Feasability of a back school assessment programme]

OBJECTIVES: Testing the feasability of a back school assessment programme in two populations of people suffering with chronic low back pain. MATERIAL: Twenty-nine patients were randomly included in a chronic low back pain assessment programme (15 patients waiting for back school and 14 patients after back school). METHODS: The programme was made of the measure of the age, the sex, the body mass index, the pain (VAS, St Antoine Hospitals Pain Questionnaire - SAPQ), the anxiety, the depression, the RIII nociceptive reflex, the fingertip-floor distance, the strength of the flexors and of the extensors of the lumbar spine (CybexR 6000 isocinetic dynamometer), the lumbar function (EIFEL, Dougados), the Dallas self-questionnaire. The Back School Education programme was made of five sessions (information, ergonomics, extension exercises). RESULTS: Comparing the two populations we did not observe significant differences concerning the age, the body mass index, the anxiety and depression levels, the pain (VAS, SAPA, RIII nociceptive reflex), the lumbar stiffness, the lumbar disability, the quality of life; the patients who had achieved back school had a peak torque of the flexors and a ratio flexors/extensors significantly lower. Comparing men and women we observed significant differences in the SAPQ and the muscles strength. The SAPQ was correlated with the depression and anxiety levels, the lumbar disability, the peak torque of the flexors. The VAS was correlated with the age, the lumbar stiffness, the depression level, the peak torque of the flexors. The RIII nociceptive reflex was correlated with the ratio flexors/extensors. CONCLUSION: This study present some biases but this objective assessment of chronic low back pain appeared as feasible. The pain must be investigated in term of intensity, expression, alleviation. The impairment of the flexors muscles in women and after back school has to be confirmed. The different tests are relevant to determinate the efficiency of the back school programmes.     

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

[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.Key words: Extracorporeal shock wave therapy, Pain, Depression     

音乐治疗对脑卒中肩痛伴有情绪障碍患者临床疗效的观察

目的:观察音乐治疗对脑卒中后肩痛伴情绪障碍患者的治疗效果,为探究脑卒中后肩痛伴情绪障碍患者的康复干预提供参考。方法:选择肩痛伴情绪障碍的脑卒中患者92例,随机分为常规组和观察组各46例。92例患者均给予常规药物治疗和康复治疗,观察组根据个体化原则联合音乐干预。干预前后对所有患者进行疼痛目测类比法(VAS),上肢Fugl-Meyer运动功能评定量表(FMA),汉密顿焦虑量表(HAMA),汉密顿抑郁量表(HAMD)评定。结果:治疗4周后,2组VAS、HAMA、HAMD评分均较治疗前明显降低(均P 0. 05),观察组更低于常规组(P0. 05); 2组FMA评分均较治疗前明显提高(均P 0. 05),观察组更高于常规组(P 0. 05)。结论:音乐治疗不仅可明显减轻脑卒中后肩痛,还可提高患者的运动功能和改善患者的情绪。     

The effects of a back rehabilitation programme for patients with chronic low back pain

AIM: The aim of this paper was to perform a pragmatic before-after analysis of a back rehabilitation programme (BRP) for patients with chronic low back pain (LBP). A total of 877 patients were recruited onto the BRP, which were carried out at four centres within the Wrightington, Wigan and Leigh NHS Trust. The BRP consisted of nine 2-hour group sessions of therapy run over 5 weeks and included 1 hour of exercise and 1 hour of education, advice problem solving and goal setting. METHOD: Using the Wilcoxen signed rank tests and paired t-tests levels of pain, disability, anxiety and depression were significantly reduced pre-post programme (P < 0.001). In addition, the levels of fitness and perceived control improved significantly (P < 0.001) suggesting that participants were better able to manage their LBP. CONCLUSION: Overall, the BRP proved to be effective in reducing pain, disability, anxiety and depression levels for people with chronic LBP. However, despite significant improvements in outcome measures only 50% of the patients completed the BRP and questionnaires post BRP. The implications of the findings are discussed with respect to modified programmes and alternative management for patients within different subgroups of LBP.     

Impact of functional restoration programs on fears, avoidance and beliefs in chronic low back pain patients]

OBJECTIVE: To assess the impact of functional restoration programs on fears, avoidance and beliefs in chronic low back pain. METHODS: Open prospective study in eight spine centers. Seventy patients enrolled in several restoration programs were evaluated before and at the end of the program. Variables recorded were pain (VAS), disability (Quebec back pain disability scale), handicap (VAS), anxiety and depression (HAD scale), and fears, avoidance and beliefs (FABQ). RESULTS: All variables recorded significantly improved at the end of the programs except for fears about professional activities (FABQ1) and lumbar mobility. Fears about physical activities (FABQ2) significantly decreased after these programs. Variations in FABQ1 and FABQ2 scores were not correlated with variations in scores of outcome measures assessing impairment, disability, and handicap. CONCLUSION: Functional restoration programs in their current form in France do not decrease fears and beliefs about professional activities in chronic low back pain patients. Adding psychosocial intervention at the work place to the functional restoration programs may lead to a better impact on fears about work thus reducing work loss.     

改良音乐疗法对急性冠脉综合征患者介入治疗术后生活质量的影响

目的探讨改良音乐疗法对急性冠脉综合征（ACS）患者介入治疗术后生活质量的影响。方法将2009年7—12月介入治疗术后的ACS患者108例进行随机分为干预组54例和对照组54例。对照组给予常规的治疗与护理,干预组除给予常规治疗与护理外,还应用改良音乐疗法即音乐运动处方给予干预,患者住院期间应用音乐运动处方干预每次10—15min,3次／d。患者出院后根据个人喜好选择不同的有氧运动方式同时聆听放松音乐,每次15～30min,2次／d。比较两组患者住院期间的焦虑、抑郁程度及左室射血分数及出院1个月的生活质量等。结果干预1周后干预组的左室射血分数、焦虑、抑郁程度与对照组比较差异有统计学意义（P〈0．01）;出院1个月时干预组的生活质量SF-36及SAQ评分及抑郁程度显著优于对照组,差异有统计学意义（P〈0．05或P〈0．01）。结论改良音乐疗法可以改善ACS患者介入治疗术后的焦虑、抑郁和生活质量水平。     

Psychobehavioural assessment for chronic low back pain]

INTRODUCTION: Psychobehavioural assessment may be a complementary approach to assess response to treatment for pain and disability in patients with low back pain. OBJECTIVES: To assess the correlation between psychobehavioural factors and pain and disability in patients with chronic low back pain in France. METHODS: We asked 83 patients with chronic low back pain to complete questionnaires during a primary care consultation by a general practitioner. Pain was measured by a visual analog scale (VAS), disability by the Quebec Back Pain Disability Scale and psychobehavioural factors by the Fear-Avoidance Beliefs Questionnaire (FABQ) and the Coping Strategy Questionnaire (CSQ). RESULTS: Pain was poorly correlated with anxiety (R = 0.36) and scores on the FABQ 1 (R = 0.46) and FABQ 2 (R = 0.30) and not correlated with depression (R = 0.22), duration of pain evolution (R = 0,10) and body mass index (R = 0.12). The duration of stopping work was poorly correlated with disability (R = 0.35) and FABQ 1 score (R = 0.43) and not correlated with pain (R = 0.11), anxiety (R = 0.11), depression (R = 0.26) and FABQ 2 score (R = 0.23). Disability was poorly correlated with scores on the FABQ 1 (R = 0.45) and FABQ 2 (R = 0.3), anxiety (R = 0.39) and depression (R = 0.47) and not correlated with pain (R = 0.25). Dramatization is the only way to cope with pain and was correlated with pain (R = 0.34), scores on the FABQ 1 (R = 0.47) and FABQ 2 (R = 0.43), disability (R = 0.38), anxiety (R = 0.44) and depression (R = 0.46). The use of prayer was poorly correlated with FABQ 1 score (R = 0.37) and anxiety (R = 0.30). Distraction was poorly correlated with scores on the FABQ 1 (R = 0.40) and FABQ 2 (R = 0.30). No strategy was correlated with duration of pain and stopping work. DISCUSSION-CONCLUSION: All the correlation assessments with psychobehaviour factors are weak. So evaluating each of these parameters will be interesting. Duration of pain was not correlated with increasing pain or change in behavioural strategy. Psychobehavioural factors are more invalidating than pain. More study is needed to assess psychobehavioural therapies in patients with low back pain.     

Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain

To determine the reliability and concurrent validity of a visual analogue scale (VAS) for disability as a single-item instrument measuring disability in chronic pain patients was the objective of the study. For the reliability study a test-retest design and for the validity study a cross-sectional design was used. A general rehabilitation centre and a university rehabilitation centre was the setting for the study. The study population consisted of patients over 18 years of age, suffering from chronic musculoskeletal pain; 52 patients in the reliability study, 344 patients in the validity study. Main outcome measures were as follows. Reliability study: Spearman's correlation coefficients (rho values) of the test and retest data of the VAS for disability; validity study: rho values of the VAS disability scores with the scores on four domains of the Short-Form Health Survey (SF-36) and VAS pain scores, and with Roland-Morris Disability Questionnaire scores in chronic low back pain patients. Results were as follows: in the reliability study rho values varied from 0.60 to 0.77; and in the validity study rho values of VAS disability scores with SF-36 domain scores varied from 0.16 to 0.51, with Roland-Morris Disability Questionnaire scores from 0.38 to 0.43 and with VAS pain scores from 0.76 to 0.84.The conclusion of the study was that the reliability of the VAS for disability is moderate to good. Because of a weak correlation with other disability instruments and a strong correlation with the VAS for pain, however, its validity is questionable.     

Effectiveness of device-based therapy for conservative management of low back pain

[Purpose] Device based therapy for low back pain (LBP) involves quantitative assessment of muscle strength, resistance and lumbar motion and tailoring the rehabilitation protocol based on this objective assessment. The purpose of this study was to determine the effectiveness of device based therapy for LBP. [Subjects and Methods] In this retrospective study, clinical data of 235 patients who underwent device-based physiotherapy for low back pain was reviewed. Pre and post-treatment outcome measures for pain (visual analogue scale or VAS score), disability (Oswestry disability index) and functional ability were compared to determine effectiveness of device-based physiotherapy at the end of 6 weeks of treatment. [Results] All outcome measures including VAS Score and mean Oswestry Disability Score showed significant improvement at the end of 6 weeks of device-based physical therapy. Before treatment, 73% of patients had moderate to severe disability which reduced to 28% after treatment. [Conclusion] Device-based therapy is effective in relieving pain, improving function and reducing disability in patients with low back pain in the short term. Device-based therapy may help to objectively evaluate the function of the spine and paraspinal muscles and help the therapist tailor treatment accordingly.Key words: Low back pain, Device-based therapy, Disability     

Chronic pain in Holocaust survivors

There is limited research on the connection between the Holocaust and chronic pain, despite evidence suggesting that medical and psychological sequelae are common in survivors. The goals of this study were: (1) to define Holocaust survivors' (n = 33) chronic pain characteristics as manifested 50 years after the war, (2) to compare survivors with controls (n = 33) who did not experience World War II atrocities, and (3) to investigate the connection between past trauma and chronic pain. Data were collected through questionnaires that included a detailed medical and pain history, visual analog scale (VAS), McGill Pain Questionnaire (MPQ), Beck Depression Inventory (BDI), Symptom Check List-90 (SCL-90), and Pain Disability Index (PDI). A comparison of variables between the two groups was conducted using multivariate analysis of variance (MANOVA) and ANOVA, and canonical discriminant analysis. Results showed that Holocaust survivors reported higher pain levels (73 +/- 18 vs. 56 +/- 21; P < 0.005), more pain sites (4.5 6 2.8 vs. 2.7 6 1.4; P < 0.05), and significantly higher depression scores (17.6 +/- 8.4 vs. 9.2 +/- 4.6; P < 0.001); they tended to utilize more medical services (5.9 +/- 3.0 vs. 5.1 +/- 2.8). Nonetheless, survivors did not regard themselves more disabled as compared with controls. They reported a higher activity level as measured by walking distance capacity, and spent significantly fewer hours resting (4.3 +/- 3.6 vs. 7 +/- 4.6; P < 0.05). This paradoxical combination of high pain intensity, moderate to severe depression, and high activity level characterizes Holocaust survivors' chronic pain. It is conceivable that by remaining active Holocaust survivors fight back their pain, distress, and depression. These findings suggest that Holocaust atrocities affect survivors' chronic pain even years later.     

Effect of music on power, pain, depression and disability

AIM: This paper reports a study testing the effect of music on power, pain, depression and disability, and comparing the effects of researcher-provided music (standard music) with subject-preferred music (patterning music). BACKGROUND: Chronic non-malignant pain is characterized by pain that persists in spite of traditional interventions. Previous studies have found music to be effective in decreasing pain and anxiety related to postoperative, procedural and cancer pain. However, the effect of music on power, pain, depression, and disability in working age adults with chronic non-malignant pain has not been investigated. METHOD: A randomized controlled clinical trial was carried out with a convenience sample of 60 African American and Caucasian people aged 21-65 years with chronic non-malignant pain. They were randomly assigned to a standard music group (n = 22), patterning music group (n = 18) or control group (n = 20). Pain was measured with the McGill Pain Questionnaire short form; depression was measured with the Center for Epidemiology Studies Depression scale; disability was measured with the Pain Disability Index; and power was measured with the Power as Knowing Participation in Change Tool (version II). RESULTS: The music groups had more power and less pain, depression and disability than the control group, but there were no statistically significant differences between the two music interventions. The model predicting both a direct and indirect effect for music was supported. CONCLUSION: Nurses can teach patients how to use music to enhance the effects of analgesics, decrease pain, depression and disability, and promote feelings of power.     

Pain Profiles and Psychosocial Distress Symptoms in Workers with Low Back Pain

Purpose:

The current study investigated the pain profiles of patients with subacute non-specific low back pain attending an outpatient return-to-work rehabilitation programme. Differences in symptoms of distress (depression and anxiety) and return to work between the pain-profile groups were assessed.

Methods:

Sixty-five volunteers who met the eligibility criteria and had complete follow-up data were included in the analysis. The mean age was 38.8 years (minimum 18, maximum 64); 38 (58.5%) were men. The median time since onset of low back pain was 30 days. Cluster analysis was used to categorize patients into groups according to pain severity scores (VAS).

Results:

Two distinct clusters—severe pain and moderate pain—emerged. There were significant differences in depressive and anxiety symptoms between the pain profiles. Further, return-to-work rates varied significantly between the two groups (31% in the severe pain cluster compared to 90% in the moderate pain cluster).

Conclusion:

Although both groups showed significant improvements in depression and anxiety symptoms over time, the severe pain cluster scored higher at discharge (higher scores indicating worse outcomes). These results highlight the importance of early identification of sub-groups at risk so that rehabilitation interventions can be focused with the goal of minimizing long-term disability.     

Yoga,Eurythmy Therapy and Standard Physiotherapy (YES-Trial) for Patients With Chronic Non-specific Low Back Pain: A Three-Armed Randomized Controlled Trial

We aimed to evaluate the effects of yoga and eurythmy therapy compared to conventional physiotherapy exercises in patients with chronic low back pain. In a three-armed, multicentre, randomized controlled trial, patients with chronic low back pain were treated for 8 weeks in group sessions (75 minutes once per week). Primary outcome was patients’ physical disability (measured by RMDQ) from baseline to week 8. Secondary outcome variables were pain intensity and pain-related bothersomeness (VAS), health-related quality of life (SF-12) and life satisfaction (BMLSS). Outcomes were assessed at baseline, after the intervention at 8 weeks and at a 16-week follow up. Data of 274 participants were used for statistical analyses. There were no significant differences between the three groups for the primary and all secondary outcomes. In all groups, RMDQ decreased comparably at 8 weeks, but did not reach clinical meaningfulness. Pain intensity and pain-related bothersomeness decreased, while quality of life increased in all 3 groups. In explorative general linear models for the SF-12’s mental health component participants in the eurythmy arm benefitted significantly more compared to physiotherapy and yoga. Furthermore, within-group analyses showed improvements of SF-12 mental score for yoga and eurythmy therapy only. All interventions were safe.Clinical Trials Register: DRKS-ID: DRKS00004651Perspective: This article presents the results of a multicentre three-armed randomized controlled trial on the clinical effects of three 8-week programs in patients with chronic low back pain. Compared to the ‘gold standard’ of conventional physiotherapeutic exercises, eurythmy therapy and yoga therapy lead to comparable symptomatic improvements in patients with chronic low back pain. However, the within-group effect sizes were small to moderate and did not reach clinical meaningfulness on patients’ physical disability (RMDQ).     

The Relation of Post-Traumatic Stress Symptoms to Depression and Pain in Patients With Accident-Related Chronic Pain

Symptoms of post-traumatic stress disorder (PTSD) are a common comorbidity in patients with a history of accident-related chronic pain and depression. However, little is known regarding the influence of PTSD in contributing to the affective distress, pain experience, and disability associated with chronic pain in this population. This study used structural equation modeling to examine 3 models that assess these relations in a sample of chronic pain patients with accident-related pain. Subjects were assessed for pain experience, depressive symptoms, anxiety, PTSD symptoms, pain disability, and relevant demographic variables. Pearson correlations indicated that symptoms of depression were significantly related to more severe pain, disability, and PTSD symptoms. PTSD symptoms were significantly associated with higher disability. The model of best fit indicated that after controlling for the influence of anxiety on the dependent measures, PTSD symptoms have a direct influence on severity of depressive symptoms, whereas depressive symptoms have a direct influence on pain intensity and an indirect impact on pain intensity by way of their effect on disability. These data point to the importance of unresolved PTSD symptoms in contributing to the level of depression, pain, and disability exhibited by chronic pain patients and highlight the need to consider directed and primary treatment of PTSD in pain rehabilitation programs.PerspectiveThis study highlights the impact of symptoms of PTSD on levels of depression, disability, and pain in patients with pain secondary to physical injury. Our results suggest that pain rehabilitation programs provide directed interventions for PTSD symptoms among this population to improve pain treatment outcomes.     

The effect of music therapy on relaxation, anxiety, pain perception, and nausea in adult solid organ transplant patients

Organ transplant recipients characteristically experience low levels of relaxation and high levels of anxiety, pain, and nausea. Although music therapy has demonstrated effectiveness in ameliorating these types of conditions with patients in other areas of medical hospitals, no studies have evaluated the effects of music therapy on solid organ transplant patients. The purpose of this study was to assess the impact of music therapy on anxiety, relaxation, pain, and nausea levels in recovering patients on the adult transplant unit of the hospital utilizing a pre-posttest design. Participants (N = 58) received an individual 15-35 minute music therapy session consisting of live patient-preferred music and therapeutic social interaction. To remain consistent with the hospital's evaluative instruments during this pilot study, participants' self-reported levels of anxiety, relaxation, pain, and nausea, were based on separate 10-point Likert-type scales. The principal investigator observed affect and verbalizations at pre and posttest. Results indicated there were significant improvements in self-reported levels of relaxation, anxiety (both p < .001), pain (p < .01), and nausea (p < .05). Although there was no reliability measure, there were significant increases in positive verbalizations and positive affect (p < .001). All participants reported that they would desire music therapy again during a future long-term hospital stay. From the results of this exploratory study, it seems that music therapy can be a viable psychosocial intervention for hospitalized postoperative solid transplant patients. Implications for clinical practice and suggestions for future research are provided.     

Comparison of movement-to-music, rhythm activities, and competitive games on depression, stress, anxiety, and anger of females in substance abuse rehabilitation

Over the past several decades the number of females using addictive substances has continuously increased. Females have different reasons for initiating substance abuse and specific treatment needs that differ from males. Researchers suggested gender specific drug rehabilitation treatment, in which female clients developed or improved functional behaviors. The purpose of this study was to investigate the effects of 3 different types of music therapy interventions on levels of depression, stress, anxiety, and anger of female clients in substance abuse rehabilitation. Ten females in an outpatient substance abuse rehabilitation program participated twice a week for 6 weeks in a music therapy program, participating in movement-to-music activities, rhythm activities, and competitive games for 2 weeks, 4 sessions each. After each intervention state-trait anxiety and levels of anger were measured. A repeated-measures ANOVA indicated no significant differences for the three types of music therapy interventions; however, data collected on daily scores, immediately before and after each session, indicated that individuals reported a decrease in depression, stress, anxiety, and anger immediately following the music therapy sessions.     

Key characteristics of low back pain and disability in college-aged adults: a pilot study

Handrakis JP, Friel K, Hoeffner F, Akinkunle O, Genova V, Isakov E, Mathew J, Vitulli F. Key characteristics of low back pain and disability in college-aged adults: a pilot study.ObjectiveTo identify which factors commonly associated with low back pain (LBP) and disability differ between college-aged persons with LBP and with no or minimal LBP.DesignClinical measurement, observational study. Subjects were assessed for LBP with the visual analog scale (VAS) and for disability from LBP using the Oswestry Disability Index (ODI). Subjects were measured for variables commonly associated with LBP and were grouped by both VAS (minimum [min]/no pain, pain) and ODI (no disability, disability) scores.SettingCollege campus at a university.ParticipantsA convenience sample (N=84) of English-speaking students (34 men, 50 women) between 18 and 30 years of age.InterventionsNot applicable.Main Outcome MeasuresSports activity (sports activity score of the Baecke Physical Activity Questionnaire), depression, hamstring and hip flexor range of motion, low back extensor endurance, abdominal strength and endurance.ResultsA significant main effect of group was found for both pain (P=.019) and disability groups (P=.006). The min/no pain and pain groups differed in back endurance (114.2±38.8s vs 94.5±44.5s, respectively; P=.04). The no disability and disability groups differed in back endurance (116.3±35.9s vs 97.1±45.7s, respectively; P=.03) and the sports activity score of the Baecke Physical Activity Questionnaire (2.98±.95 vs 2.48±.85, respectively; P=.01). Subjects with hyperkyphotic postures compared with the normative thoracic group had higher depression scores (49 vs 38.5, respectively; P=.03) and less hamstring flexibility (30.5 vs 49.9, respectively; P<.001).ConclusionsBack extensor endurance was consistently different between both the pain and disability groups. Addressing limited low back extensor endurance and low levels of physical activity in young adults may have clinical relevance for the prevention and treatment of LBP and disability.     

五行音乐疗法对全麻术后患者疼痛及情绪的影响

目的探讨五行音乐疗法对疼痛及情绪的影响。方法选择我院2016年7-8月收治的骨科等腹外科、150例全麻手术患者,根据时间将7月收治的74例患者设为对照组,8月收治76例患者设为观察组,术后6h分别对两组患者的疼痛、情绪状态进行测量。对照组实施常规护理,观察组在常规护理的基础上实施五行音乐疗法,每日2次(晨起和晚睡前),每次30min,持续3d,第3天干预结束后于次日晨评估患者疼痛、情绪及满意度情况。比较干预前后两组患者疼痛评分、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分及护理满意度。结果观察组患者疼痛评分显著低于对照组(P0.01),患者满意度明显高于对照组(P0.01),焦虑、抑郁评分明显低于对照组(P0.01)。结论五行音乐疗法能够有效减轻全麻术后患者疼痛,减轻焦虑、抑郁等负性情绪,提高患者的满意度。