertz, Christine M; O’Malley, Alistair J

    2015-01-01

    Objective Patients who use complementary and integrative health services like chiropractic manipulative treatment (CMT) often have different characteristics than patients who do not, and these differences can confound attempts to compare outcomes across treatment groups, particularly in observational studies when selection bias may occur. The purposes of this study were to provide an overview on how propensity scoring methods can be used address selection bias by balancing treatment groups on key variables and to use Medicare data to compare different methods for doing so. Methods We described 2 propensity score methods (matching and weighting). Then we used Medicare data from 2006-2012 on older, multiply comorbid patients who had a chronic low back pain episode to demonstrate the impact of applying methods on the balance of demographics of patients between 2 treatment groups (those who received only CMT and those who received no CMT during their episodes). Results Before application of propensity score methods, patients who used only CMT had different characteristics from those who did not. Propensity score matching diminished observed differences across the treatment groups at the expense of reduced sample size. However, propensity score weighting achieved balance in patient characteristics between the groups and allowed us to keep the entire sample. Conclusions While propensity score matching and weighting have similar effects in terms of balancing covariates, weighting has the advantage of maintaining sample size, preserving external validity, and generalizing more naturally to comparisons of 3 or more treatment groups. Researchers should carefully consider which propensity score method to use, as using different methods can generate different results. PMID:26547763

  7. Minimally Invasive Microendoscopic Resection of the Transverse Process for Treatment of Low Back Pain with Bertolotti's Syndrome

    Science.gov (United States)

    Sakai, Toshinori; Higashino, Kosaku; Goda, Yuichiro; Mineta, Kazuaki; Sairyo, Koichi

    2014-01-01

    Bertolotti's syndrome is characterized by anomalous enlargement of the transverse process of the most caudal lumbar segment, causing chronic and persistent low back pain or sciatica. We describe the case of a 45-year-old woman who presented with left sciatic pain and low back pain due to a recurrent lumbar disc herniation at L4-5 with Bertolotti's syndrome. Selective L5 nerve root block and local injection of lidocaine into the articulation between the transverse process and sacral ala temporarily relieved the left sciatic pain and low back pain, respectively. To confirm the effect of local injection on low back pain, we gave a second local injection, which once again relieved the low back pain. Microendoscopic resection of the pseudoarticulation region and discectomy successfully relieved all symptoms. This report illustrates the effectiveness of minimally invasive resection of the transverse process for the treatment of low back pain with Bertolotti's syndrome. PMID:25045566

  8. Minimally Invasive Microendoscopic Resection of the Transverse Process for Treatment of Low Back Pain with Bertolotti’s Syndrome

    Directory of Open Access Journals (Sweden)

    Yoichiro Takata

    2014-01-01

    Full Text Available Bertolotti’s syndrome is characterized by anomalous enlargement of the transverse process of the most caudal lumbar segment, causing chronic and persistent low back pain or sciatica. We describe the case of a 45-year-old woman who presented with left sciatic pain and low back pain due to a recurrent lumbar disc herniation at L4-5 with Bertolotti’s syndrome. Selective L5 nerve root block and local injection of lidocaine into the articulation between the transverse process and sacral ala temporarily relieved the left sciatic pain and low back pain, respectively. To confirm the effect of local injection on low back pain, we gave a second local injection, which once again relieved the low back pain. Microendoscopic resection of the pseudoarticulation region and discectomy successfully relieved all symptoms. This report illustrates the effectiveness of minimally invasive resection of the transverse process for the treatment of low back pain with Bertolotti’s syndrome.

  9. Neuroscience education in addition to trigger point dry needling for the management of patients with mechanical chronic low back pain: A preliminary clinical trial.

    Science.gov (United States)

    Téllez-García, Mario; de-la-Llave-Rincón, Ana I; Salom-Moreno, Jaime; Palacios-Ceña, Maria; Ortega-Santiago, Ricardo; Fernández-de-Las-Peñas, César

    2015-07-01

    The objective of the current study was to determine the short-term effects of trigger point dry needling (TrP-DN) alone or combined with neuroscience education on pain, disability, kinesiophobia and widespread pressure sensitivity in patients with mechanical low back pain (LBP). Twelve patients with LBP were randomly assigned to receive either TrP-DN (TrP-DN) or TrP-DN plus neuroscience education (TrP-DN + EDU). Pain intensity (Numerical Pain Rating Scale, 0-10), disability (Roland-Morris Disability Questionnaire-RMQ-, Oswestry Low Back Pain Disability Index-ODI), kinesiophobia (Tampa Scale of Kinesiophobia-TSK), and pressure pain thresholds (PPT) over the C5-C6 zygapophyseal joint, transverse process of L3 vertebra, second metacarpal, and tibialis anterior muscle were collected at baseline and 1-week after the intervention. Patients treated with TrP-DN + EDU experienced a significantly greater reduction of kinesiophobia (P = 0.008) and greater increases in PPT over the transverse process of L3 (P = 0.049) than those patients treated only with TrP-DN. Both groups experienced similar decreases in pain, ODI and RMQ, and similar increases in PPT over the C5/C6 joint, second metacarpal, and tibialis anterior after the intervention (all, P > 0.05). The results suggest that TrP-DN was effective for improving pain, disability, kinesiophobia and widespread pressure sensitivity in patients with mechanical LBP at short-term. The inclusion of a neuroscience educational program resulted in a greater improvement in kinesiophobia.

  10. An integrated care program to prevent work disability due to chronic low back pain: a process evaluation within a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    van Mechelen Willem

    2009-11-01

    Full Text Available Abstract Background In the past decade, a considerable amount of research has been carried out to evaluate the effectiveness of innovative low back pain (LBP interventions. Although some interventions proved to be effective, they are not always applied in daily practice. To successfully implement an innovative program it is important to identify barriers and facilitators in order to change practice routine. Because usual care is not directly aimed at return to work (RTW, we evaluated an integrated care program, combining a patient-directed and a workplace-directed intervention provided by a multidisciplinary team, including a clinical occupational physician to reduce occupational disability in chronic LBP patients. The aims of this study were to describe the feasibility of the implementation of the integrated care program, to assess the satisfaction and expectations of the involved stakeholders and to describe the needs for improvement of the program. Methods Eligible for this study were patients who had been on sick leave due to chronic LBP. Data were collected from the patients, their supervisors and the involved health care professionals, by means of questionnaires and structured charts, during 3-month follow-up. Implementation, satisfaction and expectations were investigated. Results Of the 40 patients who were eligible to participate in the integrated care program, 37 patients, their supervisors and the health care professionals actually participated in the intervention. Adherence to the integrated care program was in accordance with the protocol, and the patients, their supervisors and the health care professionals were (very satisfied with the program. The role of the clinical occupational physician was of additional value in the RTW process. Time-investment was the only barrier for implementation reported by the multidisciplinary team. Conclusion The implementation of this program will not be influenced by any flaws in its application

  11. [Obesity and low back pain--biology, biomechanics and epidemiology].

    Science.gov (United States)

    Flamme, C H

    2005-07-01

    Aim of the following paper is to describe the impact of obesity on low back pain. The mature disc is one of the most sparsely cellular tissues in the body, water content and concentration of proteoglycan decreases with increasing age. Both, static compressive loading and increased pressures, may result in damage of the integrity of the disc like tears of the anulus, followed by mechanical compression or chemical damage of the nerve roots. The intradiscal pressure is dependent on the body position and increases in the following order: prone, standing, upright sitting. In addition, bending and weight lifting increases the intradiscal pressure. For asymptomatic subjects, reported prevalences of disc degenerations in MRI studies are often quite high. Several studies report a significant association between body weight and low back pain, some do not. Recent research indicates that heredity has a dominant role in disc degeneration and low back pain, although the complex distributions and interactions of genetic factors are currently unknown.

  12. [Deficits in the psychological care of low back pain patients--Comments on the expertise of the expert committee for the health care system regarding low back pain].

    Science.gov (United States)

    Basler, H D

    2002-06-01

    A committee of health specialists examined the demand characteristics and efficiency of German health care services and published an expertise on the misallocation of services that among other subjects also covered the area of low back pain. Although we agree with their principal statements, we like to underscore that the objectives mentioned in the report cannot be achieved without the participation of psychologists. The process of chronicity is determined in a significant way by psychological mechanisms. Psychologists investigated these mechanisms, developed interventions for the prevention and treatment of low back pain on the basis of the results, and tested their efficacy in trials with a high methodological standard. Incorporation of psychological expertise does not only optimise prevention and treatment of low back pain and helps to prevent unnecessary suffering of the afflicted, in addition, it offers a contribution a cost containment.

  13. Dor, cinesiofobia e qualidade de Vida em pacientes com lombalgia crônica e depressão Pain, kinesiophobia and quality of life in chronic low back pain and depression

    Directory of Open Access Journals (Sweden)

    Rogério Sarmento Antunes

    2013-02-01

    Full Text Available OBJETIVO: Descrever características de dor, cinesiofobia e qualidade de vida em pacientes com lombalgia crônica associada a depressão. MÉTODOS: Estudo de delineamento transversal em que foram incluídos 193 indivíduos com lombalgia crônica. A presença de depressão foi determinada pelo Inventário de Depressão de Beck, a partir de ponto de corte validado pela Mini International Neuropsychiatric Interview. A intensidade e a qualidade da dor nos grupos com e sem depressão foram avaliadas pelo Questionário McGill. A Escala Tampa para Cinesiofobia foi aplicada para avaliar medo do movimento. Com relação à qualidade de vida, utilizou-se o Medical Outcomes Study 36. O nível de significância estatístico estabelecido foi pOBJECTIVE: To describe the characteristics of pain, kinesiophobia and quality of life in patients with chronic low back pain and depression. METHODS: Cross-sectional study in which 193 individuals with chronic low back pain were included. The presence of depression was measured by the Beck Depression Inventory, using a cutoff validated by the Mini International Neuropsychiatric Interview. The intensity and quality of pain in the groups with and without depression were assessed by the McGill Questionnaire. The Tampa Scale for Kinesiophobia was applied to assess fear of movement. With respect to quality of life, the Medical Outcomes Study 36 was used. The statistical significance level was set at p <0.05. RESULTS: The prevalence of depression was 32.1%. The group with depression had worse scores in relation to pain, kinesiophobia and quality of life (physical functioning, rolephysical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. CONCLUSION: Patients with low back pain and depression had higher pain intensity, greater fear of movement and poorer quality of life. Level of Evidence III, Cross-sectional.

  14. Evaluation of Metabolic Syndrome in Patients with Chronic Low Back Pain: Using the Fourth Korea National Health and Nutrition Examination Survey Data

    OpenAIRE

    Ha, Jae Yong

    2011-01-01

    The aim of this study was to investigate the frequency of the metabolic syndrome in patients with chronic lower back pain in Korea and to evaluate the differences in clinical characteristics in chronic lower back pain patients with and without metabolic syndrome. This was a cross-sectional study using data from the fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) 2008. The sample consisted of 1085 participants with chronic lower back pain. The diagnosis of metabolic ...

  15. Differences across health care systems in outcome and cost-utility of surgical and conservative treatment of chronic low back pain: a study protocol

    Directory of Open Access Journals (Sweden)

    Barz Thomas

    2008-06-01

    Full Text Available Abstract Background There is little evidence on differences across health care systems in choice and outcome of the treatment of chronic low back pain (CLBP with spinal surgery and conservative treatment as the main options. At least six randomised controlled trials comparing these two options have been performed; they show conflicting results without clear-cut evidence for superior effectiveness of any of the evaluated interventions and could not address whether treatment effect varied across patient subgroups. Cost-utility analyses display inconsistent results when comparing surgical and conservative treatment of CLBP. Due to its higher feasibility, we chose to conduct a prospective observational cohort study. Methods This study aims to examine if 1. Differences across health care systems result in different treatment outcomes of surgical and conservative treatment of CLBP 2. Patient characteristics (work-related, psychological factors, etc. and co-interventions (physiotherapy, cognitive behavioural therapy, return-to-work programs, etc. modify the outcome of treatment for CLBP 3. Cost-utility in terms of quality-adjusted life years differs between surgical and conservative treatment of CLBP. This study will recruit 1000 patients from orthopaedic spine units, rehabilitation centres, and pain clinics in Switzerland and New Zealand. Effectiveness will be measured by the Oswestry Disability Index (ODI at baseline and after six months. The change in ODI will be the primary endpoint of this study. Multiple linear regression models will be used, with the change in ODI from baseline to six months as the dependent variable and the type of health care system, type of treatment, patient characteristics, and co-interventions as independent variables. Interactions will be incorporated between type of treatment and different co-interventions and patient characteristics. Cost-utility will be measured with an index based on EQol-5D in combination with cost

  16. 银质针灸治疗下腰部软组织疼痛%An investigation of treatment with silver acupuncture for pain of chronic soft tissue lesions in low back

    Institute of Scientific and Technical Information of China (English)

    虞乐华; 吴南顺; 张宽平

    2002-01-01

    Objective To observe the effect of a modern silver acupuncture(MSA) on chronic soft tissue lesion in low back.Methods 89 patients suffering severe low back pain from soft tissue lesions(conversion of acute injuries,chronic overuse injuries,fibromyositis or myogelosis) were treated by MSA.The silver needles of MSA to be inserted into a series of abnormal points (local tension," trigger points" and tenderness,stiffness and muscle spasms etc.) mainly located in the connective tissue between bones and muscles in low back , should go through all soft tissues to reach the lesions along the sides of bones, lighting moxibustion fixed on the tails of the needles produced heat effect on the lesions.Treatment period might be one time to five times, 7~ 10 days interval between twice.Results The effective percents of conversion of acute injuries(72% ) or chronic overuse injuries(64% ) were significant higher than that of fibromyositis or myogelosis(29% ), P < 0.01, P< 0.05 respectively. Conclusion MSA is an effective treatment, especially for the soft tissue lesions from conversion of acute injuries and chronic overuse injuries in low back.

  17. 产妇产后慢性腰背痛发病率和风险因素%Prevalence and risk factors of chronic low back pain in puerperas after childbirth

    Institute of Scientific and Technical Information of China (English)

    关应军; 徐世元; 陈业松; 金俊; 钟兰兰; 唐霜

    2015-01-01

    Objective To observe the prevalence and risk factors of chronic low back pain in puerperas after childbirth.Methods Eight hundred and eighty-one puerperas were selected,among whom 459 cases had uterine-incision delivery,and 422 cases had spontaneous delivery.The age,height and weight of pregnant women,birth weight of newborn,history of preoperative low back pain,parity and mode of delivery were recorded.The rate of chronic low back pain occurring within 1 month after childbirth and continuing for 3 months was recorded by telephone.The factors with P values less than 0.05 would enter the Logistic regression analysis to screen the risk factors of chronic low back pain.Results Two hundred and fifty-nine puerperas (259/881,29.4%) appeared chronic low back pain,of whom 157 puerperas (157/459,34.2%)delivered by uterine-incision and 102 puerperas (102/422,24.2%) delivered spontaneously,and the difference was statistically significant (P < 0.01).Six hundred and fifty-eight puerperas had no history of preoperative low back pain,and 150 puerperas (150/658,22.8%) appeared newly developed chronic low back pain.Logistic regression analysis showed that mode of delivery,parity and history of preoperative low back pain were the risk factors of chronic low back pain.Condusions The rate of chronic low back pain in puerperas after childbirth is 29.4%,and the newly developed chronic low back pain is 22.8%.Uterineincision delivery,multiparity and history of preoperative low back pain are the risk factors of chronic low back pain for puerperas after childbirth.%目的 观察产妇产后慢性腰背痛发病率和风险因素.方法 选择产妇881例,其中剖宫产459例,顺产422例.记录产妇年龄、身高、体质量、新生儿体质量、术前腰背痛病史、生育次数及分娩方式,电话回访记录产妇1个月内发生且持续了3个月的腰背痛.将组间比较差异有统计学意义的因素行Logistic回归分析,筛选出产后慢性

  18. Active lifestyle protects against incident low back pain in seniors

    DEFF Research Database (Denmark)

    Hartvigsen, Jan; Christensen, Kaare

    2007-01-01

    STUDY DESIGN: Prospective cohort study of twins. OBJECTIVES: To investigate associations between physical activity, physical function, and incident low back pain (LBP) in an elderly population. SUMMARY OF BACKGROUND DATA: The relationship between an active lifestyle and LBP in seniors is unknown...

  19. Spinal manipulative therapy for acute low-back pain (Review)

    NARCIS (Netherlands)

    Rubinstein, S.M.; Terwee, C.B.; Assendelft, W.J.J.; Boer, M.R.M. de; Tulder, M.W. van

    2012-01-01

    BACKGROUND: Many therapies exist for the treatment of low-back pain including spinal manipulative therapy (SMT), which is a worldwide, extensively practised intervention. This report is an update of the earlier Cochrane review, first published in January 2004 with the last search for studies up to J

  20. Low Back Pain in Microgravity and Bed Rest Studies.

    NARCIS (Netherlands)

    Pool-Goudzwaard, A.L.; Belavy, D.L.; Hides, J.A; Richardson, C.A.; Snijders, C.J.

    2015-01-01

    Abstract BACKGROUND: The prevalence of low back pain (LBP) for astronauts in space (68%) is higher than the 1-mo prevalence for the general population on Earth (39%). It is unclear whether differences occur between healthy subjects and astronauts with a history of LBP. Knowledge of this issue is imp

  1. Lumbar bone mass predicts low back pain in males

    NARCIS (Netherlands)

    Hoozemans, M.J.M.; Koppes, L.L.J.; Twisk, J.W.R.; Dieën, J.H. van

    2012-01-01

    STUDY DESIGN.: Longitudinal study of lumbar bone mass as predictor of low back pain (LBP). OBJECTIVE.: To investigate whether low bone mineral content (BMC) and bone mineral density (BMD) values at the age of 36 years are associated with the prevalence of LBP at the age of 42 years among the study p

  2. Meningoradiculitis due to borreliosis presenting as low back pain only

    Energy Technology Data Exchange (ETDEWEB)

    Demaerel, P.; Crevits, I.; Baert, A.L. [Department of Radiology, University Hospitals, Leuven (Belgium); Casteels-Van Daele, M. [Department of Paediatrics, University Hospitals, Leuven (Belgium)

    1998-02-01

    We report a child with Borrelia burgdorferi meningoradiculitis. This entity, also known as Bannwarth syndrome, is rare and its presentation with low back pain only is even more unusual. The MRI findings can suggest the diagnosis. (orig.) With 1 fig., 3 refs.

  3. Low Back Pain? Relax, Breathe and Try Yoga

    Science.gov (United States)

    ... Videos & Tools Español You Are Here: Home → Latest Health News → Article URL of this page: https://medlineplus.gov/news/fullstory_163537.html Low Back Pain? Relax, Breathe and Try Yoga Review of 12 studies found small improvements in ...

  4. Does magnetic resonance imaging predict future low back pain?

    DEFF Research Database (Denmark)

    Steffens, D; Hancock, M J; Maher, C G;

    2014-01-01

    Magnetic resonance imaging (MRI) has the potential to identify pathology responsible for low back pain (LBP). However, the importance of findings on MRI remains controversial. We aimed to systematically review whether MRI findings of the lumbar spine predict future LBP in different samples...

  5. Low Back Pain in Microgravity and Bed Rest Studies.

    NARCIS (Netherlands)

    Pool-Goudzwaard, A.L.; Belavy, D.L.; Hides, J.A; Richardson, C.A.; Snijders, C.J.

    2015-01-01

    AbstractBACKGROUND:The prevalence of low back pain (LBP) for astronauts in space (68%) is higher than the 1-mo prevalence for the general population on Earth (39%). It is unclear whether differences occur between healthy subjects and astronauts with a history of LBP. Knowledge of this issue is impor

  6. Physical therapy management of low back pain has changed.

    NARCIS (Netherlands)

    Groenendijk, J.J.; Swinkels, I.C.S.; Bakker, D. de; Dekker, J.; Ende, C.H.M. van den

    2007-01-01

    Background: Since the 1990s, new insights in the physical therapy management of low back pain have been described in guidelines. Furthermore, insurance companies introduced a volume policy to control the costs for physical therapy. Objective: This study aims to establish if developments in knowledge

  7. Application of surface electromyography topography in low back pain rehabilitation

    OpenAIRE

    Tse, Yuk-hang, Jessica; 謝毓衡

    2014-01-01

    The management of low back pain (LBP) has long been a challenge as it is a highly prevalent disease worldwide due to the lack of an apparent etiology and a conclusive therapeutic treatment. Heterogeneous groups of LBP patients with diverse medical backgrounds also complicate the problem. A clinical threshold is demanded to match the patients and treatments appropriately in order to maximize the treatment success rate. Besides, the assessments of disability and pain perception due to LBP made ...

  8. Patients' interpretations of a counselling intervention for low back pain

    DEFF Research Database (Denmark)

    Angel, Sanne; Jensen, Lone Donbæk; Gonge, Birgitte Krøis

    2012-01-01

    persist. A Danish randomised controlled trial identified an effective counselling intervention on low back pain patients' physical function, bodily pain and sick leave. Counselling addressed experienced workplace barriers and physical activity. OBJECTIVE: The objective of the present study was to achieve...... of status interviews performed during the randomised controlled trial's intervention. ANALYSIS: Between two individual counselling sessions, all 110 participants were interviewed about their perspectives on adhering to their individual plans for reaching specific goals for adjustments at their workplace...

  9. Development of the Italian version of the Pain Stages of Change Questionnaire in patients with chronic low back pain: cross-cultural adaptation, confirmatory factor analysis, reliability and validity.

    Science.gov (United States)

    Monticone, Marco; Ferrante, Simona; Ferrari, Silvano; Mugnai, Raffaele; Pillastrini, Paolo; Rocca, Barbara; Vanti, Carla; Foti, Calogero

    2014-09-01

    Translating, culturally adapting and validating the Italian version of the Pain Stages of Change Questionnaire (PSOCQ-I) to allow its use with Italian-speaking patients with low back pain. The PSOCQ-I was developed by forward-backward translation, a final review by an expert committee and a test of the prefinal version to establish its correspondence with the original English version. Psychometric testing included confirmatory factor analysis, reliability by internal consistency (Cronbach's α) and test-retest reliability (intraclass coefficient correlation), and construct validity by comparing PSOCQ-I with the Pain Catastrophising Scale (PCS), the Tampa Scale of Kinesiophobia (TSK), the Roland Morris Disability Scale (RMDQ), a pain Numerical Rating Scale (NRS), and the Hospital Anxiety and Depression Scale (Pearson's correlation). The questionnaire was administered to 308 patients with chronic low back pain. Factor analysis confirmed a four-factor solution (namely, Precontemplation, Contemplation, Action, and Maintenance), achieving an acceptable data-model fit. Internal consistency (α=0.91-93) and test-retest reliability (intraclass coefficient correlation=0.74-0.81) were satisfactory. Construct validity showed moderate correlations between Precontemplation and PCS (r=0.318), TSK (r=0.385), RMDQ (r=0.320) and NRS (r=0.335); low correlations were found between the other PSOCQ subscales and PCS (r=-0.062; 0.039), TSK (r=-0.164; 0.024), RMDQ (r=-0.073; 0.004) and NRS (r=-0.170; 0.020). Low correlations were found between the PSOCQ-I subscales and anxiety (r=-0.132; 0.150) and depression (r=-0.113; 0.186). The PSOCQ was translated successfully into Italian, and proved to have a good factorial structure and psychometric properties that replicated the results of other versions. Its use is recommended for research purposes.

  10. The Effects of Stabilization and Mckenzie Exercises on Transverse Abdominis and Multifidus Muscle Thickness, Pain, and Disability: A Randomized Controlled Trial in NonSpecific Chronic Low Back Pain.

    Science.gov (United States)

    Hosseinifar, Mohammad; Akbari, Mohammad; Behtash, Hamid; Amiri, Mohsen; Sarrafzadeh, Javad

    2013-12-01

    [Purpose] This study compared the effectiveness of stabilization and McKenzie exercises on pain, disability, and thickness of the transverse abdominis and multifidus muscles in patients with nonspecific chronic low back pain. [Subjects] Thirty patients were randomly assigned into two groups: the McKenzie and stabilization exercise groups. [Methods] Before and after intervention, pain, disability, and thickness of the transverse abdominis and multifidus muscles were evaluated by visual analogue scale, functional rating index, and sonography, respectively. The training program was 18 scheduled sessions of individual training for both groups. [Results] After interventions, the pain score decreased in both groups. The disability score decreased only in the stabilization group. The thickness of the left multifidus was significantly increased during resting and contracting states in the stabilization group. The thickness of the right transverse abdominis during the abdominal draw-in maneuver, and thickness of the left transverse abdominis during the active straight leg raising maneuver were significantly increased in the stabilization group. The intensity of pain, disability score, thickness of the right transverse abdominis during the abdominal draw-in manouver, and thickness of the left transverse abdominis during active straight leg raising in the stabilization group were greater than those on the Mackenzie. [Conclusion] Stabilization exercises are more effective than McKenzie exercises in improving the intensity of pain and function score and in increasing the thickness of the transverse abdominis muscle.

  11. A Personal Projects Analysis: examining adaptation to low back pain.

    Science.gov (United States)

    Vroman, Kerryellen; Chamberlain, Kerry; Warner, Rebecca

    2009-07-01

    Personal Projects Analysis (PPA) offers an alternative approach to studying adaptation to illnesses. This study investigated adaptation to low back pain using PPA to examine the relationship between participants' perceptions of pain, and their functioning and well-being. Participants appraised their five most important projects on 26 dimensions, such as project value, success and difficulty. Factor analyses of the project ratings yielded five dispositions (Integrity, Personal Agency, Social Visibility, Pain Salience and Stressfulness). In regression analysis all five dispositions significantly predicted Physical and Social Function, Disruption of Roles, and Well-being. ;Pain Salience' was the strongest predictor of functional outcomes, and ;Stressfulness' was the best predictor of well-being.

  12. Efficacy and tolerability of a hydrocodone extended-release tablet formulated with abuse-deterrence technology for the treatment of moderate-to-severe chronic pain in patients with osteoarthritis or low back pain

    Directory of Open Access Journals (Sweden)

    Hale ME

    2015-09-01

    Full Text Available Martin E Hale,1 Charles Laudadio,2 Ronghua Yang,2 Arvind Narayana,2 Richard Malamut2 1Gold Coast Research, LLC, Plantation, FL, 2Teva Branded Pharmaceutical Products R & D, Inc., Frazer, PA, USA Abstract: This double-blind, placebo-controlled study evaluated the efficacy and safety of hydrocodone extended release (ER developed with abuse-deterrence technology to provide sustained pain relief and limit effects of alcohol and tablet manipulation on drug release. Eligible patients with chronic moderate-to-severe low back or osteoarthritis pain were titrated to an analgesic dose of hydrocodone ER (15–90 mg and randomized to placebo or hydrocodone ER every 12 hours. The primary efficacy measure was change from baseline to week 12 in weekly average pain intensity (API; 0=no pain, 10=worst pain imaginable. Secondary measures included percentage of patients with >33% and >50% increases from baseline in weekly API, change from baseline in weekly worst pain intensity, supplemental opioid usage, aberrant drug-use behaviors, and adverse events. Overall, 294 patients were randomized and received ≥1 dose of placebo (n=148 or hydrocodone ER (n=146. Weekly API did not differ significantly between hydrocodone ER and placebo at week 12 (P=0.134; although, in post hoc analyses, the change in weekly API was significantly lower with hydrocodone ER when excluding the lowest dose (15 mg; least squares mean, –0.20 vs 0.40; P=0.032. Significantly more patients had .33% and .50% increase in weekly API with placebo (P<0.05, and mean weekly worst pain intensity was significantly lower with hydrocodone ER at week 12 (P=0.026. Supplemental medication usage was higher with placebo (86% than hydrocodone ER (79%. Incidence of aberrant drug-use behaviors was low, and adverse events were similar between groups. This study did not meet the primary endpoint, although results support the effectiveness of this hydrocodone ER formulation in managing chronic low back or

  13. A randomized double-blind, placebo-controlled efficacy and safety study of ALO-02 (extended-release oxycodone surrounding sequestered naltrexone) for moderate-to-severe chronic low back pain treatment.

    Science.gov (United States)

    Rauck, Richard L; Hale, Martin E; Bass, Almasa; Bramson, Candace; Pixton, Glenn; Wilson, Jacquelyn G; Setnik, Beatrice; Meisner, Paul; Sommerville, Kenneth W; Malhotra, Bimal K; Wolfram, Gernot

    2015-09-01

    The objective of this multicenter, double-blind, placebo-controlled, randomized withdrawal study was to evaluate the efficacy and safety of ALO-02, an abuse-deterrent formulation containing pellets of extended-release oxycodone hydrochloride (HCl) surrounding sequestered naltrexone HCl, compared with placebo in the treatment of moderate-to-severe chronic low back pain. An open-label titration period in which all patients received ALO-02 was followed by a double-blind treatment period where patients meeting treatment response criteria were randomized to either a fixed dose of ALO-02 or placebo. Daily average low back pain was assessed using an 11-point numeric rating scale (NRS)-Pain. Of the 663 patients screened, 410 received ALO-02 during the open-label conversion and titration period and 281 patients were randomized to the double-blind treatment period (n = 134, placebo; n = 147, ALO-02). Change in the mean NRS-Pain score from randomization baseline to the final 2 weeks of the treatment period was significantly different favoring ALO-02 compared with placebo (P = 0.0114). Forty-four percent of patients treated with placebo and 57.5% of patients treated with ALO-02 reported ≥30% improvement in weekly average NRS-Pain scores from screening to the final 2 weeks of the treatment period (P = 0.0248). In the double-blind treatment period, 56.8% of patients in the ALO-02 group and 56.0% of patients in the placebo group experienced a treatment-emergent adverse event (TEAE). The most common treatment-related TEAEs for ALO-02 during the treatment period were nausea, vomiting, and constipation, consistent with opioid therapy. ALO-02 has been demonstrated to provide significant reduction of pain in patients with chronic low back pain and has a safety profile similar to other opioids.

  14. Harpgophytum procumbens for osteoarthritis and low back pain: A systematic review

    Directory of Open Access Journals (Sweden)

    Chrubasik Sigrun

    2004-09-01

    Full Text Available Abstract Background The objective of this review is to determine the effectiveness of Harpagophytum procumbens preparations in the treatment of various forms of musculoskeletal pain. Methods Several databases and other sources were searched to identify randomized controlled trials, quasi-randomized controlled trials, and controlled clinical trials testing Harpagophytum preparations in adults suffering from pain due to osteoarthritis or low back pain. Results Given the clinical heterogeneity and insufficient data for statistical pooling, trials were described in a narrative way, taking into consideration methodological quality scores. Twelve trials were included with six investigating osteoarthritis (two were identical trials, four low back pain, and three mixed-pain conditions. Conclusions There is limited evidence for an ethanolic Harpagophytum extract containing less than Harpagophytum powder at 60 mg harpagoside in the treatment of osteoarthritis of the spine, hip and knee; (2 the use of an aqueous Harpagophytum extract at a daily dose of 100 mg harpagoside in the treatment of acute exacerbations of chronic non-specific low back pain; and (3 the use of an aqueous extract of Harpagophytum procumbens at 60 mg harpagoside being non-inferior to 12.5 mg rofecoxib per day for chronic non-specific low-back pain (NSLBP in the short term. Strong evidence exists for the use of an aqueous Harpagophytum extract at a daily dose equivalent of 50 mg harpagoside in the treatment of acute exacerbations of chronic NSLBP.

  15. Evaluation of metabolic syndrome in patients with chronic low back pain: using the fourth Korea national health and nutrition examination survey data.

    Science.gov (United States)

    Ha, Jae Yong

    2011-12-01

    The aim of this study was to investigate the frequency of the metabolic syndrome in patients with chronic lower back pain in Korea and to evaluate the differences in clinical characteristics in chronic lower back pain patients with and without metabolic syndrome. This was a cross-sectional study using data from the fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) 2008. The sample consisted of 1085 participants with chronic lower back pain. The diagnosis of metabolic syndrome was made according to the criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) and the Korean Society for the Study of Obesity. The prevalence of metabolic syndrome among chronic lower back pain patients was 36.2% (30.2% male, 38.6% female). According to our results, female sex, advanced age, and high BMI were risk factors for metabolic syndrome. These results from a representative sample show that metabolic syndrome is common in chronic lower back pain patients in Korea. Clinicians managing chronic lower back pain should consider the risk factors for metabolic syndrome.

  16. Patterns of health care utilization for low back pain

    Directory of Open Access Journals (Sweden)

    Stewart WF

    2015-08-01

    Full Text Available Walter F Stewart,1 Xiaowei Yan,1 Joseph A Boscarino,1 Daniel D Maeng,1 Jack Mardekian,2 Robert J Sanchez,3 Michael R Von Korff41Geisinger Center for Health Research, 2Pfizer, Inc., 3Regeneron Pharmaceuticals, Inc., 4Group Health Research Institute, Seattle, WA, USABackground: The purpose of this study was to determine if primary care patients with low back pain (LBP cluster into definable care utilization subgroups that can be explained by patient and provider characteristics.Materials and methods: Adult primary care patients with an incident LBP encounter were identified from Geisinger Clinic electronic health records over 5 years. Two-thirds of the cohort had only one to two encounters. Principal component analysis was applied to the data from the remaining one-third on use of ambulatory, inpatient, emergency department, and surgery care and use of magnetic resonance imaging, injections, and opioids in 12 months following the incident encounter. Groups were compared on demographics, health behaviors, chronic and symptomatic disease burden, and a measure of physician efficiency.Results: Six factors with eigenvalues >1.5 explained 71% of the utilization variance. Patient subgroups were defined as: 1–2 LBP encounters; 2+ surgeries; one surgery; specialty care without primary care; 3+ opioid prescriptions; laboratory dominant care; and others. The surgery and 3+ opioid subgroups, while accounting for only 10.4% of the cohort, had used disproportionately more magnetic resonance imaging, emergency department, inpatient, and injectable resources. The specialty care subgroup was characterized by heavy use of inpatient care and the lowest use of injectables. Anxiety disorder and depression were not more prevalent among the surgery patients than in the others. Surgery patients had features in common with specialty care patients, but were older, had higher prevalence of Fibromyalgia, and were associated primary care physicians with worse efficiency

  17. Lumbar Radiofrequency Rhizotomy in Patients with Chronic Low Back Pain Increases the Diagnosis of Sacroiliac Joint Dysfunction in Subsequent Follow-Up Visits.

    Science.gov (United States)

    Rimmalapudi, Varun Kumar; Kumar, Sanjeev

    2017-01-01

    Chronic back pain is often a result of coexisting pathologies; secondary causes of pain can become more apparent sources of pain once the primary pathology has been addressed. The objective of our study was to determine if there is an increase in diagnosis of Sacroiliac joint pain following a Lumbar Rhizotomy. A list of patients who underwent Lumbar Radiofrequency during a 6-month period in our clinic was generated. Records from subsequent clinic visits were reviewed to determine if a new diagnosis of SI joint pathology was