Prevalence of low back pain and factors associated with chronic disabling back pain in Japan

Purpose

This study aimed to report lifetime and 4-week low back pain (LBP) prevalence and examine factors associated with chronic LBP and back pain disability over a lifetime in a Japanese adult population.

Methods

In February 2011, 1,063,083 adults aged 20–79 years registered as internet research volunteers were randomly selected to participate in a questionnaire survey. The data from 65,496 respondents were analyzed to calculate age-standardized lifetime and 4-week prevalence. Chronic LBP and back pain disability were defined as LBP lasting for ≥3 months and a consecutive ≥4-day-long absence, respectively. Factors associated with chronic disabling back pain over a lifetime were examined by multiple logistic regression modeling.

Results

The lifetime LBP prevalence was 83 % and 4-week prevalence was 36 %; majority of the respondents had disability-free LBP. Smoking [adjusted odds ratio (aOR): 1.17; 95 % CI: 1.05, 1.30], lower educational level (aOR: 1.21; 95 % CI: 1.09, 1.34), history of disabling back pain among family members and/or significant others (aOR: 1.46; 95 % CI: 1.27, 1.67), occupational LBP (aOR: 1.34; 95 % CI: 1.16, 1.55), traffic injury (aOR: 2.81; 95 % CI: 2.07, 3.81), compensated work injury (aOR: 2.42; 95 % CI: 1.92, 3.05), radiating pain (aOR: 4.94; 95 % CI: 4.45, 5.48), low back surgery (aOR: 10.69; 95 % CI: 9.02, 12.68), and advice to rest upon back pain consultation (aOR: 3.84; 95 % CI: 3.36, 4.40) were associated with chronic disabling back pain over a lifetime.

Conclusions

LBP is common in Japan as in other industrialized countries. The association between the advice to rest and chronic disabling back pain supports recent treatment guidelines emphasizing continuation of daily activities.     

The association of pain with physical activities in chronic low back pain.

Most patients with chronic low back pain associate strenuous physical activities with increased pain. This association can cause avoidance of those activities believed to cause intolerable discomfort. This study explored the relationship of performance of physical activities with self-reported pain measures in 40 consecutive patients with disabling low back pain (mean duration 17 months) during a functional restoration rehabilitation program (mean treatment period 7 weeks). Evaluations were performed at initial presentation and at program completion. Measures included quantification of performance on eight physical tests assessing flexibility, lifting capacity and endurance. Before physical testing patients were asked to complete a pain analog scale, a quantified pain drawing, and a rating of the pain anticipated to result from the performance of each physical test. Results showed that pain measures did not generally correlate with measured physical performance. At completion of treatment, significant improvement in performance on all physical tests was found, but these were not associated with consistent changes in pain measures. These results demonstrate that subjects with chronic low back pain can increase their physical performance abilities within their same pain experiences. Medical recommendations for subjects' involvement in physical activities should not be based solely on the reported association of pain with those activities.     

The association between static pelvic asymmetry and low back pain.

STUDY DESIGN: A cross-sectional case-control approach was used to estimate the association between low back pain of less than 12 months' duration and pelvic asymmetry among 21-50-year-old patients seeking physical therapy services. OBJECTIVE: To evaluate the premise that asymmetrical positioning of the innominates of the pelvis is a source of low back pain. SUMMARY OF BACKGROUND DATA: No published studies have been conducted to evaluate systematically the association between low back pain and pelvic asymmetry in a clinic-based sample. METHODS: Pelvic landmark data were obtained in 144 cases and 138 control subjects. The associations of low back pain with levels of pelvic asymmetry were estimated by use of odds ratios and 95% confidence intervals. Effect modification and confounding of the low back pain-pelvic asymmetry association by several factors was assessed and alternative asymmetry measures considered. RESULTS: Pelvic asymmetry was not positively associated with low back pain in any way that seemed clinically meaningful. Asymmetry of posterior superior iliac spine landmarks showed some evidence of a weak positive association with low back pain. CONCLUSIONS: In the absence of meaningful positive association between pelvic asymmetry and low back pain, evaluation and treatment strategies based on this premise should be questioned.     

The association between cigarette smoking and back pain in adults.

STUDY DESIGN: A retrospective cohort study of adolescent idiopathic scoliosis. A comparison group of persons without scoliosis was also selected randomly from the general population. OBJECTIVES: To estimate the association between level of cigarette smoking and the prevalence and severity of back pain. METHODS: A postal questionnaire was used to elicit information on smoking histories, a variety of indices of low back pain, and potential confounding factors. The association between smoking and back pain was estimated separately for men and women in the cohort and in the comparison group using ordinal regression models. RESULTS: The questionnaire was completed by 1287 women and 184 men who had adolescent idiopathic scoliosis and by 1130 women and 621 men in the comparison population who did not have scoliosis. Statistically significant associations between back pain and current cigarette smoking were found in the two groups of women and men with scoliosis, but not among men selected from the general population. In the three former groups, proportional odds ratios comparing current smokers to persons who never smoked ranged from 1.4 to 1.9. Among current smokers, the prevalence of back pain increased with cigarette consumption, and the proportional odds ratios ranged from 1.2 to 1.8 per 10 pack-years (no. of cigarettes smoked per day x no. of years/20). In these three groups, intensity, frequency, and duration of episodes of back pain also were found to increase with smoking consumption. CONCLUSION: The finding that smokers have more frequent episodes of back pain may imply that smoking exacerbates back pain, and the observation that stronger associations between back pain and smoking were found in the scoliosis cohort suggests that smoking may have a greater impact on persons with damaged spines.     

Management of chronic disabling low back pain with 360 degrees fusion. Results from pain provocation test and concurrent posterior lumbar interbody fusion, posterolateral fusion, and pedicle screw instrumentation in patients with chronic disabling low back pain.

STUDY DESIGN: A follow-up study conducted by an independent observer was performed on the authors' first 29 consecutive patients treated with concurrent posterior lumbar interbody fusion, posterolateral fusion, and pedicle screw instrumentation, for whom at least 2 years had transpired since the operation. OBJECTIVE: To evaluate the results of concurrent instrumented posterior lumbar interbody fusion and posterolateral fusion used to manage chronic disabling low back pain. SUMMARY OF BACKGROUND DATA: Patients chosen for surgery all had a history of chronic disabling low back pain exceeding 2 years and a sick leave period in excess of 6 months (average, 3.4 years). METHODS: From 1989 to 1993, 29 consecutive patients were surgically treated with fusion. The level of fusion was chosen depending on radiologic changes and results from a intradiscal injection provocation test. Bone union was verified by computed tomography scan with 1-mm-thin slices and sagittal reformation, and by a "second look" in all but three patients. All patients were evaluated subsequently by an independent observer in November 1995, 4.7 years after surgery on the average. RESULTS: Bone fusion was obtained in 27 of the 29 patients (93%). There was a highly significant reduction in back and leg pain measurements. Of the 29 patients, the results were excellent in 9 patients (31%), good in 6 patients (21%), fair in 6 patients (21%), and poor in 8 patients (27%). A total of 18 patients (62%) had returned to work. CONCLUSION: The authors consider posterior lumbar interbody fusion with concurrent posterolateral fusion and pedicle screw instrumentation a possible method for managing chronic disabling low back pain.     

The treatment of chronic back pain

Structures innervated by the dorsal primary ramus play a significant part in the genesis of chronic backache and associated leg pain. The features of this syndrome are described and compared with those in the more familiar clinical picture following intervertebral disc degeneration. However these clinical entities are seldom entirely separate and the diagnosis is often also complicated by psychosomatic factors and the consequences of previous back surgery. A technique of percutaneous facet denervation with a radiofrequency probe, although by no means successful in every case, is entirely safe and a very wothwhile procedure. It has helped many patients, who would otherwise have been disabled by pain and restricted in their activities.     

The association between isoinertial trunk muscle performance and low back pain in male adolescents

The literature reports inconsistent findings regarding the association between low back pain (LBP) and trunk muscle function, in both adults and children. The strength of the relationship appears to be influenced by how LBP is qualified and the means by which muscle function is measured. The aim of this study was to examine the association between isoinertial trunk muscle performance and consequential (non-trivial) low back pain (LBP) in male adolescents. Healthy male adolescents underwent anthropometric measurements, clinical evaluation, and tests of trunk range of motion (ROM), maximum isometric strength (STRENGTH) and peak movement velocity (VEL), using an isoinertial device. They provided information about their regular sporting activities, history and family history of LBP. Predictors of “relevant/consequential LBP” were examined using multivariable logistic regression. LBP status was reassessed after 2 years and the change from baseline was categorised. At baseline, 33/95 (35%) subjects reported having experienced consequential LBP. BMI, a family history of LBP, and regularly playing sport were each significantly associated with a history of consequential LBP (p < 0.05). 85/95 (89%) boys participated in the follow-up: 51 (60%) reported no LBP at either baseline or follow-up (never LBP); 5 (6%) no LBP at baseline, but LBP at follow-up (new LBP); 19 (22%) LBP at baseline, but none at follow-up; and 10 (12%) LBP at both time-points (recurrent/persistent LBP). The only distinguishing features of group membership in these small groups were: fewer sport-active in the “never LBP” group); worse trunk mobility, in the “persistent LBP” group, lower baseline sagittal ROM in the “never LBP” and “new LBP” (p < 0.05). Regular involvement in sport was a consistent predictor of LBP. Isoinertial trunk performance was not associated with LBP in adolescents.     

The association between pro-inflammatory biomarkers and nonspecific low back pain: a systematic review

BACKGROUND CONTEXT

About 85% of the patients with low back pain seeking medical care have nonspecific low back pain (NsLBP), implying that no definitive cause can be identified. Nonspecific low back pain is defined as low back pain and disability which cannot be linked to an underlying pathology, such as cancer, spinal osteomyelitis, fracture, spinal stenosis, cauda equine, ankylosing spondylitis, and visceral-referred pain. Many pain conditions are linked with elevated serum levels of pro-inflammatory biomarkers. Outcomes of interest are NsLBP and the level of pro-inflammatory biomarkers.

Recurrent disabling work-related spinal disorders after prior injury claims in a chronic low back pain population.

BACKGROUND CONTEXT: Multiple compensation injury claims are an understudied phenomenon in the chronic back pain and occupational injury literature. Assumptions about poor treatment outcomes for patients presenting with prior injury can lead to denial of treatment, even though these assumptions have not been empirically addressed. Functional restoration has been demonstrated to be an effective rehabilitation treatment for disabling, work-related chronic back pain, although its' relative utility with recurrent injury (RI) patients has not been previously evaluated. PURPOSE: To assess demographic, psychosocial and work history/adjustment differences between the two groups, and to investigate whether patients with recurrent work-related spinal injury claims benefit from functional restoration treatment at a level equivalent to patients with nonrecurrent injuries. STUDY DESIGN/SETTING: A prospective cohort design assessing characteristics and outcomes of patients with recurrent work-related spinal disorders, compared with a group of patients without prior work-related spine injury claims, all treated with the same interdisciplinary rehabilitation protocol. PATIENT SAMPLE: A cohort of consecutively treated functional restoration rehabilitation patients (n=395) divided into two groups based on a history of prior work-related injury. The RI (n=172) group had at least one prior work-related injury claim (with or without lost time), whereas the nonrecurrent injury (NRI; n=223) group did not. OUTCOME MEASURES: The RI and NRI groups were assessed for prospectively collected demographic, psychosocial and work history/adjustment data. A structured clinical interview addressing socioeconomic outcomes and assessing work return, health utilization, recurrent injury and case closure was administered 1 year after discharge from the treatment program. METHODS: Consecutive patients from a regional referral center for tertiary rehabilitation treatment of chronic work-related musculoskeletal injuries were evaluated with a comprehensive biopsychosocial assessment protocol at pretreatment and posttreatment. Moreover, at 1 year after completing the program, a structural telephone interview was conducted that assessed health and socioeconomic outcomes. RESULTS: For the 1-year socioeconomic outcomes (such as posttreatment injury), the RI patients responded to rehabilitation at a level equivalent to the NRI patients. Demographic analyses revealed that RI patients, relative to NRI patients, were older, more represented by the dominant culture, had more education, had a shorter length of disability, had less severe types of injuries, had a greater rate of non-work-related health conditions, received higher disability payments, and had slightly greater job demand. The RI group also had a greater rate of pre-injury Axis I psychiatric disorders, particularly substance abuse/dependence disorders, than the NRI group. In addition, the RI group had greater job stability than the NRI group. CONCLUSIONS: The results of this study indicate that, although patients with recurrent injuries evidence differences in demographic, psychosocial and work history/adjustment differences when compared with patients with nonrecurrent injuries, their 1-year outcomes after tertiary, medically directed rehabilitation are identical. Both groups demonstrate very low rates of further work-related injuries through the first posttreatment year. Patients with recurrent injuries appear to develop skills in dealing with the workers' compensation system with a familiarity not seen in NRI patients. Of course, these results will need to be replicated in other settings to determine whether they can be generalized to the entire workers' compensation population.     

The association between physical activity and neck and low back pain: a systematic review

The effect of physical activity on neck and low back pain is still controversial. No systematic review has been conducted on the association between daily physical activity and neck and low back pain. The objective of this study was to evaluate the association between physical activity and the incidence/prevalence of neck and low back pain. Publications were systematically searched from 1980 to June 2009 in several databases. The following key words were used: neck pain, back pain, physical activity, leisure time activity, daily activity, everyday activity, lifestyle activity, sedentary, and physical inactivity. A hand search of relevant journals was also carried out. Relevant studies were retrieved and assessed for methodological quality by two independent reviewers. The strength of the evidence was based on methodological quality and consistency of the results. Seventeen studies were included in this review, of which 13 were rated as high-quality studies. Of high-quality studies, there was limited evidence for no association between physical activity and neck pain in workers and strong evidence for no association in school children. Conflicting evidence was found for the association between physical activity and low back pain in both general population and school children. Literature with respect to the effect of physical activity on neck and low back pain was too heterogeneous and more research is needed before any final conclusion can be reached.     

老年慢性疼痛患者疼痛接受度对生活质量的影响

目的探讨老年患者慢性疼痛接受度对其生活质量的影响。方法采用McGill疼痛问卷、中文版简易慢性疼痛接受问卷及简明生活质量量表,对太原市3所三甲医院就诊的235例老年慢性疼痛患者进行调查。结果老年慢性疼痛患者McGill疼痛得分(61.89±22.55)分,慢性疼痛接受得分为(23.79±5.23)分,活动参与得分高于疼痛意愿;生活质量得分为(57.01±15.41)分;疼痛接受与生活质量呈正相关(P0.01),且是生活质量的预测因素。结论疼痛接受程度越高,老年慢性疼痛患者的生活质量越好。医护人员应根据疼痛接受中活动参与的益处,制定促进老年慢性疼痛患者参与活动的诊疗计划,以促进老年患者生活质量的提高。     

白三烯与疼痛的研究进展

背景 白三烯是一类具有多种生物学功能的炎性脂类分子,在哮喘、炎症性肠病等多种与炎症反应相关的疾病中起到重要作用.近些年研究表明,白三烯存在于致痛性炎症反应产物内,促进痛觉的产生. 目的 文章通过总结国内外对白三烯与疼痛关系的研究,认为白三烯是疼痛发生和发展中必不可少的炎症因子. 内容 文章从白三烯的结构及生物学功能入手,从炎症因子、离子通道、胶质细胞3个方面分析了白三烯参与炎性疼痛、神经病理性疼痛等多种疼痛的发生与发展.趋向随着人们对白三烯研究的日益深入,白三烯将成为疼痛治疗的一个新型的靶点.