Mindfulness meditation for the treatment of chronic low back pain in older adults: a randomized controlled pilot study

The objectives of this pilot study were to assess the feasibility of recruitment and adherence to an eight-session mindfulness meditation program for community-dwelling older adults with chronic low back pain (CLBP) and to develop initial estimates of treatment effects. It was designed as a randomized, controlled clinical trial. Participants were 37 community-dwelling older adults aged 65 years and older with CLBP of moderate intensity occurring daily or almost every day. Participants were randomized to an 8-week mindfulness-based meditation program or to a wait-list control group. Baseline, 8-week and 3-month follow-up measures of pain, physical function, and quality of life were assessed. Eighty-nine older adults were screened and 37 found to be eligible and randomized within a 6-month period. The mean age of the sample was 74.9 years, 21/37 (57%) of participants were female and 33/37 (89%) were white. At the end of the intervention 30/37 (81%) participants completed 8-week assessments. Average class attendance of the intervention arm was 6.7 out of 8. They meditated an average of 4.3 days a week and the average minutes per day was 31.6. Compared to the control group, the intervention group displayed significant improvement in the Chronic Pain Acceptance Questionnaire Total Score and Activities Engagement subscale (P=.008, P=.004) and SF-36 Physical Function (P=.03). An 8-week mindfulness-based meditation program is feasible for older adults with CLBP. The program may lead to improvement in pain acceptance and physical function.     

护理人员腰痛相关因素调查

目的 探讨护理人员腰痛及疼痛程度的影响因素.方法 对广州市一家三级甲等医院502名护理人员进行问卷调查.结果 调查对象中过去1年里出现腰痛者307例(61.16％),最近1周有腰痛症状者173例(34.46％).最近1周存在腰痛的调查对象中轻度疼痛者占23.70％,中度及重度疼痛者分别为61.85％和14.45％.已婚者较未婚者的患病率高;所在的工作科别不同,患病率及疼痛程度也不同;工龄越长,疼痛程度越重.结论 护理人员腰痛的患病率与婚姻状况及工作科别有关;疼痛程度与工作科别及工龄有关.     

Usual source of care for adults with and without back pain: medical expenditures panel survey data pooled for years 2000 to 2006

Objectives

The purpose of this study was to explore the extent to which individuals with back pain or other health conditions and individuals with no health problems report having a usual source of care (USC) for their health care needs.

Methods

This study evaluated longitudinal Medical Expenditures Panel Survey data (data pooled for survey calendar years 2000-2006). Comparisons were made between adult Medical Expenditures Panel Survey respondents identified as having a back pain condition (n = 10 194) compared with those without back pain but with other health condition (n = 45 541) and those with no back pain and no other condition (n = 5497).

Results

Compared with individuals with no health problems, those with back pain were almost 8 times more likely (odds ratio, 7.8; P < .001) to report having a USC, and those with other health problems besides back pain were 5 times more likely (odds ratio, 5.4; P < .001). For those with a USC, individuals with back pain and those with other problems but not back pain were both approximately one-and-a-half times more likely than those without any health problems to report a specific provider type as their USC (P < .001).

Conclusion

Study findings suggest that relatively healthy adults without back pain are less likely to have a USC than those with back pain or other health problems.     

Methylsulfonylmethane for treatment of low back pain: A safety analysis of a randomized,controlled trial

ObjectiveTo ensure that 16 weeks of methylsulfonylmethane (MSM) does not cause adverse effects in patients with the musculoskeletal disorders of osteoarthritis and back pain.DesignWe carried out a subgroup analysis on data from a randomized, double-blind, placebo-controlled trial, “The use of Methylsulfonylmethane (MSM) in the treatment of low back pain,” to determine the safety of taking 6 g daily of MSM (OptiMSM®, Bergstrom Nutrition). We monitored metabolic parameters to determine whether MSM altered hematologic, liver or kidney function. We also monitored physiologic parameters of blood pressure and weight.SettingFamily Medicine Residency, Mike O’Callaghan Military Medical Center.Main outcome measuresMetabolic parameters as measured by hematologic function - white blood cells (WBC), platelets, hemoglobin (Hb), glucose; liver function as measured by - total bilirubin, alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Physiologic parameters as measured by weight, diastolic (DBP) and systolic blood pressure (SBP); kidney function as measured by creatinine.ResultsAnalysis of outcome measures showed no significant difference between MSM and placebo (p < 0.05) safety values.ConclusionMSM has no effects on WBC, platelets, Hb, total bilirubin, AST, ALT, creatinine weight, DBP, or SBP in this study.     

Catastrophizing and internal pain control as mediators of outcome in the multidisciplinary treatment of chronic low back pain.

The aim of the present study was to examine (a) whether a cognitive-behavioral treatment (differentially) affects pain coping and cognition; and (b) whether changes in pain coping and cognition during treatment mediate treatment outcome. Participants in this randomized clinical trial were 148 patients with chronic low back pain attending a multidisciplinary treatment program consisting of operant-behavioral treatment plus cognitive coping skills training (N = 59) or group discussion (N = 58) or allocated to a waiting list control condition (N = 31). Patients improved with respect to level of depression, pain behavior and activity tolerance at posttreatment and 12-month follow-up. Treatment also resulted in a short- and long-term decrease in catastrophizing and an enhancement of internal pain control. Changes in catastrophizing and to a lesser degree in internal pain control mediated the reduction in level of depression and pain behavior following treatment. The use of behavioral and cognitive interventions aimed at decreasing catastrophizing thoughts about the consequences of pain and promoting internal expectations of pain control possibly constitute an important avenue of change irrespective of the type of treatment.     

妊娠相关下腰痛预防与管理的最佳证据总结

目的检索并获取妊娠相关下腰痛预防及管理的相关证据,为临床提供参考。方法系统检索相关网站、数据库关于妊娠相关下腰痛预防及管理的所有证据,包括指南、最佳临床实践信息册、证据总结、系统评价及专家共识等,检索时限为建库至2020年9月。由2名研究员独立对文献进行质量评价并通过专家论证会对证据推荐级别进行评定。结果共纳入20篇文献,包括1篇临床决策、2篇指南、12篇系统评价及5篇随机对照试验,总结出27条关于妊娠相关下腰痛预防与管理的最佳证据,包括评估与诊断、日常生活管理、多学科管理、药物管理与非药物管理5个方面。结论该研究总结、形成了多学科合作的妊娠相关下腰痛预防与管理方案,证据转化时应充分结合临床环境、孕妇意愿,有针对性的选择最佳证据,降低妊娠相关下腰痛发生率、减轻疼痛。     

Efficacy of spinal manipulative therapy for low back pain of less than three months' duration

OBJECTIVES: To review the efficacy of spinal manipulation for low back pain of less than 3 months duration.Data sources Randomized clinical trials on spinal manipulative therapy for low back pain were identified by searching EMBASE, CINAHL, MEDLINE, and the Physiotherapy Evidence Database (PEDro).Study selection Outcome measures of interest were pain, return to work, adverse events, disability, quality of life, and patient satisfaction with therapy.Data extraction Methodological assessment of the trials was performed using the PEDro scale. Trials were grouped according to the type of intervention, outcome measures, and follow-up time. Where there were multiple studies with sufficient homogeneity of interventions, subjects, and outcomes, the results were analyzed in a meta-analysis using a random effects model.Data synthesis Thirty-four papers (27 trials) met the inclusion criteria. Three small studies showed spinal manipulative therapy produces better outcomes than placebo therapy or no treatment for nonspecific low back pain of less than 3 months duration. The effects are, however, small. The findings of individual studies suggest that spinal manipulative therapy also seems to be more effective than massage and short wave therapy. It is not clear if spinal manipulative therapy is more effective than exercise, usual physiotherapy, or medical care in the first 4 weeks of treatment. CONCLUSIONS: Spinal manipulative therapy produces slightly better outcomes than placebo therapy, no treatment, massage, and short wave therapy for nonspecific low back pain of less than 3 months duration. Spinal manipulative therapy, exercise, usual physiotherapy, and medical care appear to produce similar outcomes in the first 4 weeks of treatment.     

Acupuncture for low back pain: results of a pilot study for a randomized controlled trial.

OBJECTIVES: To pilot procedures to be used in a randomized controlled trial of acupuncture for low back pain. DESIGN: Uncontrolled clinical trial. SETTING: Primary care and acupuncture clinics in York, England. SUBJECTS: 20 patients with low back pain lasting 1 month or more. INTERVENTIONS: 10 sessions of individualized acupuncture from a traditional acupuncturist. MAIN OUTCOME MEASURES: Change in Oswestry low back pain disability questionnaire; present pain intensity scale; effect on daily living scale, and SF-36 general health questionnaire at post-treatment and 6 months after the end of treatment. RESULTS: 14 patients completed follow-up. Patients had similar severity scores at baseline to those referred to an NHS outpatient clinic. Post-treatment, there were statistically significant improvements in Oswestry, present pain intensity, effect on daily living and the physical functioning, social functioning, bodily pain, vitality and mental health sub-scales of the SF36. Similar results were found at the six month follow-up. Oswestry scores showed reduced levels of pain at 6 months compared to than at post-treatment, falling approximately 40% from baseline. CONCLUSIONS: Though the improvements in pain and quality in life may be due to the natural course of back pain, the promising responses justify further research. The procedures used in the study are appropriate for a randomized controlled trial. Drop-out could be reduced by more careful patient monitoring.     

The influence of a chiropractic manipulation on lumbar kinematics and electromyography during simple and complex tasks: a case study

OBJECTIVE: To investigate whether a more sophisticated and detailed analysis of both simple and complex tasks may yield more information regarding the short-term influence of an adjustment on spine biomechanics. METHODS: The study used a single-subject, before-after design. Three-dimensional spine kinematics and trunk muscle electromyography were assessed during a variety of tasks performed by a professional golfer exhibiting non-specific, chronic, low back pain. The patient received a right-to-left and left-to-right spinous pull adjustment. RESULTS: After the adjustment, changes were seen in all 3 axes of motion during a golf swing, with concomitant muscle responses. In addition, changes in the off axes of motion were seen during simple movement tasks. CONCLUSIONS: A more detailed spine kinematic analysis, specifically analysis of motion in the nonprincipled axes, yielded more information regarding the short-term influence of an adjustment on lumbar spine motion and muscle function.     

Analyzing chronic low back pain: the relative contribution of pain coping strategies

Sixty-two chronic low back pain patients were administered the Coping Strategies Questionnaire (CSQ) to assess the frequency of use and perceived effectiveness of a variety of cognitive and behavioral pain coping strategies. Analysis of individual variables revealed that CSQ factors, gender, physical examination findings, and chronicity of pain had significant effects on one or more of a series of pain, psychological distress or behavioral measures. To assess the relative contribution of each of these variables hierarchical stepwise regression analyses were carried out. These analyses revealed that the Helplessness factor of the CSQ explained 50% of the variance in psychological distress (Global Severity Index of the SCL-90R), and 46% of the variance in depression (Beck Depression Inventory). Patients scoring high on this CSQ factor had significantly higher levels of psychological distress. None of the demographic or medical status variables explained a significant proportion of variance in the psychological distress measures. The Diverting Attention and Praying factor of the CSQ explained a moderate (9%), but significant amount of variance in pain report. Patients scoring high on this factor had higher scores on the McGill Pain Questionnaire. Coping strategies were not strongly related to pain behavior measures such as guarding or uptime. A consideration of pain coping strategies may allow one to design pain coping skills training interventions so as to fit the needs of the individual low back pain patient.     

改进移动患者方法预防ICU护士职业腰背痛发生

目的 探讨改进移动患者方法在预防ICU护士职业腰背痛中的作用.方法 对20名ICU护士进行改进移动患者方法的培训.对参加培训的护士,工作2个月后,进行调查取样,采用自行设计问卷,了解改进移动患者方法在预防ICU护士职业腰背痛中的作用.结果:年铃、累计监护患者总时间、ICU工作年限与护士职业腰背痛的发生呈正相关,而对移动方法掌握程度、文化程度及对职业腰背痛危害性的认识程度与其呈负相关;应用该方法移动患者后,护士腰背痛的发作频率低于培训前,差异有统计学意义(P<0.05).结论:培训和教育ICU护士掌握改进移动患者方法,可提高其预防职业腰背痛的意识,降低护士职业腰背痛的发生率,提高工作效率.     

Aerobic exercise training in addition to conventional physiotherapy for chronic low back pain: a randomized controlled trial

Chan CW, Mok NW, Yeung EW. Aerobic exercise training in addition to conventional physiotherapy for chronic low back pain: a randomized controlled trial.

Objective

To examine the effect of adding aerobic exercise to conventional physiotherapy treatment for patients with chronic low back pain (LBP) in reducing pain and disability.

Design

Randomized controlled trial.

Setting

A physiotherapy outpatient setting in Hong Kong.

Participants

Patients with chronic LBP (N=46) were recruited and randomly assigned to either a control (n=22) or an intervention (n=24) group.

Interventions

An 8-week intervention; both groups received conventional physiotherapy with additional individually tailored aerobic exercise prescribed only to the intervention group.

Main Outcome Measures

Visual analog pain scale, Aberdeen Low Back Pain Disability Scale, and physical fitness measurements were taken at baseline, 8 weeks, and 12 months from the commencement of the intervention. Multivariate analysis of variance was performed to examine between-group differences.

Results

Both groups demonstrated a significant reduction in pain (P<.001) and an improvement in disability (P<.001) at 8 weeks and 12 months; however, no differences were observed between groups. There was no significant difference in LBP relapse at 12 months between the 2 groups (χ²=2.30, P=.13).

Conclusions

The addition of aerobic training to conventional physiotherapy treatment did not enhance either short- or long-term improvement of pain and disability in patients with chronic LBP.     

Material handling performance of patients with chronic low back pain during functional capacity evaluation: a comparison between three countries

Purpose. Functional Capacity Evaluations (FCEs) are batteries of tests designed to measure patients' ability to perform work-related activities. Although FCEs are used worldwide, it is unknown how patients' performances compare between countries or settings. This study was performed to explore similarities and differences in FCE performance of patients with chronic low back pain (CLBP) between three international settings that utilize the same FCE protocol.

Methods. Standardized FCEs were performed on three cohorts of patients with CLBP: A sample from an outpatient rehabilitation context in The Netherlands (n = 121), a Canadian sample in a Worker's Compensation context (n = 273), and a Swiss sample in an inpatient rehabilitation context (n = 170). Patients were undergoing FCE as part of their usual clinical care. Means and standard deviations of maximum performance on the FCE material handling items were calculated and differences compared using ANOVA. Multivariable linear regression was used to determine the relationship between country of origin and FCE performance while controlling for potential confounders including, age, sex, duration of back pain problems, and self-reported pain and disability ratings.

Results. Compared to the Dutch sample, the mean performance of patients in the Canadian and Swiss samples was consistently lower on all FCE items. This association remained statistically significant after controlling for potential confounders.

Conclusions. Considerable differences were observed between settings in maximum weight handled on the various FCE items. Future FCE research should examine the effects of a number of potentially influential factors, including variability in evaluator judgements across settings, the evaluator-patient interaction and patients' expectations of the influence of FCE results on disability compensation.     

Prevalence and risk factors associated with low back pain in Iranian surgeons

Objectives

Low back pain (LBP) is a common and costly occupational injury among health care professionals. The purpose of this study was to investigate the prevalence and risk factors of LBP in surgeons and to analyze how individual and occupational characteristics contribute to the risk of LBP.

Methods

A cross sectional study was conducted on 250 randomly selected surgeons including 112 general surgeons, 95 gynecologists and 43 orthopedists from 21 hospitals at northern Iran. A structured questionnaire including demographic, lifestyle, occupational characteristics as well as prevalence and risk factors of LBP was used. Visual analogue scale and Oswestry low back disability questionnaires were also used to assess the pain intensity and functional disability, respectively.

Results

Point, last month, last six months, last year and lifetime prevalence of LBP was 39.9%, 50.2%, 62.3%, 71.7% and 84.8%, respectively. The highest point prevalence was related to the gynecologists with 44.9%, and the lowest for general surgeons (31.7%). Age, body mass index, smoking, general health, having an assistant, job satisfaction, using preventive strategies and years of practice were found to be correlated with the prevalence of LBP (P < .05 in all instances except for age and job satisfaction). Prolonged standing, repeated movements and awkward postures were the most prevalent aggravating factors (85.2%, 50.2% and 48.4%, respectively). Rest was found to be the most relieving factor (89.5%).

Conclusions

The results of this study demonstrate that the prevalence of LBP amongst surgeons appears to be high and highlights a major health concern. Further large scale studies, including other specialties and health professions such as physical therapy, chiropractic, and general medicine, should be performed.     

Utilization of Low Back Pain Patient Reported Outcome Measures Within Chiropractic Literature: A Descriptive Review

Objective

The purpose of this review was to determine the most commonly reported and utilized low back pain (LBP) Patient Reported Outcome Measures (PROMs) within the chiropractic literature and to investigate their temporal and methodological publication characteristics.

Lumbar manipulation and exercise for the treatment of acute low back pain in adolescents: a randomized controlled trial

Abstract

Objectives:

Low back pain (LBP) is a common condition in adolescents. Although much has been written about the efficacy of lumbar manipulation for adults with LBP, little is known about its effectiveness in adolescents. This study had two primary aims: (1) to assess the efficacy of adding lumbar manipulation to an exercise program in adolescents with acute (<90 days) LBP and (2) to report and assess any adverse reactions associated with lumbar manipulation noted in this study.

Methods:

Patients were randomly assigned to receive lumbar manipulation or sham manipulation. All patients performed 4 weeks of physical therapy exercise. Pain, patient-specific functional scale (PSFS), and global rating of change (GROC) scores were measured at evaluation, 1 week, 4 weeks, and 6 months. Relative risk was calculated for adverse reactions noted.

Results:

We recruited 35 consecutive patients with acute LBP. One patient was excluded after being diagnosed with a spondylolysis, 34 patients remained for analysis. Both groups experienced significant improvement over time in all measures. There were no differences between groups for pain, PSFS, or GROC scores. No increased risk of adverse reaction from lumbar manipulation was noted.

Discussion:

The addition of lumbar manipulation to exercise did not benefit adolescents with acute LBP. There was not an increased risk of an adverse reaction noted in this study from lumbar manipulation performed on adolescents. Further research needs to be done to identify factors that predict positive outcomes following lumbar manipulation in adolescents.     

Lumbar manipulation and exercise for the treatment of acute low back pain in adolescents: a randomized controlled trial

ObjectivesLow back pain (LBP) is a common condition in adolescents. Although much has been written about the efficacy of lumbar manipulation for adults with LBP, little is known about its effectiveness in adolescents. This study had two primary aims: (1) to assess the efficacy of adding lumbar manipulation to an exercise program in adolescents with acute (<90 days) LBP and (2) to report and assess any adverse reactions associated with lumbar manipulation noted in this study.MethodsPatients were randomly assigned to receive lumbar manipulation or sham manipulation. All patients performed 4 weeks of physical therapy exercise. Pain, patient-specific functional scale (PSFS), and global rating of change (GROC) scores were measured at evaluation, 1 week, 4 weeks, and 6 months. Relative risk was calculated for adverse reactions noted.ResultsWe recruited 35 consecutive patients with acute LBP. One patient was excluded after being diagnosed with a spondylolysis, 34 patients remained for analysis. Both groups experienced significant improvement over time in all measures. There were no differences between groups for pain, PSFS, or GROC scores. No increased risk of adverse reaction from lumbar manipulation was noted.DiscussionThe addition of lumbar manipulation to exercise did not benefit adolescents with acute LBP. There was not an increased risk of an adverse reaction noted in this study from lumbar manipulation performed on adolescents. Further research needs to be done to identify factors that predict positive outcomes following lumbar manipulation in adolescents.     

神经肌肉激活技术治疗非特异性下背痛的临床研究

目的探讨神经肌肉激活技术治疗非特异性下背痛的临床疗效。方法 36例非特异性下背痛患者,分为治疗组18例和对照组18例,治疗组使用神经肌肉激活技术进行训练,对照组予以手法治疗。治疗前及治疗后以及4周后对症状及表面肌电进行评定。结果治疗后治疗组症状和肌肉功能的改善结果明显优于对照组(P<0.01)。结论对非特异性下背痛的治疗,神经肌肉激活技术是良好的治疗手段。