Back supports at workplace. A new strategy to prevent lower-back disorders?

Disorders of the lower back represent an increasing socioeconomic problem. The widespread use of back supports is recommended as a protective tool but there are some discrepancies regarding the effectiveness of such equipment. In this paper we give information concerning the biomechanical and clinical effects both for occupational physicians and for users of back supports in industry. While an increase in intra-abdominal pressure has been confirmed by different research groups, the deduced hypothesis suggesting a decrease of spinal compression is an object of discussion. In some papers unfavorable effects of back supports on blood pressure, heart rate, and other physiological responses have been discussed. On the other hand, restriction of the range-of-motion seems to cause some protection against extreme movements of the spine. A review of the literature and our own experience permit us to recommend selective use of this device together with other preventive methods.      

Differential pharmacotherapy in back pain

Summary For low-back pain different analgesic and adjuvant drugs are available. In accordance to the special pathophysiology and stage of disease unwanted side-effects and contraindications of each drug have to be taken into consideration. Mainly the non-steroidal anti-inflammatory as well as the non-acid antipyretic drugs are in use. During episodes of acute pain the short-term application of central acting opioids or myotonolytic drugs can be neccessary. In long-lasting therapies for chronic low-back pain a medication with antidepressants is recommended. Supporting the primarily indicated therapeutic modalities pharmacologic therapy enables to an early painfree mobilisation. This is still the best prevention against further chronification.      

Chronic pain and gender in Salvador population, Brazil

Chronic pain is a public health problem with high impact on various population segments. There are few population studies with the aim of delineating the profile of the chronic pain patient, and generating data for actions to prevent, control and minimize the problem. The aim of this study was to estimate the prevalence of chronic pain in the population of Salvador, Bahia, Brazil and identify independent predictors associated with this morbidity. A cross-sectional study was conducted in a sample population of 2297 individuals of >20 years of age, in Salvador, Brazil. A standardized questionnaire was applied at home to collect data about socio-demographic characteristics, lifestyle, chronic pain and abdominal circumference measurement. The chronic pain was defined as pain with a duration of longer than 6 months. Prevalence of pain and the OR (univariate analysis) were estimated and adjusted (logistic regression), and their ICs at 95% and p<0.05 in the two analyses. The presence of chronic pain was found in 41.4% of the total study population, women being more affected (48.4% against 32.8% in men), with OR of 1.92 IC 95% 1.6-2,28 p<0.001. Among the studied factors, in the gross analysis, the following were shown to be associated with chronic pain: conjugal situation, smoking, excessive alcohol consumption, presence of central obesity and age, all with p<0.05. In the multivariate analysis, female sex, smoking, excessive alcohol consumption, and age were sustained as independent predictors. The presence of chronic pain was predominant in women, the elderly, smokers or ex-smokers and excessive alcohol consumers.     

The effect of manual therapy in acute low back pain (LBP)

Summary In 14 patients with acute LBP the effect of manual therapy was examined. The examination was conducted with the Triflexometer, which is an electromechanical measuring instrument for examination of the posture and function of the spine. This instrument makes possible the measurement of the spine in resting as well as in moving positions, and it is also suitable for recording local disturbances of the movement. In our study we measured the spine from C7 to S2 in the sagittal and frontal planes. Improvement in movement was detected in all patients following manual therapy, as well as in ante-, retro- and lateral flexion on both sides, and local functional disturbances also disappeared partially or totally. Our study shows that the Triflexometer makes it possible to record the effect of manual therapy in acute LBP. The proof of the local functional disturbances after manual therapy indicates that these patients have a higher risk of new episodes of acute LBP or perhaps of chronic LBP, and because of that there it is necessary to use other treatment forms.      

Neuropathic pain in the general population: A systematic review of epidemiological studies

Most patients with neuropathic pain symptoms present and are managed in primary care, with only a minority being referred for specialist clinical assessment and diagnoses. Previous reviews have focused mainly on specific neuropathic pain conditions based in specialist settings. This is the first systematic review of epidemiological studies of neuropathic pain in the general population. Electronic databases were searched from January 1966 to December 2012, and studies were included where the main focus was on neuropathic pain prevalence and/or incidence, either as part of a specific neuropathic pain-related condition or as a global entity in the general population. We excluded studies in which data were extracted from pain or other specialist clinics or focusing on specific population subgroups. Twenty-one articles were identified and underwent quality assessment and data extraction. Included studies differed in 3 main ways: method of data retrieval, case ascertainment tool used, and presentation of prevalence/incidence rates. This heterogeneity precluded any meta-analysis. We categorised comparable incidence and prevalence rates into 2 main subgroups: (1) chronic pain with neuropathic characteristics (range 3–17%), and (2) neuropathic pain associated with a specific condition, including postherpetic neuralgia (3.9–42.0/100,000 person–years [PY]), trigeminal neuralgia (12.6–28.9/100,000 PY), painful diabetic peripheral neuropathy (15.3–72.3/100,000 PY), glossopharyngeal neuralgia (0.2–0.4/100,000 PY). These differences highlight the importance of a standardised approach for identifying neuropathic pain in future epidemiological studies. A best estimate of population prevalence of pain with neuropathic characteristics is likely to lie between 6.9% and 10%.     

Neurobiological basis of painful, function-disturbed joints

Joints are innervated by nociceptive nerve fibres (nociceptors), which are only activated by tissue-damaging stimuli. This activation causes pain in conscious humans. The sensory terminals of many nociceptors in the tissue are sensitized by inflammatory processes. Under these conditions, normally innocuous and non-painful stimuli are sufficient to activate nociceptors and to elicit pain. The effect of inflammatory mediators such as bradykinin and prostaglandins is important for the process of sensitization. In addition to their sensory function, many nociceptors have an efferent function. They evoke a neurogenic inflammation by the release of neuropeptides such as substance P and calcitonin gene-related peptide into the tissue. The efferent function of nociceptors contributes to the generation of inflammatory lesions of the tissue.      

Previous Mental Disorders and Subsequent Onset of Chronic Back or Neck Pain: Findings From 19 Countries

Associations between depression/anxiety and pain are well established, but its directionality is not clear. We examined the associations between temporally previous mental disorders and subsequent self-reported chronic back/neck pain onset, and investigated the variation in the strength of associations according to timing of events during the life course, and according to gender. Data were from population-based household surveys conducted in 19 countries (N?=?52,095). Lifetime prevalence and age of onset of 16 mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the occurrence and age of onset of back/neck pain were assessed using the Composite International Diagnostic Interview. Survival analyses estimated the associations between first onset of mental disorders and subsequent back/neck pain onset. All mental disorders were positively associated with back/neck pain in bivariate analyses; most (12 of 16) remained so after adjusting for psychiatric comorbidity, with a clear dose-response relationship between number of mental disorders and subsequent pain. Early-onset disorders were stronger predictors of pain; when adjusting for psychiatric comorbidity, this remained the case for depression/dysthymia. No gender differences were observed. In conclusion, individuals with mental disorder, beyond depression and anxiety, are at higher risk of developing subsequent back/neck pain, stressing the importance of early detection of mental disorders, and highlight the need of assessing back/neck pain in mental health clinical settings.

Epidemiology of chronic back pain among adults and elderly from Southern Brazil: a cross-sectional study

BackgroundChronic back pain (CBP) can negatively affect one’s quality of life and health condition, posing significant social and economic burdens.Objectives(1) To determine the prevalence of CBP and analyze associated factors in adult and elderly individuals in a municipality in southern Brazil; (2) to verify who sought medical attention or missed work because of back pain; and (3) to estimate the impact of CBP on selected health outcomes.MethodsThis was a population-based cross-sectional study conducted with individuals aged 18 years and older. CBP was defined as “pain for three consecutive months in the cervical, thoracic, or lumbar regions in the last year.” Demographic, socioeconomic, behavioral, and physical and mental health information was collected. The impact of CBP was assessed by the etiological fraction method.ResultsThe prevalence of CBP was 20.7% (95% CI: 18.3, 23.0) among the 1300 study participants. The factors associated with CBP were women, elderly, smokers, obesity, and sleeping fewer hours per night, as well as those with higher mental stress levels, history of fracture, arthritis/rheumatism, and work-related musculoskeletal disorder/repetitive strain injury. One-third of those with CBP missed work (31%) and 68% visited the physician over a 12-month period. All health outcomes analyzed (poor or very poor sleep quality, regular or poor health perception, worsened quality of life, depressive symptoms, perceived sadness) were significantly associated with CBP.ConclusionOne in five adults or elderly reported having CBP over the previous 12 months. This condition was associated with poorer health perception, poorer quality of life, and depressive symptoms.     

Comorbidity of low back pain: representative outcomes of a national health study in the Federal Republic of Germany.

BACKGROUND: Unlike other biopsychosocial risk factors, the role of comorbidity in low back pain is largely unknown. AIMS: The purpose is (1) to generate prevalence data on back pain in the total adult population and (2) to identify the most common physical comorbidities in subjects with back pain. This paper also (3) analyses the gender-specific and age-specific comorbidity structure. METHODS: The National German Health Survey is the first study to provide the basis for a representative nationwide analysis of back pain prevalence and the associated comorbidities. The net sample comprises a total of 7124 Germans aged 18-79. RESULTS: One in three Germans (34%) experienced back pain during the seven days prior to being interviewed. The one-year prevalence rate is 59%. All the morbidities investigated by us are more common in subjects with back pain than in individuals without back pain. The most common comorbidities associated with back pain are musculoskeletal disorders like rheumatoid arthritis, osteoarthritis and osteoporosis, followed by cardiovascular and cerebrovascular disease. CONCLUSIONS: The present study investigating 31 physical diseases is the most extensive analysis to date on the topic of back pain and comorbidity. This is an attempt to cast light on the tangled relationships involved in developing and coping with back pain. In view of the large percentage of unspecific back pain, we believe it is important for physicians treating back pain to extend their history and diagnostic analysis skills to embrace comorbidities related to the back pain.     

Open functional magnetic resonance imaging of structural defects of the alar ligaments

Summary To investigate longstanding cervicocephalic symptoms after trauma to the atlanto- occipital joint – applying exclusion criteria – 95 patients, 56 females (n = 59 %), 39 males (n = 41 %) with an average age of 39 years – between 21 and 55 years of age – were investigated on an open 0.2 Tesla magnet MAGNETOM OPEN using a special coil device. Functional dynamic MRI studies of the upper cervical spine were conducted between November 1995 and December 1996. Two continuous functional studies were performed, tilting of the upper cervical spine to the right and left and then axial rotation in dorsal decubitus position also to the right and left. The types of rupture were classified as Type I: Complete rupture – 3 %; Type II a: Incomplete rupture with an extensive structural lesion – 20 %; Type II b: Intraligamentous rupture of fibres with resulting scar formation and local bulging – 11 %; Type III-lesion: a central intraligamentous alteration of signal – 39 %. With the presently available diagnostic methods no demonstrable lesion could be recognized in 27 % patient involving the liagments of the atlanto-occipital region. This study clearly shows that type I and type II a lesions are accompanied by injuries to the ypsilateral transverse ligament of the atlas. The functional MRI-examination of the atlanto-occipital joint in an open system is an appropriate modality to document morphological alterations. With the MRI-studies, until the end point of rotation was reached, a deviation of the dens could be demonstrated in the presence of ligamentous pathology. Instability of the atlanto-occipital joints was documented as a result. The frequency of structural lesions in the vicinity of the dens offer an argument for the assumption that overstretching by mechanical shear- and forces of overheating become effective at the point of contact between the periosteum of the dens and the alar ligaments as a result of excessive rotation of the atlanto-occipital region.      

Epidemiology of chronic pain in Denmark: An update

The most recent Danish health survey of 2005 is based on a region-stratified random sample of 10.916 individuals. Data were collected via personal interviews and self-administrated questionnaires. Respondents suffering from chronic pain were identified through the question ‘Do you have chronic/long-lasting pain lasting 6 months or more?’ The prevalence of chronic pain among individuals with a present or earlier cancer diagnosis was also assessed. In all, 7275 individuals (66.6%) completed a personal interview and 5552 individuals (50.9% of the original sample) completed and returned the self-administrated questionnaire. The same questions were included in the survey in 2000 and, hence, it was possible to evaluate the trends in the past five years. In all, 20.2% of the adult Danish population has chronic pain. From year 2000–2005 the prevalence of chronic pain has remained stable. Generally, chronic pain was associated with female gender and increasing age. Higher prevalence of chronic pain were associated with being divorced, separated or widowed, having less than 10 years of education and high BMI. Musculoskeletal diseases (66.8%) were the most common cause for chronic pain and most persons with chronic pain rated their health and quality of life as poor. Persons with earlier or present cancer diagnosis were more likely to report chronic pain. A substantial part of persons with chronic pain were not satisfied with the examinations and treatments offered. In conclusion, over a five-year period the prevalence of chronic pain in Denmark has remained stable, but high.     

The therapeutical value of muscle energy technique according to Mitchel in pain of the spine

Zusammenfassung Es werden die Behandlungsergebnisse der Muscle energy technique nach Mitchel bei Wirbels?ulenbeschwerden dargestellt. St?rungen der Gelenksbeweglichkeit am Becken, der Wirbels?ule und den Rippen k?nnen mit der Muscle energy technique diagnostiziert werden. Die Therapie hat einen hohen Erfolg. Die H?ufigkeit der Behandlung ist gering. Die Therapie ist risikofrei für den Patienten. Sie ist eine Alternative zu chirotherapeutischen Techniken mit Impuls.      

The population prevalence of foot and ankle pain in middle and old age: a systematic review

A systematic review and meta-analysis of population-based epidemiological studies was undertaken to determine the prevalence of foot and ankle pain in middle and old age. Searches were conducted in the following electronic databases from inception to October 2010: PubMed, EMBASE, AMED, CINAHL, Cochrane, PEDro, and SportDiscus. Full-text English language articles were included if they used population sample frames, cross-sectional design or analysis, and reported prevalence estimates for foot and/or ankle pain in adults aged 45 years and over. Thirty-four articles from 31 studies involving 75,505 participants provided 529 prevalence estimates based on different case definitions and population strata. Random-effects meta-analyses of studies with comparable case definitions provided pooled prevalence estimates, for frequent foot pain of 24% (95% confidence interval 22-25%; n = 3; I² = 46%) and for frequent ankle pain of 15% (95% confidence interval 13-16%; n = 2; I² = 0). Small sample sizes and low response rates in some studies, together with heterogeneous case definitions, limit confident conclusions on the distribution, subtypes, and impact of foot/ankle pain. Narrative synthesis of evidence from existing studies suggested preponderance in females, an age-related increase in prevalence in women but not men, that the toes/forefoot were the most common anatomical sites of pain, and that moderate disability in an aspect of daily life was reported by two-thirds of cases. This review provides estimates of the community burden of foot and ankle pain in middle and old age. By outlining the scale of this clinical problem, these findings can be used to inform health care planning and provision.     

Dysfunction of the motor system as a specialty of the regulation part of the motor system. A model

Summary The attempt was made to explain dysfunctions of the motor system – analogical to electronic data processing systems – as a speciality of the regulation part of the motor system. Thereby dysfunctions can be seen as misplaced variables in the regulation software with not defined or unknown values of afferences or combination of afferences. This leads to a failure of the corresponding software modul that results in the loss of function which is regulated through this modul. Especially with changing of afference through manual treatment or through needling, a replacement of the variables can be reached and this leads to normal function. With this hypothesis all phenomens of dysfunctions can be explained.      

Back pain in older male Italian‐born immigrants in Australia: The importance of socioeconomic factors

Back pain is common in older people and is associated with functional disability and poor self‐rated health. Older persons are under‐represented in back pain research, and research on back pain in older persons from ethnic minorities is particularly sparse. We investigated differences in back pain characteristics, effects and medication use in a population‐based sample of 335 Italian‐born immigrants and 849 Australian‐born men aged 70years and over. There were 189 (62%) Italian‐born men and 507 (63%) Australian‐born men who reported experiencing back pain in the past 12months. Despite no difference in the reported prevalence of back pain between the two groups of men, Italian‐born men were more likely to report that their pain was frequent, severe and chronic. Italian‐born men were also more likely to report having other sites of pain and that they had limited their activities in the past 12months due to back pain. Despite these differences, the use of analgesic medication was the same in both groups. Multivariate analyses showed that differences in pain characteristics and effects between the two groups of men were explained by socioeconomic factors such as years of education and occupation history.     

Contributions of prognostic factors for poor outcome in primary care low back pain patients

Background: Back pain is common and some sufferers consult GPs, yet many sufferers develop persistent problems. Combining information on risk of persistence and prognostic indicator prevalence provides more information on potential intervention targets than risk estimates alone. Aims: To determine the proportion of primary care back pain patients with persistent problems whose outcome is related to measurable prognostic factors. Methods: Prospective cohort study of back pain patients (30–59 years) at five general practices in Staffordshire, UK (n =389). Baseline factors (demographic; episode duration; symptom severity; pain widespreadness; anxiety; depression; catastrophising; fear‐avoidance; self‐rated health) were assessed for their association with disabling and limiting pain after 12‐months. The proportion of those with persistent problems whose outcome was related to each factor was calculated. Results: Prevalence of prognostic factors ranged from 23% to 87%. Strongest predictors were unemployment (adjusted relative risk (RR) 4.2; 95% CI 2.0, 8.5) and high pain intensity (4.1; 1.7, 9.9). The largest proportions of persistent problems were related to high pain intensity (68%; 95% CI 27, 87%) and unemployment (64%; 33, 82%). Combining these indicated that 85% of poor back pain outcome is related to these two factors. Poor self‐rated health, functional disability, upper body pain and pain bothersomeness were related with outcome for over 40% of those with persistent problems. Conclusions: Several factors increased risk of poor outcome in back pain patients, notably high pain and unemployment. These risks in combination with high prevalence of risk factors in this population distinguish factors that can help identify targets or sub‐groups for intervention.     

Back pain in relation to musculoskeletal disorders in the jaw-face: a matched case-control study

Back pain and temporomandibular disorders are both common conditions in the population with influence on the human motor system, but a possible co-morbidity between these conditions has not been fully investigated. The aim of this study was to test the hypothesis of an association between long-term back pain and pain and/or dysfunction in the jaw-face region. Back pain was defined as pain in the neck, shoulders and/or low back. The study-population comprised 96 cases with long-term back pain and 192 controls without back pain. We used a screening procedure, a questionnaire and a clinical examination of the jaw function. The questionnaire focused on location, frequency, duration, intensity and impact on daily life of symptoms in the jaw-face and back regions. The analysis was conducted on 16 strata, matched by age and sex for case vs. control, using Mantel-Haenszel estimates of matched odds ratio (OR) and 95% confidence interval (CI) as well as the corrected Mantel-Haenszel chi(2) test. The overall prevalence of frequent symptoms in the jaw-face region, as reported in the questionnaire, was 47% among cases and 12% among controls. The difference was statistically significant (P<0.0001) with a sevenfold odds ratio (CI: 3.9-13.7). Moderate to severe signs from the jaw region were clinically registered among 49% of the cases and 17% of the controls (P<0.0001, OR: 5.2, CI: 2.9-9.2). The results showed statistically significant associations between long-term back pain and musculoskeletal disorders in the jaw-face and indicate co-morbidity between these two conditions.     

Prevalence of chronic pain with neuropathic characteristics in the general population

We conducted a large nationwide postal survey to estimate the prevalence of chronic pain with or without neuropathic characteristics in the French general population. A questionnaire aimed at identifying chronic pain (defined as daily pain for at least 3 months), evaluating its intensity, duration and body locations, was sent to a representative sample of 30,155 subjects. The DN4 questionnaire was used to identify neuropathic characteristics. Of the questionnaires, 24,497 (81.2%) were returned and 23,712 (96.8%) could be assessed. Seven thousand five hundred and twenty-two respondents reported chronic pain (prevalence=31.7%; [95%CI: 31.1-32.3]) and 4709 said the pain intensity was moderate to severe (prevalence=19.9%; [95%CI: 19.5-20.4]). Neuropathic characteristics were reported by 1631 respondents with chronic pain (prevalence=6.9%; [95%CI: 6.6-7.2]), which was moderate to severe in 1209 (prevalence=5.1% [95%CI: 4.8-5.4]). A higher prevalence of chronic pain with neuropathic characteristics was associated with middle age (50-64 years), manual professions and those living in rural areas. It was more frequently located in the lower limbs and its intensity and duration were higher in comparison with chronic pain without neuropathic characteristics. This large national population-based study indicates that a significant proportion of chronic pain patients report neuropathic characteristics. We identified distinctive socio-demographic profile and clinical features indicating that chronic pain with neuropathic characteristics is a specific health problem.