Responder analyses in randomised controlled trials for chronic low back pain: an overview of currently used methods

Purpose

To provide an overview and a critical appraisal of the use of responder analyses in published randomised controlled trials (RCTs) of interventions for chronic low back pain (LBP). The methodology used for the analyses, including the justification, as well as the implications of responder analyses on the conclusions was explored.

Methods

A convenience sample of four systematic reviews evaluating 162 RCTs of interventions for chronic LBP was used to identify individual trials. Randomised trials were screened by two reviewers and included if they performed and reported a responder analysis (i.e. the proportion of participants achieving a pre-defined level of improvement). The cutoff value for responders, the period of follow-up, and the outcome measure used were extracted. Information on how RCT authors justified the methodology of their responder analyses was also appraised.

Results

Twenty-eight articles (17 %) using 20 different definitions of responders were included in this appraisal. Justification for the definition of responders was absent in 80 % of the articles. Pain was the most frequently used domain for the definition of response (50 %), followed by back-specific function (30 %) and a combination of pain and function (20 %). A reduction in pain intensity ≥50 % was the most common threshold used to define responders (IQR 33–60 %).

Conclusions

Few RCTs of interventions for chronic LBP report responder analyses. Where responder analyses are used, the methods are inconsistent. When performing responder analyses authors are encouraged to follow the recommended guidelines, using empirically derived cutoffs, and present results alongside mean differences.     

The Prolo Scale: history, evolution and psychometric properties

Background

The Prolo Scale (PS) is a widely accepted assessment tool for lumbar spinal surgery results. Nevertheless, in the literature there is a dearth of consensus about its application, interpretation and accuracy. The purpose of this review is to investigate the evolution of the PS from its introduction in 1986 to the present, including an analysis of different versions of the scale and research on the existing studies investigating its psychometric properties.

Materials and methods

PubMed, Cochrane Library and PEDro databases were searched. Studies in English, Italian, French, Spanish and German published from 1986 to December 2012 were analyzed.

Results

The original lumbar surgery outcome scale consisted of two Likert-type scales (economic and functional). There are three more versions of the scale: Schnee proposed one consisting of 10 items, Brantigan made one with 20 items and introduced 2 more subscales (pain and medication), and Davis adapted the scale for the cervical spine. PS is often mentioned without any specific reference to the version used; therefore, a homogeneous comparison of studies is difficult to achieve. Several authors agree on the need to embrace a multidimensional measuring system to evaluate low back pain (LBP), but there is still no consensus regarding the most reliable tool. To date, PS has been mostly used as secondary outcome measure in association with validated primary measures for LBP.

Conclusions

The Prolo Scale has been adopted for clinical examination for 20 years because it is easy to administer and useful to compare significant amounts of data from surgical studies carried out at different times. Although several authors demonstrated the scale sensitivity among a battery of tests, no thorough validation study was found in the current literature.     

Knowledge on health and back care education related to physical activity and exercise in adolescents

Purpose

The aim of this study was to analyze the relationship between the specific level of knowledge on health and back care-related physical activity practice and exercise with low back pain (LBP) in adolescents.

Methods

This is a cross-sectional study. The sample consisted of a total of 576 adolescents aged 13–18 years (mean age 15.5, SD 1.4). Self-reported questionnaires were used to record specific knowledge on health and back care and LBP in healthy adolescents.

Results

The prevalence of LBP was 46.3 % [95 % confidence interval (CI) 44.9–47.8]. Students with LBP scored slightly higher than non-sufferers, getting non-significant values. The level of specific knowledge increased with age (F = 7.308; p = 0.002). Stepwise logistic regression analysis showed that older girls group (>16 years old) was significantly associated with LBP odds ratio (OR) 2.9 (95 % CI 1.77–4.74; p = 0.000).

Conclusions

High school students have a low level of specific knowledge. Back care education in the school curriculum is recommended.

     

Surgery versus conservative care for neck pain: a systematic review

Objective

General practitioners refer patients with continued neck pain that do not respond well to conservative care frequently to secondary care for further assessment. Are surgical interventions to the cervical spine effective when compared to conservative care for patients with neck pain?

Design

Systematic review.

Method

The search strategy outlined by the Cochrane Back Review Group (CBRG) was followed. The primary search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to June 2011. Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of adults with neck pain, which evaluated at least one clinically relevant primary outcome measure (e.g. pain, functional status, recovery), were included. In addition, treatments had to include surgery and conservative care. Two authors independently assessed risk of bias using the criteria recommended by the CBRG and extracted the data. The quality of the evidence was rated using the GRADE method.

Results

Patients included had neck pain with or without radiculopathy or myelopathy. In total, three RCTs and six CCTs were identified comparing different surgical interventions with conservative care, of which one had a low risk of bias. Overall there is very low quality of evidence available on the effectiveness of surgery compared to conservative care in neck pain patients showing overall no differences.

Conclusion

Most studies on surgical techniques comparing these to conservative care showed a high risk of bias. The benefit of surgery over conservative care is not clearly demonstrated.     

Kindliche Ureterabgangsstenose in einem Zuweisungszentrum

Background

Ureteropelvic junction obstruction is the most frequent malformation of the upper urinary tract and treatment with conservative or operative management remains controversial. In this study we present the retrospective analysis of 129 children with ureteropelvic junction obstruction who underwent conservative or operative management.

Material and methods

A total of 129 children with ureteropelvic junction obstruction, who were treated in the department of pediatric nephrology at the University of Essen from 1998–2005, were included into the analysis. Clinical charts were reviewed for the parameters urinary tract infections (total number, severity, bacteriology), antibiotics, ultrasound, Tc-99 diuresis renography, and management (conservative or operative). Statistical analysis was performed using the SPSS software (Version 11.0)

Results

A total of 89 urinary tract infections was observed in 52 children. The mean width of renal pelvis was 3.04±1.33 cm in the operative group and 1.98±1.2 cm in the conservative group (p=0.001, ANOVA test). Tc-99 diuresis renography was performed in 70 children of which 46 children received primarily conservative management and 24 children were operated. In the conservative group 6 children underwent pyeloplasty later on due to aggravation of renal function. In 59 out of 129 cases diuresis nephrography was not performed due to only mild ectasia.

Conclusions

This study demonstrates that conservative management is safe in children with ureteropelvic junction obstruction with no or only little constricted renal function, if a close-meshed surveillance protocol is followed and parental compliance is given.     

Improvement in low back pain following spinal decompression: observational study of 119 patients

Study design

Prospective clinical observational study of low back pain (LBP) in patients undergoing laminectomy or laminotomy surgery for lumbar spinal stenosis (LSS).

Objectives

To quantify any change in LBP following laminectomy or laminotomy spinal decompression surgery.

Patients and methods

119 patients with LSS completed Oswestry Disability Index questionnaire (ODI) and Visual Analogue Scale for back and leg pain, preoperatively, 6 weeks and 1 year postoperatively.

Results

There was significant (p < 0.0001) reduction in mean LBP from a baseline of 5.14/10 to 3.03/10 at 6 weeks. Similar results were seen at 1 year where mean LBP score was 3.07/10. There was a significant (p < 0.0001) reduction in the mean ODI at 6 weeks and 1 year postoperatively. Mean ODI fell from 44.82 to 25.13 at 6 weeks and 28.39 at 1 year.

Conclusion

The aim of surgery in patients with LSS is to improve the resulting symptoms that include radicular leg pain and claudication. This observational study reports statistically significant improvement of LBP after LSS surgery. This provides frequency distribution data, which can be used to inform prospective patients of the expected outcomes of such surgery.     

A longitudinal study for incidence of low back pain and radiological changes of lumbar spine in asymptomatic Japanese military young adults

Introduction

The relation between radiological abnormalities on lumbar spine and low back pain (LBP) has been debated, presumably because of potential biases related to heterogeneity in selection of the subjects, radiological abnormalities at entry, or its cross-sectional observation in nature. Therefore, the aim of this study of a selected population of asymptomatic Japanese Self Defense Forces (JSDF) young adults male with normal lumbar radiographs was to investigate the incidence of newly developed lumbar degenerative changes at middle age and to study their association to LBP.

Subjects and methods

In 1990, 84 JSDF male military servicemen aged 18 years, without a history of LBP and radiological abnormal findings, were enrolled. After 20 years, 84 subjects were underwent repeated X-ray and completed questionnaires on current LBP and lifestyle factors.

Results

The prevalence of LBP was demonstrated 59 %, with 85 % of them showing mild pain. Analysis of lumbar radiographs revealed that 48 % had normal findings and 52 % had degenerative changes. The association between LBP and life style factors was not demonstrated. Lumbar spine in subjects with LBP was more degenerated than in those without. Although disc space narrowing and LBP did not achieve a statistical significance, a significant correlation existed between vertebral osteophyte and LBP in univariate and multivariate analysis (OR 3.0; 95 % CI 1.227–7.333).

Discussion and conclusions

This longitudinal study demonstrated the significant association between vertebral osteophyte and incidence of mild LBP in initially asymptomatic and radiologically normal subjects. These data provide the additional information concerning the pathology of LBP, but further study is needed to clarify the clinical relevance.     

Cystatin C-based equation for estimating glomerular filtration rate in Japanese children and adolescents

Background

Renal inulin clearance is the gold standard for evaluation of kidney function, but is compromised by problems of collecting urine samples in children, especially those <6 years or with a bladder dysfunction. Therefore, we should utilize the serum cystatin C (cysC)-based estimated glomerular filtration rate (eGFR) for measuring serum cysC. The purpose of the present study is to determine the applicability of the new serum cysC-based eGFR in Japanese children and adolescents, including infants with chronic kidney disease (CKD), for evaluation of renal function.

Methods

Inulin clearance and standardized serum cysC level determined by the colloidal gold immunoassay were measured in 135 pediatric CKD patients between the ages of 1 month and 18 years with no underlying disease that affects renal function except CKD, to determine serum cysC-based eGFR in Japanese children and adolescents.

Results

We showed the inulin clearance by expression of 1/serum cysC in pediatric CKD patients, which resulted in the equation: inulin GFR (mL/min/1.73 m²) = 104.1 × 1/serum cysC (mg/L) ? 7.80. We also validated the cysC-based eGFR formula for Japanese adults. eGFR values obtained with the adult formula significantly underestimated GFR by approximately 8 % in children with CKD.

Conclusion

We determined the new cysC-based eGFR formula is useful for clinical screening of renal function in Japanese children and adolescents, including infants.     

Influence of seasonal variation on blood pressure measurements in children, adolescents and young adults

Background

Seasonal fluctuations in outdoor temperature have been shown to affect blood pressure in adults. The aim of our study was to determine whether blood pressure measurements in children and adolescents in Central Europe undergo seasonal variation or are influenced by outdoor temperature.

Methods

The blood pressure of 6,714 subjects (3,497 boys, 3,237 girls) aged 3 to 21 (median age 10.6) years was routinely measured. The study cohort comprised both healthy and sick children and adolescents visiting outpatient clinics and during hospitalisation.

Results

Cross-sectional analysis showed a significant seasonal variation in blood pressure measurements. The mean increase of systolic/diastolic blood pressure was 4.45/2.42 mmHg during the winter. A significant correlation between average outdoor temperature and systolic blood pressure was found (ρ?=??0.074 p?<?0.001). However, the effect was only detectable at an average temperature below 0 °C/32 °F and above 10 °C/50 °F. For each 1 °C increase in average outdoor temperature, the systolic blood pressure fell by 0.12 mmHg.

Conclusions

Blood pressure measurements in children and adolescents, even in a temperate climate, are influenced by temperature and subject to seasonal variation. Considering seasonal variations in blood pressure could be of clinical interest.     

A prospective,cluster-randomized controlled trial of exercise program to prevent low back pain in office workers

Purpose

The objective of this study was to evaluate the effects of an exercise program focusing on muscle stretching and endurance training on the 12-month incidence of low back pain (LBP) in office workers.

Methods

A 12-month prospective cluster-randomized controlled trial was conducted in healthy office workers with lower-than-normal trunk extension flexibility or trunk muscle endurance. Healthy office workers (n = 563) were randomly assigned at the cluster level into either intervention (n = 282) or control (n = 281) groups. Participants in the intervention group received an exercise program that included daily stretching exercise and twice-a-week muscle endurance training. Those in the control group received no intervention. The 12-month incidence of LBP was the primary outcome. Secondary outcome were pain intensity, disability level, and quality of life and health status. Analyses were performed using the Cox proportional hazard models.

Results

Over the 12-month follow-up, 8.8 % of participants in the intervention group and 19.7 % in the control group developed incidence of LBP. Hazard rate ratios showed a protective effect of the exercise program for LBP (HR = 0.37, 95 % CI 0.22–0.64) after adjusting for biopsychosocial factors. There was no significant difference in pain intensity, disability, and quality of life and health status between those who reported incidence of LBP in the intervention and control groups.

Conclusion

An exercise program consisting of muscle stretching and endurance training is an effective intervention to reduce incident LBP for office workers with lower-than-normal trunk extension flexibility or trunk muscle endurance.     

Can decompression surgery relieve low back pain in patients with lumbar spinal stenosis combined with degenerative lumbar scoliosis?

Introduction

Decompression with fusion is usually recommended in patients with lumbar spinal stenosis (LSS) combined with degenerative lumbar scoliosis (DLS). However, elderly patients with LSS and DLS often have other comorbidities, and surgical treatment must be both safe and effective. The aim of this study was to investigate whether decompression surgery alone alleviates low back pain (LBP) in patients with LSS and DLS, and to identify the predictors of postoperative residual LBP.

Materials and methods

A total of 75 patients (33 males and 42 females) with a mean age of 71.8 years (range 53–86 years) who underwent decompression surgery for LSS with DLS (Cobb angle ≥ 10°) and had a minimum follow-up period of 1 year, were retrospectively reviewed using the Japanese Orthopaedic Association scoring system for the assessment of lumbar spinal diseases (JOA score). Radiographic measurements included coronal and sagittal Cobb angles, apical vertebral rotation (Nash-Moe method), and anteroposterior and lateral spondylolisthesis. Logistic regression analysis was performed to investigate the predictors of residual LBP after surgery.

Results

Forty-nine patients had preoperative LBP, of which 29 (59.1 %) experienced postoperative relief of LBP. Logistic regression analysis demonstrated that the degree of apical vertebral rotation on preoperative radiography was significantly associated with postoperative residual LBP (odds ratio, 8.16, 95 % confidence interval, 1.55–83.81, p = 0.011).

Conclusion

A higher degree of apical vertebral rotation may therefore be an indicator of mechanical LBP in patients with LSS and DLS. Decompression with fusion should be recommended in these patients.     

Prevalence of low back pain among health sciences students

Aim

To determine the prevalence of low back pain (LBP) among health sciences students and to identify the associated factors.

Methods

Cross-sectional study was conducted among 1163 students from five health sciences colleges during the academic year 2016–2017. Self-administered questionnaire was conducted and included 4 sections: demographic characteristics, risk factors, Nordic musculoskeletal questionnaire and Oswestry disability questionnaire. Data were analyzed using SPSS.

Results

Mean age was 20.74 ± (1.59 years). 70.9% of students were female. Lifetime prevalence of LBP was 56.6%, 12-month prevalence 48.8%, and point prevalence 21.2%. Dentistry students had highest lifetime prevalence of LBP (67.6%) with significant p value (<0.001). Male were found to have higher lifetime prevalence compared to female (p ≤ 0.001). Spending more than 10 h on computer or tablet was significantly associated with LBP (OR 2.19; 95% CI 1.30–3.70; p = 0.003). Feeling discomfort on bed was associated with LBP (OR 1.81; 95% CI 1.38–2.38; p ≤ 0.001). Uncomfortable college furniture was associated with LBP (OR 1.40; 95% CI 1.09–1.79; p = 0.008). Using heavy backpack was found to be associated with LBP (OR 1.49; 95% CI 1.01–2.03; p = 0.011). Most of students LBP (90.3%) found to cause minimal disability on Oswestry scale.

Conclusion

This study has shown high prevalence of LBP among future healthcare provider. These risk factors should be well established to minimize the prevalence of LBP among future health sciences students. Dentistry students at higher risk of developing LBP compared to other students.

     

Blood pressure tracking in children and adolescents

Background

High blood pressure is a major risk factor for cardiovascular disease. Blood pressure tracking could help to identify individuals with potential hypertension. Therefore, we have asked whether or not tracking was of predictive value for the development of hypertension in early life.

Methods

Blood pressure was routinely measured in 13,261 children and adolescents in outpatient clinics as well as during hospitalization. In one analysis, 568 individuals with elevated and normotensive blood pressure values were evaluated after 2, 4, and 6 years of follow-up. In a second analysis, 2,157 individuals with normotensive blood pressure were examined in a paired t test.

Results

The follow-up analysis showed a significant tracking effect. However, the Pearson correlation coefficients of the systolic and diastolic blood pressure standard deviation scores (SDS) decreased over time. Upon the follow-up after 6 years, 35.6 % of the children and adolescents with elevated blood pressure values remained in the elevated range group. Of the children within the normotensive blood pressure range, 80.4 % remained normotensive after 6 years. Children with normotensive blood pressure showed a stronger tracking than those who had had one hypertensive blood pressure reading. Children with higher body mass index (BMI) at follow-up changed blood pressure SDS track from initially normal to higher blood pressure values.

Conclusions

Blood pressure tracking in children and adolescents is moderate. We conclude that the predictive power of a single hypertensive blood pressure measurement during a single visit is rather small, and thus repetitive measurements across several consecutive visits are necessary.     

The prevalence and severity of low back pain and associated symptoms in 3,009 old men

Purpose

The aim of this study is to evaluate the prevalence and severity of low back pain (LBP) and the influence of sciatica and neurological deficits in old men.

Material and method

Mister osteoporosis Sweden includes 3,014 community-dwelling men aged 69–81 years. At study start 3,009 participants answered questions on LBP, low back pain and sciatica (LBP + SCI) or low back pain and sciatica with associated neurological deficits (LBP + SCI + NEU) during the preceding 12 months. Data are presented as proportions or medians with mid-quartile ranges. Differences between groups were tested by χ² test and Kruskall-Wallis test.

Results

24 % had experienced LBP without SCI, 8 % LBP + SCI and 14 % LBP + SCI + NEU. 10 % of the men with LBP, 22 % of those with LBP + SCI, and 36 % of those with LBP + SCI + NEU rated the pain as severe (p < 0.001). 23 % of the men with LBP, 31 % of those with LBP + SCI and 50 % of those with LBP + SCI + NEU reported limitation in activity of daily living (ADL) (p < 0.001). Men with only LBP had to restrict their activities for 7 days (3–14), those with LBP + SCI 6 days (2–14) and those with LBP + SCI + NEU 10 days (3–30) (p < 0.05).

Conclusions

The 1-year prevalence of LBP in community living men aged 69–81 years was close to 50 % but for individuals with LBP or LBP + SCI the morbidity was low with more than two-thirds having no limitations in ADL. In men with LBP + SCI + NEU more than one-third rated the pain as severe and close to half had limitations in ADL.     

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.     

Prevalence of the human papillomavirus (HPV) expression of the inner prepuce in asymptomatic boys and men

Objective

To investigate the prevalence of high-risk (HR) and low-risk (LR) human papillomavirus (HPV) in prepuces of boys and men without any HPV related lesions.

Patients and methods

Between 2009 and 2011, a total collective of 250 boys and men were investigated in this prospective study. The samples were subdivided into 3 groups regarding their age, consisting of 125 (50 %) children (0–10 years), 38 (15.2 %) adolescents (11–20 years) and 87 (34.8 %) adults (>20 years). In situ hybridization (ISH) was performed to detect HR and LR virus types within the epithelium, followed by microscopic interpretation and determination between episomal and integrative signal pattern.

Results

Our results revealed high levels of HPV concentration (HR and LR) in all age groups: HR versus LR positivity was seen in 45.5 versus 35 % (children), 60.6 versus 63.6 % (adolescents) and 58.3 versus 48.6 % (adults). The topmost rate of HR (59.8 %)- and LR (50.6 %)-positive probes was found in the group with high estimated sexual activity (>14 years).

Conclusion

Concerning the high prevalence of male HPV infection even in children, indicating non-sexual transmission pathways, inclusion of boys in the vaccination program seems to be required reducing their burden of HPV related disease.     

Lipopolysaccharide-binding protein: a potential marker of febrile urinary tract infection in childhood

Background

Urinary tract infections (UTIs) are encountered frequently in children, and their early diagnosis and treatment are important. This study evaluates the diagnostic value of serum concentrations of lipopolysaccharide-binding protein (LBP), an acute-phase protein, in children with febrile UTI and compares it to those of the total white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6).

Methods

The study population comprised 77 consecutive patients with a first-episode febrile UTI (33 boys) with a median age of 11 months [interquartile range (IQR), 5.5–33 months], 21 healthy controls (11 boys) with a median age of 10 months (IQR, 5–20.5 months) and 58 febrile controls with a fever due to other causes (28 boys) with a median age of 12.5 months (IQR, 7–30 months). LBP, IL-6, PCT, and CRP were measured for both patients and control groups.

Results

The serum levels of LBP (p? < ?0.001), CRP (p? < ?0.001), PCT (p? = ?0.001), IL-6 (p? = ?0.002), ESR (p? = ?0.020), and WBC (p? < ?0.001) were higher in patients with febrile UTI than in the healthy and febrile control groups. The LPB cut-off value for best sensitivity and specificity in patients with febrile UTI was >43.23 mg/l. Furthermore, the area under the receiver operating characteristic curve was significantly greater for LBP than for CRP (p? = ?0.014), PCT (p? < ?0.001), ESR (p? < ?0.001), WBC (p? = ?0.002) and IL-6 (p? = ?0.006).

Conclusions

The results of this study suggest that the serum LBP concentration constitutes a reliable biologic marker for the diagnosis of a febrile UTI in children.     

Effect of depression and neuropathic pain using questionnaires on quality of life in patients with low back pain; cross-sectional retrospective study

Purpose

The present study investigated the percentage of low back pain (LBP) patients who have depressive symptoms and neuropathic pain and analyzed the effects of these on the quality of life (QOL) in these patients.

Methods

Of the 650 new patients with LBP that visited the hospital between June 2012 and December 2013, 309 patients who completed questionnaires to assess LBP and QOL were included in the study. The questionnaire included demographic items, the self-rated depression scale (SDS)-Zung, the Japanese version of the PainDETECT questionnaire (PDQ-J), numerical pain rating scale (NRS), and QOL assessments. The patients were divided into two groups according to their SDS-Zung scores: a nondepressed group with SDS scores <40 and a depressed group with SDS-Zung scores ≥50.

Results

One hundred twenty-five patients (40.5 %) were classified as nondepressed and 63 (20.4 %) as depressed. The mean PDQ-J score was higher in depressed patients than in nondepressed patients. The frequency of neuropathic pain was greater in depressed patients, with neuropathic pain observed in 17 of the 63 (27 %) depressed LBP patients and 11 of the 125 (9 %) nondepressed LBP patients. The SDS-Zung and PDQ-J scores of LBP patients were correlated significantly (r = 0.261, p < 0.001). Depressed patients had higher pain NRS scores and lower QOL scores compared with nondepressed patients.

Conclusions

Both the depressed patients and those with neuropathic LBP had a higher level of pain, greater pain-related disability, and poorer QOL compared with nondepressed patients. This is the first study to use the SDS-Zung and PDQ-J screening questionnaires to estimate the presence of neuropathic pain associated with depressive symptoms in LBP patients and to evaluate the impact of these on QOL.

     

No kidding: low back pain and type of container influence adolescents’ perception of load heaviness

Purpose

The relationship between low back pain (LBP) and the lifting/carrying of loads is still a matter of great discussion. In teenagers, the weight of the school bag has been considered to play a pathogenic role in LBP but the relationship between the actual weight of the school bag and LBP symptoms does not seem to be a straightforward one. Numerous factors have been identified that influence the perception of weight. This study aimed to evaluate the influence of low back pain and the type of container on the perception of load heaviness by healthy teenagers.

Methods

A convenience sample of 80 healthy teenage males (mean ± SD age 13.9 ± 2.1 years) was recruited from the members of two local sports clubs. The volunteers were evaluated during one of their training sessions. Information about a history of consequential LBP was gathered by questionnaire. Subjects were invited to estimate the weight of three bags (a typical school bag, a sports bag with the logo of a well-known brand, and a neutral bag) containing two different loads (total weights approximately 3 and 5 kg).

Results

Consequential LBP (i.e., LBP requiring medical attention and/or interfering with usual sports activities) was reported by 26.2 % of them. The majority of the LBP episodes occurred ≥3 months before the tests. Overall, teenagers significantly (p ≤ 0.05) underestimated the weight of the sports bag compared with the school bag and the neutral bag. Compared with those with no LBP, subjects with a history of LBP overestimated the weight of the heavier load.

Conclusions

Our results suggest that several subjective variables significantly influence the perception of load heaviness. Until we have a better understanding of the mechanical role of the backpack weight versus the perception of its weight in the aetiology of LBP, any recommendations about the schoolbag weight limit should be viewed with caution.