压力生物反馈仪测试腰痛的信度评价

背景：关于下背痛的治疗方案种类繁多,至今仍没有一个确定的治疗手段。压力生物反馈仪是测量腹部肌肉活性的工具,对腰痛患者测试的信度研究较少。目的：探讨压力生物反馈仪用于评估腰痛患者的信度及可行性。方法：将符合入选条件的30例慢性腰痛患者作为受试者,选取4组动作,分别为动作A俯卧位,动作B仰卧屈膝位,动作C仰卧单侧屈髋屈膝位,动作D俯卧单侧肩关节前屈位,分别测试不同动作下的腹内压,由同一测试者在1周内对受试者进行前后两次测试。信度评价指标为组内相关系数(ICC)。结果与结论：动作A具有良好的信度,ICC值为0.853 (95%CI：0.691-0.930);动作B具有中等相关性,ICC值为0.751(95%CI：0.477-0.882);动作C具有中等相关性,ICC值为0.789(95%CI：0.557-0.900);动作D具有良好的相关性,ICC值为0.892(95%CI：0.641-0.919)。因此压力生物反馈用于评估腰痛具有良好的信度,可用于腰痛患者的评价。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Predictors of disability in patients with chronic low back pain

IntroductionChronic low back pain (CLBP) is a common and disabling health problem. In this study, we aimed to assess the relationship between pain intensity, the components of catastrophizing, depression and disability in patients with chronic low back pain.Material and methodsSeventy-six patients diagnosed with CLBP (age range 25–77 years; 73.7% female) participated in the study. Participants’ socio-demographic data were collected: age, gender, height, weight, and work status (employed or retired). All participants were asked to complete the Pain Catastrophizing Scale (PCS), the visual analogue scale (VAS), the Oswestry Disability Questionnaire (ODQ), and the Beck Depression Inventory (BDI).ResultsThe mean group scores revealed moderate CLBP complaints (VAS – 4 [3–6]), mild depression (BDI – 10 [5–16]), a moderate level of catastrophizing (PCS total score 20.5 [10–34]) and moderate disability (Oswestry Disability Index [ODI] – 31 [14–38]). Positive significant correlations were found between ODI and age, residence, work status, VAS, PCS-rumination, PCS-magnification, PCS-helplessness and BDI, and also between PCS subscales and VAS. Our multivariate linear regression analysis showed that age, pain intensity, PCS-helplessness and depression can predict disability in patients with CLBP, explaining 84% of the variance of disability (R² = 0.851, adjusted R² = 0.843).ConclusionsA multidisciplinary approach is needed for patients with CLBP and should include physical, mental and social evaluation in order to offer an optimal treatment.     

Treatment duration and cost of work-related low back pain in Korea

The purpose of this study is to present the information on the duration of treatment and the cost of work-related low back pain. Using the compensation-database for 1997 work-related low back pain (n=9,277), this study estimated the duration of treatment, the cost of work-related low back pain, the relationship between them, and probability of being off treatment at different intervals. The mean and the median of the treatment duration are 252.6 days and 175 days. The mean and the median of the cost of total insurance benefit are 37,700,000 won and 14,400,000 won. The treatment duration of 51% of the study subjects was less than 6 months and their cost accounted for 10.2% of the total insurance benefit. The subjects who were treated more than 24 months were 5.8% but it accounted for 29.2% of the cost. It was found that approximately 50% of the subjects who will remain on treatment at the end of n months would be off treatment at the end of n+5 months. This study presents the point in time when the low back pain (LBP) workers need to prepare to return to work by forecasting their off-treatment period. From the treat duration and cost perspectives, this study may be utilized as evidence for active management of work-related LBP.     

Transdermal fentanyl for chronic low back pain

Purpose

Chronic low back pain is a common clinical problem. As medication, non-steroidal anti-inflammatory drugs are generally used; however, they are sometimes non-effective. Recently, opioids have been used for the treatment of chronic low back pain, and since 2010, transdermal fentanyl has been used to treat chronic non-cancer pain in Japan. The purpose of the current study was to examine the efficacy of transdermal fentanyl in the treatment of chronic low back pain.

Materials and Methods

This study included patients (n=62) that suffered from chronic low back pain and were non-responsive to non-steroidal anti-inflammatory drugs. Their conditions consisted of non-specific low back pain, multiple back operations, and specific low back pain awaiting surgery. Patients were given transdermal fentanyl for chronic low back pain. Scores of the visual analogue scale and the Oswestry Disability Index, as well as adverse events were evaluated before and after therapy.

Results

Overall, visual analogue scale scores and Oswestry Disability Index scores improved significantly after treatment. Transdermal fentanyl (12.5 to 50 µg/h) was effective in reducing low back pain in 45 of 62 patients; however, it was not effective in 17 patients. Patients who experienced the most improvement were those with specific low back pain awaiting surgery. Adverse events were seen in 40% of patients (constipation, 29%; nausea, 24%; itching, 24%).

Conclusion

Disability Index scores in 73% of patients, especially those with specific low back pain awaiting surgery; however, it did not decrease pain in 27% of patients, including patients with non-specific low back pain or multiple back operations.     

Back and neck extensor loading and back pain provocation in urban bus drivers with and without low back pain

This study assessed low back and trapezius muscle activity in bus drivers, with or without recurrent low back pain (LBP), during the long term driving. In addition, low back and neck–shoulder pain intensities and fatigue were measured and the effect of low back support was observed. Also the possible source of LBP was attempted to assess by vibration pain provocation test and lumbar MRI.

Forty bus drivers (recurrent LBP n = 25) participated in this study. Low back and neck–shoulder pain and subjective fatigue intensity was assessed by visual analogue scales (VAS) before and after driving. Lumbar paraspinal and trapezius muscle activation during driving was measured by surface EMG. Vibration pain provocation test was applied for all subjects.

Average paraspinal myoelectric activity during driving was approximately 1% of MVC in both groups. Average trapezius myoelectric activity during driving was from 2 to 4% of MVC. Trapezius muscle activity was higher in back healthy drivers than in those with LBP. The low back support had no effect either on paraspinal or trapezius EMG activity. Low back and neck–shoulder fatigue increased during driving in both groups especially in those subjects with positive vibration pain provocation. The neck–shoulder pain and fatigue were more severe in drivers suffering from LBP. Low back support had no effect on low back and neck–shoulder subjective fatigue and neck–shoulder pain but tended to limit the LBP increase during driving. Paraspinal muscle loading in urban bus drivers was very limited and either LBP or ergonomic low back support had no effect on it. Trapezius muscle seemed to be less active in drivers suffering from recurrent LBP. Internal disc disruptions may expose to pain and fatigability during driving.     

下腰疼痛的生物力学分析

背景:下腰痛是人类极容易发生的疾病,原因复杂,发生机制依然不能完全阐明。目的:针对下背疼痛起因做一详细的力学分析。方法:藉由生物力学原理,应用计算软件Matlab与图像软件Photoshop对L4及两侧的小关节进行3D力学模拟。分析不同体质量的人在不同弯腰角度、提取不同重物时,L3-L4椎间盘所承受的滑脱力,以及在不同程度椎间盘退化的情形下,应力转移至关节囊的百分比。结果与结论:①L4因弯腰搬动物品时所受的压力会随着弯腰的角度增加而呈非线性递减,弯腰角度越大L4所受压力越小;当弯腰搬取物品时,L4所承受的压力与人体质量或物品质量呈正比;②当人弯腰达75°时,由于环状应力的产生可使腰大肌所承受的力可达体质量的20倍,来回反复做相同的动作就会使肌肉疲劳,进而对其造成损伤;椎间盘的退化也会将原先正常作用在周边组织的应力放大4倍左右,而对这些组织造成应力伤害。     

Effect of experimentally induced low back pain on postural sway with breathing

Although breathing perturbs balance, in healthy individuals little sway is detected in ground reaction forces because small movements of the spine and lower limbs compensate for the postural disturbance. When people have chronic low back pain (LBP), sway at the ground is increased, possibly as a result of reduced compensatory motion of the trunk. The aim of this study was to determine whether postural compensation for breathing is reduced during experimentally induced pain. Subjects stood on a force plate with eyes open, eyes closed, and while breathing with hypercapnoea before and after injection of hypertonic saline into the right lumbar longissimus muscle to induce LBP. Motion of the lumbar spine, pelvis, and lower limbs was measured with four inclinometers fixed over bony landmarks. During experimental pain, motion of the trunk in association with breathing was reduced. However, despite this reduction in motion, there was no increase in postural sway with breathing. These data suggest that increased body sway with breathing in people with chronic LBP is not simply because of reduced trunk movement, but instead, indicates changes in coordination by the central nervous system that are not replicated by experimental nociceptor stimulation.     

下腰痛患者脑网络的动态功能连接

目的:探究下腰痛（LBP）患者脑网络功能连接的动态变化。方法:对20例LBP患者及20例健康志愿者进行静息态 脑功能核磁共振扫描,采用连接数目熵（CNE）比较LBP患者与健康志愿者大脑的动态功能连接变化,分析LBP患者各独立 脑区的功能灵活性与年龄和日本骨科协会（JOA）量表评分的相关性。结果:全脑水平,LBP患者CNE低于正常人（P＜0.05）, 显著改变的脑区集中在额叶皮层、颞叶皮层、皮质下核团及部分枕叶皮层。脑区水平,LBP 患者中AAL 15（r=-0.525 5, P=0.020 8）、AAL32（r=-0.529 2,P=0.019 8）、AAL41（r=-0.546 9,P=0.015 4）、AAL62（r=0.601 5,P=0.006 4）、AAL76（r=-0.513 3, P=0.024 6）、AAL89（r=0.461 9, P=0.046 5）和AAL90（r=0.508 5, P=0.026 2）与年龄有临床相关性。LBP患者AAL17（r=-0.499 1, P=0.029 6）、AAL 47（r=0.481 4, P=0.036 9）、AAL 82（r=-0.554 8, P=0.013 7）、AAL 90（r=-0.562 1, P=0.012 3）与临床JOA量 表评分有相关性。结论:LBP患者全脑功能网络的功能灵活性是降低的。CNE动态功能连接的测量不仅为量化大脑活动 的时间与空间行为提供了一个新的框架,而且可以探索LBP脑功能变化的机理。     

Multivariate analyses of the MMPI profiles of low back pain patients

A multivariate clustering procedure was used to identify replicable, homogeneous MMPI profile subgroups among three independent cohorts of male (N=233) and female (N=315) low back pain (LBP) patients. Three subgroups were replicated across all male cohorts and four subgroups were replicated across all female cohorts. Multiple discriminant analysis showed that for both male and female patients between-subgroup variability was significantly greater than within-subgroup variability. The results suggest that LBP patients may not be solely characterized by MMPI profiles featuring the conversion V configuration. Examination of the profile subgroups also suggests there may be distinct, pain-related, behavioral attributes associated with each subgroup which might have important implications for practitioners' choice of treatment modalities. Suggestions are made for research regarding the development of specific, optimal treatments for various LBP patient subgroups.The current study was originally presented at the meeting of the Southeastern Psychological Association, Hollywood, Florida, May 1977.     

Discrimination and racial disparities in health: evidence and needed research

This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.     

Ultrasound evidence of altered lumbar fascia in patients with low back pain

Different hypotheses have been proposed about the role of lumbar connective tissue in low back pain (LBP). However, none of the previous studies have examined the change in the elastic behavior of lumbar fascia in patients with LBP. The present study aimed to evaluate the changes in the elastic behavior of lumbar fascia in patients with chronic non-specific LBP based on ultrasound imaging. The sonographic strain imaging assessed the thoracolumbar fascia (TLF) of 131 human subjects (68 LBP and 63 non-LBP). Assessments were done at L2–L3 and L4–L5 levels bilaterally. The points were located 2 cm lateral to the midpoint of the interspinous ligament. There were no significant differences in age, sex, and BMI between LBP and healthy individuals. There is a strong inverse relationship between pain severity (r = −0.76, n = 68, p = 0.004) and the TLF elastic modulus coefficient. No significant relationship were observed between age (r = 0.053, n = 68, p = 0.600), BMI (r = −0.45, n = 68, p = 0.092), and gender (r = −0.09, n = 68, p = 0.231) with the TLF elasticity coefficient. The LBP group had a 25%–30% lower TLF elastic modulus coefficient than healthy individuals. The present study is the first to evaluate the elastic coefficient of TLF using the ultrasound imaging method. The study results showed that the TLF elastic coefficient in patients with LBP was reduced compared to healthy individuals and directly related to LBP severity.     

Completion of advance directives among African Americans and Whites adults

ObjectiveThe primary purpose of this study was to analyze the completion of advance directives among African American and White adults and examine related factors, including demographics, socio-economic status, health conditions, and experiences with health care providers.MethodsThis study used data from the Survey of California Adults on Serious Illness and End-of-Life 2019. We compared correlates of completion of advance directives among a sample of 1635 African American and White adults. Multivariate analysis was conducted.ResultsWhites were 50% more likely to complete an advance directive than African Americans. The major differences between African Americans and Whites were mainly explained by the level of mistrust and discrimination experienced by African Americans and partially explained by demographic characteristics. Our study showed that at both bivariate and multivariate levels, participation in religious activities was associated with higher odds of completion of an advance directive for both African Americans and Whites.ConclusionInterventional studies needed to address the impact of mistrust and perceived discrimination on advance directive completion.Practical implicationsCulturally appropriate multifaceted, theoretical- and religious-based interventions are needed that include minority health care providers, church leaders, and legal counselors to educate, modify attitudes, provide skills and resources for communicating with health care providers and family members.     

Impaired postural compensation for respiration in people with recurrent low back pain

This study evaluated the degree to which the disturbance to posture from respiration is compensated for in healthy normals and whether this is different in people with recurrent low back pain (LBP), and to compare the changes when respiratory demand is increased. Angular displacement of the lumbar spine and hips, and motion of the centre of pressure (COP), were recorded with high resolution and respiratory phase was recorded from ribcage motion. With subjects standing in a relaxed posture, recordings were made during quiet breathing, while breathing with increased dead-space to induce hypercapnoea, and while subjects voluntarily increased their respiration to match ribcage expansion that was induced in the hypercapnoea condition. The relationship between respiration and the movement parameters was measured from the coherence between breathing and COP and angular motion at the frequency of respiration, and from averages triggered from the respiratory data. Small angular changes in the lumbopelvic and hip angles were evident at the frequency of respiration in both groups. However, in quiet standing, the LBP subjects had a greater displacement of their COP that was associated with respiration than the control subjects. The LBP group had a trend for less hip motion. There were no changes in the movement parameters when respiratory demand increased involuntarily via hypercapnoea, but when respiration increased voluntarily, the amplitude of motion and the displacement of the COP increased in both groups. The present data suggest that the postural compensation to respiration counteracts at least part of the disturbance to posture caused by respiration and that this compensation may be less effective in people with LBP.     

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

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.     

椎间盘源性腰痛的诊断及治疗进展

椎间盘源性腰痛是慢性腰痛的常见类型,是导致残疾的首要原因之一,给社会带来了巨大的经济负担。由于椎间盘解剖结构的特殊性,目前关于椎间盘源性腰痛的具体机制尚不清楚,其诊断及治疗尚未达成统一共识。国内外对于椎间盘源性腰痛的治疗主要包括保守治疗及外科手术治疗,治疗的目的是缓解临床症状,而不是从根本上逆转椎间盘退变。近年来生物治疗开始兴起,为椎间盘源性腰痛的治疗提供了新的方向,但国内关于生物治疗的相关研究报道较少。本文就椎间盘源性腰痛的诊断及治疗进展作一综述,以期为临床提供相关参考。     

Functional disability in nonspecific low back pain: The role of pain-related fear and problem-solving skills

Previous studies have shown that pain disability in chronic back pain patients is closely associated with pain-related fear and avoidance. This study was aimed at replicating this finding in a sample of low back pain (LBP) patients with a new episode of sick leave. In addition, the supplemental value of problem solving in predicting pain disability was examined. It was further hypothesized that problem solving would moderate the effects of daily stress on pain disability. The results were partly as predicted. Pain-related fear, pain intensity, pain catastrophizing, daily stress, and problem solving were found to be individually related to functional disability, of which pain intensity and pain catastrophizing were the strongest predictors. Problem solving neither added predictive value regarding pain disability, nor could the moderating role of problem solving be confirmed. Surprisingly, and in disagreement with previous findings, pain intensity was found to be closely related to disability in this sample of LBP patients. This study was supported by Grant No. 940-31-004 of the Council for Medical and Health Research of the Netherlands (MW-NWO).     

Lumbar muscularity and its relationship with age,occupation and low back pain

Summary This paper considers an internal standard of lumbar muscularity. The cross-sectional areas (A _cs) of the intervertebral disc and paraspinal muscles were measured in 147 working men from an axial magnetic resonance image passing through the L3-4 disc. Lumbar muscularity was expressed by two ratios; the ratio between the A _cs of the right psoas and the A _cs of the intervertebral disc (P:disc), and the ratio between the combined A _cs values of the right erector spinae and quadratus lumborum and the A _cs of the disc (ESQL:disc). When the subjects were divided into two age groups (76 aged 20–30 years and 71 aged 31–58 years) lumbar muscularity was found to be significantly greater (P < 0.001) in the younger age group (P:disc=0.8, SD 0.2; ESQL:disc=2.0, SD 0.3) than in the older age group (P:disc =0.7, SD 0.2; ESQL:disc=1.8, SD 0.3). Lumbar muscularity was not significantly affected by occupation or by a history of low back pain.     

Adolescent low back pain among secondary school students in Ibadan,Nigeria

Background

Adolescent low back pain (ALBP) can be considered a signal or precursor of a serious organic disease or telltale sign of future incidence of low back pain in adulthood. Published articles on ALBP in Nigeria are not readily available.

Objectives

The study''s objectives were to investigate the prevalence of Adolescent Low Back Pain (ALBP) among secondary school students in Ibadan, Nigeria and the prevalence''s association with some socio-demographic variables.

Methods

Participants were adolescent students from 15 secondary schools in Ibadan. Data was collected using a respondent-administered, validated questionnaire on low back pain in adolescents. Participants (Female: 298; Male: 273) aged 14.23 ±2.27 years (range 10–19) were recruited through multi-stage random sampling. Five hundred and seventy-one (83.97%) of the 680 copies of the questionnaire administered were returned. Data was analysed using mean, standard deviation, frequency, percentages, and Chi-square test with alpha level at 0.05.

Result

Lifetime, twelve-month, one-month and point prevalence rates of ALBP were 58.0%, 43.8%, 25.6% and 14.7% respectively. Age at first experience of ALBP was 11.86 ± 2.36 years. Gender was not significantly associated with any rate (p ≥0.317). Age (p ≤ 0.043) and engagement in commercial activities (p ≤ 0.025) were significantly associated with all period prevalence rates while injury to the back was significantly associated with all period prevalence rates except point prevalence (p = 0.087).

Conclusion

Adolescent low back pain is common among secondary school students in Ibadan and its prevalence is significantly associated with age and engagement in commercial activities, but not with gender.