Risikofaktoren für Rückenschmerzen bei Kindern und Jugendlichen in Industrienationen

Factors that have led to the increasing prevalence of back pain amongst children and adolescents living in industrialized nations are mostly unknown. The following literature review was aimed at determining the risk factors for back pain amongst children and adolescents. We searched both PUBMED and MEDLINE between the years 1985 and 2003 for the keywords "children or adolescents" and "back pain". Only data published in original articles were used. The risk for suffering back pain is influenced by physical, behavioural, emotional and social factors. The effects of physical activity, sitting, muscle status, weight of schoolbags, exercise, television and computer use, as well as age and gender on the development of back pain in children and adolescents were examined. Associations between continuous or recurring back pain and psychosocial factors (lifestyle, emotional factors, social relationships) could be demonstrated. There was no relationship between changes of the spine seen by radiological tests and the development of chronic back pain. Longitudinal epidemiological studies are urgently needed to delineate the risk factors for the development as well as the natural history of chronic back pain in the young.     

Verbesserung der Compliance für Bewegungsübungen bei chronischen Rückenschmerzen mittels Handy-App

Manuelle Medizin - Kreuzschmerzen sind aufgrund der Häufigkeit in den Industriestaaten ein großes gesellschaftliches und ökonomisches Gesundheitsproblem. Als wichtigste Therapie zur...     

Rückenschmerz

Ohne Zusammenfassung

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Back painSo many questions and still far too few answers

     

Körperbild und Rückenschmerz

Background

Many factors seem to be causal for non-specific low back pain and are sometimes controversially discussed. Some years ago the concept of subjective body image attracted attention but due to the inconsistent use of terms and concepts it is difficult to classify publications in the literature. Studies confirmed a difference between the body images of patients with low back pain and healthy controls so that an inclusion of body image concepts could be relevant for causation and therapy.

Objective

This article presents an overview of the current state of research on the association between body image and low back pain and with respect to the allocation of body image in psychosocial concepts of low back pain.

Material and methods

Relevant studies on body image and low back pain were reviewed and are discussed with respect to the different use of terms and concepts of body image. Moreover, an approach for integration of the body image into current psychosocial concepts and therapy of low back pain is presented. Finally, it is discussed whether consideration of the body image could be of value in the therapy of low back pain.

Results

Studies have shown that low back pain patients have a more negative body image compared to healthy controls. There is a lack of studies on clinical evidence for the application and effectiveness of interventions that influence the body image in low back pain.

Conclusion

Further studies are necessary which include body image concepts as a possible psychosocial risk factor, in particular studies on the mechanism of body image procedures.

     

Diskogener Rückenschmerz und degenerative Spinalstenose

Surgery in acute and/or chronic low back pain is still a matter of intensive and controversial discussions. A vast number of minimally invasive or so called semi-invasive procedures have been published in the last 3 decades, but evidence-based data on efficacy and benefit of most of these techniques are still lacking. However, empirical data suggest good or at least satisfactory clinical results for a limited number of procedures if they are applied under restrictive indication criteria. Discogenic low back pain and lumbar spinal stenosis belong to the most frequent diagnoses associated with low back pain. This article gives a survey on definitions, indication criteria and modern surgical or semi- invasive techniques used for the treatment of these two pathologic entities. Discogenic low back pain: This clinical and morphological entity is defined as low back pain arising mainly from disc degeneration. Pain generators are usually nociceptors in the cartilaginous endplates, in the outer anulus fibrosus as well as in the periosteum of the vertebral bodies. Clinical symptoms correlate with morphologic changes detected with MR-imaging (modic type I) or with contained disc protrusions mainly without neurological symptoms. Surgery is rarely indicated, spontaneous remissions occur in more than 60% of all cases. Spinal fusion has been the only surgical option in cases which did not respond to conservative therapy. Recently, electro-thermal modulation of the posterior anulus fibrosus has been published as a semi- invasive technique to relieve low back pain generated by fissures in the outer anulus and ingrowing nociceptors (intradiscal electro-thermal therapy, IDET(TM)). First results are promising, however, prospective randomised studies comparing this technique with conservative therapy are still lacking. The same is true for artificial nucleus pulposus replacement using hydrogel cushions implanted in the intervertebral space after removal of the nucleus pulposus from posterior or through an anterior approach (PDN, prosthetic disc nucleus(TM)). In cases with severe disc degeneration total disc replacement is another innovative option (ProDisc(TM)). Two metal endplates with titanium surface coating are implanted through a minimal invasive anterior approach (mini-laparotomy). A polyethylene inlay anchored in the caudal endplate holds the distance between the endplates and preserves the physiological range of motion between the two vertebral bodies. Degenerative lumbar spinal stenosis: Narrowing of the spinal canal due to degenerative changes of the disc, the facet joints and thickening of the yellow ligament is a geriatric disease which is diagnosed in increasing numbers within the last 10 years. More than 80% of the patients present with low back pain in association with neurogenic claudication. Neurological symptoms at rest are less frequently found. The spontaneous course shows progressive symptoms in more than 50% of all patients. More than 35% of the patients have associated diseases which might influence the perioperative course, complication rates and outcomes of surgery. Surgery is indicated in patients with progressive neurological symptoms, unacceptable decrease of quality of life or progressive intractable pain. In patients with mainly "leg symptoms" microsurgical mono- or multisegmental decompression is the procedure of choice. If low back pain is predominant and associated with degenerative instability such as degenerative spondylolisthesis or lumbar scoliosis, decompression must be combined with instrumented spinal fusion. In general a restrictive indication for surgery must be recommended especially for spinal fusion procedures. Non-fusion techniques such as intradiscal electro thermal therapy or spine arthroplasty with replacement of nucleus pulposus or total disc show promising early results; however, little is known about the long-term effect. It should be a principle to apply surgery in the least invasive way.     

Psychosoziale Faktoren der Schmerzchronifizierung bei Patienten in der stationären orthopädischen Rehabilitation von chronisch unspezifischem Rückenschmerz

Background

The aim of this study was to investigate the criterion validity of the Mainz Pain Staging System (MPSS), considering the four axes of the MPSS separately.

Methods and design

Psychological and pain-related impairments were analysed depending on the stage of axis (I, II, III) for each single axis of the MPSS in a consecutive sample of 280 patients with chronic low back pain in orthopaedic inpatient rehabilitation. In addition, the distribution of frequency of clinically significant symptoms in depression, anxiety and somatisation were examined depending on the stage of axis.

Results

For all axes, an increasing stage was associated with greater psychological and pain-related impairments. Particularly patients assigned to stage III on axis 1 (temporal aspects) and 2 (spatial aspects) and patients assigned to stage II on axis 3 (drug intake) and 4 (utilisation of the health care system) showed enhanced psychosocial impairments and more frequently had clinically relevant symptoms in psychological variables.

Conclusion

Findings confirm the criterion validity of the MPSS for chronic low back pain. In addition, results support the significance of psychosocial factors for the further development of chronicity.     

Chronischer Rückenschmerz

Background

The aim of the study was to replicate the different reaction groups: “Fröhlicher Durchhalter (FD)” who are characterised by a positive mood and endurance strategies, “Depressiver Durchhalter (DD)” with depressive mood and cognitions to hold on and “Depressiver Vermeider (DV)” who are depressed with social and physical avoidance strategies. The replication was conducted with more feasible methods than the Kiel Pain Inventory (KPI), which had been frequently used in former research. This might effectuate a superior intervention outcome.

Patients/methods

The sample (n=290) consisted of patients after their first nucleotomy at the beginning of the inpatient medical rehabilitation. Selection of the scales was based on cognitive-emotional and behavioural pain characteristics. Therefore 14 scales of generic standardised questionnaires were investigated

Results

The cluster analysis revealed two heterogeneous groups: the FD (n=203, 75.7%) and DV (n=65, 24.3%). MANOVA showed significant differences between both groups (Wilks’ lambda: F (14,253)=30.97; p<.001); especially the emotional pain characteristics were relevant.

Conclusion

The study contributes to the methodological stability of two postulated groups. Thus further research should foster the development of risk-based interventions to evaluate if these groups offer an appropriate differentiation in rehabilitation.     

Mehrdimensionale Erfassung der Schmerzwahrnehmung und ihre Bedeutung für das Verhalten chronischer Rückenschmerzpatienten

A consecutive series of 98 patients presenting at an orthopedic outpatient clinic with chronic low back pain of at least 6 months' duration and with no organic findings (ruled out by clinical and radiological examination) were evaluated by means of a questionnaire which included the constructs "patient history," "pain-related restrictions," and "depression." Pain perception was evaluated with an adjective list revealing four main factors: two affective factors, i.e., "suffering from pain" and "anxiety," and two sensory factors, i.e., "acuteness" and "rhythmics of pain." The two affective factors (as against the sensory factors) subsequently influence the degree of pain intensity (measured with a visual analog scale), the patient's history and the patient's perceived impairment of daily life. Depression (von Zerssen scale) correlated with pain factors only when the whole range of pain factors was considered. The implications for treatment in patients with a high score for affective factors in the adjective list (indicator for a low success rate with traditional therapy) are discussed.     

Stellungnahme der Österreichischen Röntgengesellschaft und der Österreichischen Gesellschaft für Pneumologie

The National Lung Screening Trial (NLST) could demonstrate, for the first time, in a prospective randomized trial, that low-dose CT screening (LD-CT) may decrease lung cancer mortality. At the moment, it is unclear how these results will be applicable to Austria. Specifically, the definition of the population at an increased risk for lung cancer and management of the high rate of false-positive results are problematic. As a consequence, lung cancer screening in Austria is recommended following the guidelines of the Austrian Society of Radiology and the Austrian Society of Pneumology. The recommendations suggest that only individuals with a significantly increased risk for lung cancer should be screened (age > 55 years, 30 pack-years, active or former smokers since < 15 years). The screened individuals must be informed about the high probability of false-positive screening results and the necessity for additional follow-up examinations or invasive examinations. The screened individuals must be informed that a CT screening may not prevent them from developing an inoperable lung cancer. In addition, CT screening examinations should be performed with a low-dose CT technique for at least three years at yearly intervals. In view of the high probability of false-positive findings, the evaluation of detected pulmonary nodules should be performed according to an already established standardized protocol.     

Bedeutung der gesundheitsbezogenen Lebensqualität und Religiosität für die Akzeptanz von chronischen Schmerzen

Background

Modern medical analgesia is based on a bio-psycho-social model of disease. From this bio-psycho-social perspective it seems essential to include religiosity in the multidimensional and interdisciplinary assessment of pain patients.

Material and methods

A total of 450 consecutively referred in- and outpatients to a neurological department completed an epidemiologic pain questionnaire. This patient self-administered questionnaire included diagnostic screening tests for anxiety and depression, a generic health-related quality of life measure and sociodemographic questions. Pain severity grades and pain chronicity stages were measured. The acceptance of chronic pain was assessed with the chronic pain acceptance questionnaire. The significance of religiosity was measured employing the structure of religiosity test.

Results

Of the neurological patients 82% complained of having had pain within the past 3 months and 79% within the last 12 months. Patients who accepted the pain and pursued their daily activities despite the pain were less depressive and anxious and showed an enhanced health-related quality of life. The importance of religion to the pain patients was associated with a higher level of pain tolerance.

Conclusions

This study proved that the significance of religiosity to the patient is related to psychic distress and health-related quality of life and at the same time may play an important role in the bio-psycho-social pain concept.     

Selbstmanagement in der Manualtherapie bei Patienten mit chronischen Rückenschmerzen

Chronic non-specific back pain usually has no direct association with a measurable pathology. Nevertheless, affected patients can experience significant functional impairment in their everyday lives and work. As such, several individual findings, particularly on a psychosocial level, go to make up the overall clinical presentation. If acute symptoms persist despite the sound application of effective techniques or if pain has already become chronic, an interdisciplinary assessment should be considered. Guideline-compliant multimodal interdisciplinary treatment comprises various components: intensive education that takes a biopsychosocial disease model into account, medicinal pain therapy, physiotherapy, everyday training, stress management and sports therapy. To guarantee long-term success, it is essential to integrate an appropriate self-management program into everyday life in order to cope with back pain. This article discusses the aim, content, and implementation of a self-management program of this type.     

Besteht ein Zusammenhang zwischen Rückenschmerz und der Stabilit?t der lumbalen Wirbels?ule in der Schwangerschaft?

During pregnancy approximately 50% of women suffer from low back pain (LBP), which significantly affects their everyday life. The pain could result in chronic insomnia, limit the pregnant women in their ability to work and produce a reduction of their physical activity. The etiology of the pain is still critically discussed and not entirely understood. In the literature different explanations for LBP are given and one of the most common reasons is the anatomical changes of the female body during pregnancy; for instance, there is an increase in the sagittal moments because of the enlarged uterus and fetus and the occurrence of hyperlordosis.The aim of this study was to describe how the anatomical changes in pregnant women affect the stability and the moments acting on the lumbar spine with the help of a simplified musculoskeletal model.A two-dimensional musculoskeletal model of the lumbar spine in the sagittal plane consisting of five lumbar vertebrae was developed. The model included five centres of rotation and three antagonistic pairs of paraspinal muscles. The concept of altered acting torques during pregnancy was explored by varying the geometrical arrangements. The situations non-pregnant, pregnant and pregnant with hyperlordosis were considered for the model-based approach. These simulations were done dependent on the stability of the erect posture and local countertorques of every lumbar segment.In spite of the simplicity of the model and the musculoskeletal arrangement it was possible to maintain equilibrium of the erect posture at every lumbar spinal segment with one minimum physiological cross-sectional area of all paraspinal muscles. The stability of the musculoskeletal system depends on the muscular activity of the paraspinal muscles and diminishing the muscular activity causes unstable lumbar segments.The relationship between the non-pregnant and the pregnant simulations demonstrated a considerable increase of acting segmental countertorques. Simulating an increased lordosis for the pregnant situation in the sagittal plane substantially reduced these acting countertorques and therefore the demand on the segmental muscles.It is assumed that hyperlordosis is a physiological adaptation to the anatomical changes during pregnancy to minimize the segmental countertorques and therefore the demand on the segmental muscles.Further, it can be expected that an enhanced muscle activity caused by selective activity of lumbar muscles increases the stability of the lumbar spine and may improve the situation with LBP during pregnancy.     

Wirksamkeit klassischer Massagetherapie bei chronischen Rückenschmerzen und Funktionsstörungen im Bewegungssystem

Manuelle Medizin - Klassische Massagetherapie (KMT) ist laut Physiotherapie-Ausbildungs- und Prüfungsverordnung Basis diagnostischer Tastfähigkeit zur Beurteilung von...     

Zur Funktion der branchiogenen Reflexzonen für Chemo- und Pressoreception

Research in Experimental Medicine -