Associations between low back pain,urinary incontinence,and abdominal muscle recruitment as assessed via ultrasonography in the elderly

Background:

Low back pain (LBP) and urinary incontinence (UI) are highly prevalent among elderly individuals. In young adults, changes in trunk muscle recruitment, as assessed via ultrasound imaging, may be associated with lumbar spine stability.

Objective:

To assess the associations between LBP, UI, and the pattern of transversus abdominis (TrA), internal (IO), and external oblique (EO) muscle recruitment in the elderly as evaluated by ultrasound imaging.

Method:

Fifty-four elderly individuals (mean age: 72±5.2 years) who complained of LBP and/or UI as assessed by the McGill Pain Questionnaire, Incontinence Questionnaire-Short Form, and ultrasound imaging were included in the study. The statistical analysis comprised a multiple linear regression model, and a p-value <0.05 was considered significant.

Results:

The regression models for the TrA, IO, and EO muscle thickness levels explained 2.0% (R²=0.02; F=0.47; p=0.628), 10.6% (R²=0.106; F=3.03; p=0.057), and 10.1% (R²=0.101; F=2.70; p=0.077) of the variability, respectively. None of the regression models developed for the abdominal muscles exhibited statistical significance. A significant and negative association (p=0.018; β=-0.0343) was observed only between UI and IO recruitment.

Conclusion:

These results suggest that age-related factors may have interfered with the findings of the study, thus emphasizing the need to perform ultrasound imaging-based studies to measure abdominal muscle recruitment in the elderly.     

Factors defining care‐seeking in low back pain – A meta‐analysis of population based surveys

Little is known about factors determining health care‐seeking behavior in low back pain. While a number of studies have described general characteristics of health care utilization, only a few have aimed at appropriately assessing determinants of care‐seeking in back pain, by comparing seekers and non‐seekers. The objective of this systematic review was to identify determinants of health care‐seeking in studies with well‐defined groups of care‐seekers and non‐seekers with non‐specific low back pain. A search was conducted in Medline, AMED, Cinahl, Web of Science, PsycINFO, National Research Register, Cochrane Library and LILACS looking for population‐ based surveys of non‐specific low back pain patients older than 18 years, published since 1966. To be included in the review, studies needed to report on characteristics of well‐defined groups of care‐seekers and non‐seekers. Methodological quality was assessed using a criteria list based on sampling, response rate, data reproducibility, power calculation and external validity. Risk estimates were expressed as odd ratios (95% confidence intervals). When possible, meta‐analyses were performed, using a random effects model. Eleven studies were included in the review. Pooled results show that women are slightly more likely to seek care for their back pain as are patients with a previous history of back pain. Pain intensity was only slightly associated with care‐seeking, whereas patients with high levels of disability were nearly eight times more likely to seek care than patients with lower levels of disability.     

Modelling the prevalence and cost of back pain with neuropathic components in the general population

Background: Although there is increasing knowledge of the prevalence of neuropathic pain, little has been done to isolate the cost of neuropathic pain, especially with reference to the frequent complaint of back pain. Aims: To estimate the prevalence of neuropathic components in back pain and associated costs. Methods: We used available epidemiological data to model the prevalence of neuropathic back pain in the general adult population, combining three studies: painDETECT 1, painDETECT 2, and the German back pain research network (GBPRN) study, representing a total of 21,047 subjects. The painDETECT screening questionnaire was used in the former two surveys to assess neuropathic pain components. Costing data were obtained from 1718 participants in the GBPRN survey. Results: According to our model, approximately 4% of the general adult population experienced back pain with a neuropathic component. Owing to the greater severity of neuropathic pain, its costs were found to be disproportionately high: among patients with persistent back pain, typical costs associated with a person suffering neuropathic back pain were higher than those of an average back pain patient, and as much as 67% higher than those of a patient with nociceptive back pain only. Approximately, 16% of the total costs associated with back pain were attributable to pain with a neuropathic component. Conclusions: Back pain with neuropathic components is likely to affect a relevant proportion of the general adult population and cause a disproportionately high share of back pain‐related costs.     

Do epidemiological results replicate? The prevalence and health‐economic consequences of neck and back pain in the general population

Current estimates of the prevalence and consequences of neck and back pain vary greatly between studies. It is not known whether this variance is due to differences in methodology, or if it depends on the dynamics of the problem over time. The aim of this study was consequently an attempt to replicate and extend the findings of a previous epidemiological study using the same methodology on a new population. A survey of 3000 35-45 year olds, selected at randon, was conducted to determine the prevalence, site, frequency and intensity of the pain as well as any work loss or health-care utilization. The response rate was 69% and an analysis of non-responders showed that they were very similar to responders, but had a slightly lower prevalence. The results replicated the original study: 73% reported back pain during the past year and the consequences included considerable suffering and functional impairment. Moreover, 17% of those reporting pain had utilized sick leave during the past year for the problem, while an additional 14% had been off work but had not used sick leave. Sufferers averaged 3.5 health-care visits during the past year. However, the consumption of resources was highly skewed and about 6% of the sufferers accounted for over 50% of the costs. It was concluded that when the same selection criteria and assessment techniques are employed, the results found are quite similar. This implies that much of the huge variation in reported prevalence rates and consequences of back pain may be due to methodological differences. This underscores the need for standardized methods.     

The course of chronic and recurrent low back pain in the general population

Using latent class analysis (LCA), a previous study on patients attending primary care identified four courses of low back pain (LBP) over the subsequent 6 months. To date, no studies have used longitudinal pain recordings to examine the “natural” course of recurrent and chronic LBP in a population-based sample of individuals. This study examines the course of LBP in the general population and elaborates on the stability and criterion-related validity of the clusters derived. A random sample of 400 individuals reporting LBP in a population-based study was asked to complete a comprehensive questionnaire at the start and end of the year’s survey, and 52 weekly pain diaries in between. The latter were analyzed using LCA. 305 individuals returned more than 50% of the diaries. Four clusters were identified (severe persistent, moderate persistent, mild persistent, and fluctuating). The clusters differed significantly with regards to pain and disability. Assessment of cluster stability showed that a considerable proportion of patients in the “fluctuating” group changed their classification over time. Three of the four clusters describing the typical course of pain matched the clusters described previously for patients in primary care. Due to the population-based design, this study achieves, for the first time, a close insight into the “natural” course of chronic and recurrent low back pain, including individuals that did not necessarily visit the general practitioner. The findings will help to understand better the nature of this pain in the general population.     

Loading along the lumbar spine as influence by speed,control, load magnitude,and handle height during pushing

Background

Low back loading and risk associated with pushing activities have been poorly understood. Previous studies have demonstrated that increases in anterior/posterior shear forces are primarily initiated by antagonistic coactivity within the torso. Yet, few studies have considered the range of activities that might contribute to the antagonistic coactivation and subsequent spine loading.

Methods

Twenty subjects were tested to examine how various physical factors might influence spine loads during pushing tasks that workers might experience in industrial settings. Load magnitude, speed of push, required control, and handle height were varied while pushing both carts and overhead suspended loads. A biologically-assisted biomechanical model was used to assess compression, anterior/posterior shear, and lateral shear over the various levels of the lumbar spine.

Findings

Anterior/posterior shear loads were greatest at the upper levels of the lumbar spine and of a magnitude that would be of concern. Anterior/posterior shear was influenced by all experimental factors to varying degrees except for the nature of the load (cart vs. suspended).

Interpretation

This study confirms the notion that pushing and pulling is not as simple a task as once believed since it entails a complex biomechanical activity. Spine shear forces result from a complex coactivation of trunk muscle activities and spine orientations that are influenced by several occupational factors. This study may help explain why low back pain rates in some work environments associated with lifting may not be reduced even when lifting interventions (that change the task from lifting to pushing) are employed.     

Low and high-frequency TENS in post-episiotomy pain relief: a randomized,double-blind clinical trial

Objective

To evaluate the effectiveness of low-frequency TENS (LFT) and high-frequency TENS (HFT) in post-episiotomy pain relief.

Method

A randomized, controlled, double-blind clinical trial with placebo composed of 33 puerperae with post-episiotomy pain. TENS was applied for 30 minutes to groups: HFT(100 Hz; 100 µs), LFT (5 Hz; 100 µs), and placebo (PT). Four electrodes were placed in parallel near the episiotomy and four pain evaluations were performed with the numeric rating scale. The first and the second evaluation took place before TENS application and immediately after its removal and were done in the resting position and in the activities of sitting and ambulating. The third and fourth evaluation took place 30 and 60 minutes after TENS removal, only in the resting position. Intragroup differences were verified using the Friedman and Wilcoxon tests, and the intergroup analysis employed the Kruskal-Wallis test.

Results

In the intragroup analysis, there was no significant difference in the PT during rest, sitting, and ambulation (P>0.05). In the HFT and LFT, a significant difference was observed in all activities (P<0.001). In the intergroup analysis, there was a significant difference in the resting position in the HFT and LFT (P<0.001). In the sitting activity, a significant difference was verified in the second evaluation in the HFT and LFT (P<0.008). No significant difference was verified among the groups in ambulation (P<0.20).

Conclusions

LFT and HFT are an effective resource that may be included in the routine of maternity wards.     

Natural course of acute neck and low back pain in the general population: The HUNT study

In this prospective cohort study we aimed to describe the natural course of acute neck and low back pain in a general population of Norway. We screened 9056 subjects aged 20–67 years who participated in a general health survey for a new episode of neck or low back pain the previous month. The screening identified 219 subjects who formed the cohort for this study. Pain intensity was reported on a numeric rating scale (0–10) at 1, 2, 3, 6, and 12 months after start of the new pain episode. The course of pain was described for neck and low back pain, different baseline pain levels, age groups, and number of pain sites at baseline. Use of medication and health care was described and associations between pain intensity and seeking health care were estimated. Pain declined rapidly within 1 month after a new pain episode, with a reduction of 0.91 (95% confidence interval [CI] 0.50–1.32) for neck pain and 1.40 (95% CI 0.82–1.99) for low back pain with little change thereafter. However, pain remained unchanged over the follow-up year for those with equal pain in the neck and low back areas at baseline and for those reporting 4 or more pain sites at baseline. Only 1 in 5 sought health care for their complaints. Still, the course of pain was comparable to effect sizes reported in interventional studies. This study thus contributes natural course reference data for comparisons of pain outcome in clinical trials and practice.     

Corrective surgery using a gridiron incision for abdominal pain caused by a folded ovary in the third trimester of pregnancy

IntroductionSonography and magnetic resonance imaging (MRI) may be helpful to obtain an accurate diagnosis of acute abdominal pain in pregnancy. Adnexal torsion presenting in the first or second trimester can be confirmed and treated through laparoscopic surgery; however laparoscopic surgery in the third trimester can be difficult owing to the large uterus, and a gridiron incision can be useful.Case Report/Case presentationAn 18-year-old gravida 1, para 0 (G1P0) woman at 30 + 4 weeks of gestation presented with sudden-onset cyclic pain in the right lower quadrant. Abdominal ultrasonography showed a normal appendix, and MRI showed a normal appendix and normal ovaries. The patient’s prominent tender point was marked and compared with the MR images, which confirmed the mark as the position of the right ovary. Laparotomy was performed through a gridiron incision, and a folded right ovary was identified. The ovary was unfolded, and TachoSil® and Surgicel® were used to maintain the unfolded position. The patient’s pain resolved, and her postoperative course was uneventful. She delivered a healthy, 2540-g male baby at 35 weeks’ gestation.Discussion/ConclusionsA gridiron incision was useful to treat a folded ovary in the third trimester and to evaluate the adnexa and minimize uterine manipulation.     

Number of pain sites is associated with demographic, lifestyle, and health-related factors in the general population

Research on widespread pain often relies upon case definitions bounded by duration limits or “cut-offs.” In clinical reality, however, there are no natural cut-off points between localized and widespread pain. Rather, pain is best represented by a continuum of “widespreadness” from localized pain to pain spread across the body. The objective of this paper was to describe the number of pain sites (NPS) reported in a population study and its association with demographic, lifestyle, and health-related factors. Using a cross-sectional design, the Standardized Nordic Questionnaire was used to measure musculoskeletal pain among seven age groups in Ullensaker, Norway (n = 2926). Results showed that women reported a higher mean NPS than men. A higher NPS was also found for individuals who were separated or divorced, undergoing rehabilitation, or who had a disability pension. Additionally, greater NPS was reported by smokers, individuals with less physical activity, and a higher BMI. A strong linear relationship was found between NPS and reduction in overall health, sleep quality, and psychological health. Results from a multivariate linear regression analysis showed that overall health, sleep quality, and gender demonstrated the strongest associations with increasing NPS, accounting for 31.4% of the variance. Our study indicates that the straightforward and simple method of counting the NPS could be important in managing the complex problem of musculoskeletal pain.     

Differential association of general and health self-efficacy with disability, health-related quality of life and psychological distress from musculoskeletal pain in a cross-sectional general adult population survey

Although evidence reveals that self-efficacy is associated with disability in people with pain, there is less known about this relationship in primary care settings and no published information in general population samples. This study aimed to assess the relationship between pain, self-efficacy, health-related quality of life, psychological distress and disability in a general population sample. A randomly selected sample from electoral registers of the lower North Island of New Zealand was mailed a survey questionnaire. Presence of musculoskeletal pain was defined as "pain present for at least seven consecutive days during the last month". Respondents were divided into three groups on the basis of pain: no pain, pain present for less than 12 months and pain present for 12 months or longer. Health Self-efficacy, General Self-efficacy, General Health Questionnaire, modified Health Assessment Questionnaire and EuroQol-5D were also included in the survey instrument. There were 289/471 (61%) returned questionnaires from eligible subjects (of an original sample of 540). General linear modelling found evidence of an association between pain status and self-efficacy with disability, explaining 16.4-18.8% of variability in mHAQ scores. In addition, we found evidence of an interaction between pain status and general self-efficacy, suggesting a stronger relationship between general self-efficacy and disability for pain present for 12 months or more. This interaction was not observed for health self-efficacy. General self-efficacy was more strongly related to psychological distress and this association was not influenced by pain status. Health-related quality of life was associated with health self-efficacy but not general self-efficacy.     

Reference values for respiratory pressures in a general adult population – results of the Study of Health in Pomerania (SHIP)

Background and Objective: Respiratory muscle pressures have been gaining increasing interest because of prognostic value. The study aim was to acquire reference values for respiratory pressures in a large‐scale population‐based survey – the Study of Health in Pomerania (SHIP). Methods: One thousand eight hundred and nine participants (885 men) of a cross‐sectional epidemiologic survey, called ‘Study of Health in Pomerania – SHIP’, underwent lung function and respiratory muscle pressure measurements. After excluding individuals with cardiopulmonary disorders, prediction equations for men and women were established by quantile regression analysis. Results: The final study population comprised 912 individuals (432 men), aged 25–80 years. The study provides a representative set of sex‐specific prediction equations of respiratory muscle strength. Respiratory pressures are decreasing with age and are lower in women when compared to men. Conclusions: Prediction equations for relevant respiratory pressures are given. Based on this well‐described population‐based survey with extensive cardiopulmonary investigations to exclude relevant interfering disorders a sufficient comprehensive set of reference values was obtained.     

Pain and clinical findings in the low back: A study of industrial employees with 5‐, 10‐, and 28‐year follow‐ups

Little is known about the relationships of clinical findings in the low back with low back pain (LBP) in the normal working population. We studied whether physiotherapist's findings in the low back were associated with local and radiating LBP among a cohort (n = 902) of employees in the engineering industry. A systematic non‐proportional sample was drawn in strata by age, gender, and occupational class. The non‐proportionality aimed at increasing sample size in smaller strata. Physiotherapists performed the straight‐leg raising test (SRL), and made assessments of the fingertip‐to‐floor distance and pain in palpation of the lumbar interspinous spaces. The variables on pain at the interspinous spaces and the SRL tests were entered in cluster analysis. Three clusters emerged: no, minor, and severe clinical findings. In logistic regression analysis at baseline, limited forward flexion and the clinical findings cluster variable were associated with local and, particularly, radiating LBP. Follow‐ups of the occurrence of local and radiating LBP at 5, 10, and 28 years from baseline were made. At the 5‐year follow‐up among subjects with no radiating LBP at baseline, the OR of radiating LBP for the clusters of minor and severe clinical findings compared to no findings were 2.7 (95% CI 1.4–5.1) and 3.8 (2.0–6.9), respectively, adjusted for age, gender, and occupational class. At the 10‐year follow‐up, the latter cluster predicted new reports of radiating LBP (1.9; 1.0–3.1) and of local LBP (4.1; 1.9–9.0, among subjects with no local LBP at baseline), similarly adjusted. No associations between limited forward flexion and new cases of LBP were observed. Thus, membership in clusters with different levels of findings in simple clinical measurements predicted new reports of radiating LBP, in particular, among employees. The generalizability of the results may be limited due to the characteristics of the sampling.     

Combined effects of major depression, pain and somatic disorders on general functioning in the general adult population

This study was carried out to assess the prevalence of major depressive disorder (MDD) in persons suffering from pain symptoms in various locations, both with and without comorbid somatic disorders and to analyze the single and combined effects of MDD, pain symptoms and somatic disorders on general functioning in the community. The 12-month prevalence of MDD, somatic disorders and pain symptoms, grouped according to location, were determined among 4181 participants from a community sample. Depression was assessed utilising the Composite International Diagnostic Interview. Pain symptoms were self-reported by participants whereas medical diagnoses were validated by medical examinations. General functioning was evaluated utilising the established MOS-SF-36 scale. The prevalence of MDD was significantly increased for persons with pain in any location. In the absence of a somatic disorder, MDD prevalence was highest in persons with abdominal/chest pain (9.3%) and arm or leg pain (7.9%) and lowest in persons with back pain (6.2%). Mental and physical well-being were lowest for persons with both MDD and a somatic disorder, irrespective of pain locations. Increasing numbers of pain locations impaired mental and physical well-being across all groups, but the effect on mental well-being was most marked in participants with MDD and comorbid somatic disorders. The presence of pain increases risk of associated MDD. The number of pain locations experienced, rather than the specific location of pain, has the greatest impact on general functioning. Not only chronic pain, but pain of any type may be an indicator of MDD and decreased general functioning.     

Longitudinal association between cardiovascular health and arterial stiffness in the Chinese adult population

ObjectiveArterial stiffness may be an intermediary biological pathway involved in the association between cardiovascular health (CVH) and cardiovascular disease. We aimed to evaluate the effect of CVH on progression of brachial–ankle pulse wave velocity (baPWV) over approximately 4 years.MethodsWe included 1315 cardiovascular disease-free adults (49±12 years) who had two checkups from 2010 to 2019. CVH metrics (current smoking, body mass index, total cholesterol, blood pressure, and fasting plasma glucose) were assessed at baseline, and the number of ideal CVH metrics and CVH score were calculated. Additionally, baPWV was examined at baseline and follow-up.ResultsMedian baPWV increased from 1340 cm/s to 1400 cm/s, with an average annual change in baPWV of 15 cm/s. More ideal CVH metrics and a higher CVH score were associated with lower baseline and follow-up baPWV, and the annual change in baPWV, even after adjustment for confounding variables. Associations between CVH parameters and baseline and follow-up baPWV remained robust in different sex and age subgroups, but they were only able to predict the annual change in baPWV in men and individuals older than 50 years.ConclusionsOur findings highlight the benefit of a better baseline CVH profile for progression of arterial stiffness.     

Providing information at the initial consultation to patients with low back pain across general practice,chiropractic and physiotherapy – a cross-sectorial study of Danish primary care

ObjectiveClinical guidelines for managing low back pain (LBP) emphasise patient information, patient education and physical activity as key components. Little is known about who actually receives information. This study investigates to what extent information at the first consultation with general practitioner (GP), chiropractor (DC) and physiotherapist (PT) in Danish primary care is provided to patients with LBP.Design and settingThis cross-sectorial study was conducted as a prospective survey registration of LBP consultations at the three primary health care professions in Denmark.InterventionClinicians ticked off a paper survey chart during or after consultations with patients who visited the clinic for LBP (Approval number: ID # 11.220).Subjects33 GPs, 43 DCs and 61 PTs registered first-time consultations.Main outcome measuresThe primary outcome was provision of information, overall and across care settings.ResultsThe overall proportion of patients provided with information was 72%, but this varied among professions (GP, 44%; DC, 76%; and PT, 74%). Provision of information increased to 78% if patients had increased emotional distress or back-related leg pain below the knee. The strongest association with provision of information was having two or three signs of elevated distress (OR 2.58 and 5.05, respectively, p= 0.00) or physical disability (OR 2.55, p= 0.00).ConclusionIn more than a quarter of first-time consultations, patient information was not provided. Large variation in providing information was found across the settings. The proportion provided with information increased for sub-populations having elevated distress or back-related leg pain below the knee.

Key Points

•  Clinical guidelines recommend patient information, patient education and physical activity for managing low back pain (LBP)  • Information is not provided in more than a quarter of first-time consultations in Danish primary care settings that manage these patients.
•  • Information increased for the sub-populations having elevated distress and back-related leg pain below the knee.
•  • The conducted primary care surveys monitored clinical activity and illustrated variations in provision of information.