Influence of occupational factors on the relation between socioeconomic status and self-reported back pain in a population-based sample of German adults with back pain

STUDY DESIGN: Population-based cross-sectional postal survey and interview substudy. OBJECTIVES: To examine the association between socioeconomic status and severe back pain and to determine whether this association can be explained by occupational factors. SUMMARY OF BACKGROUND DATA: Like other disorders, back pain and its consequences are inversely related to indicators of high socioeconomic status. METHODS: The associations between indicators of socioeconomic status and presence or severity of current back pain (no back pain or back pain of low intensity and low disability versus back pain with high intensity and/or high disability) were investigated in a survey among German adults 25 to 74 years of age (n = 2731) and an interview substudy of 770 participants with a recent history of back pain.- RESULTS: In the survey, educational level was inversely associated with back pain and severe current back pain. Similarly, in the interview substudy, educational level, vocational training, occupational class, household income, and health insurance status were inversely related to severe current back pain. Age-adjusted and gender-adjusted odds ratios were 0.36 (95% confidence interval [CI] 0.25-0.52) for immediate educational level and 0.37 (95% CI 0.18-0.73) for high educational level. Recalled work tasks at the onset of back pain were significant risk factors of severe current back pain (heavy physical work: odds ratio [OR] 1.77, 95% CI 1.06-2.93; work in bent position among males: OR 1.89, 95% CI 1.03-3.46). After adjusting for occupational class or work tasks, the association between educational level and severe current back pain remained unchanged.- CONCLUSIONS: The findings support the hypothesis that severe back pain is less prevalent among adults of higher socioeconomic status. The underlying mechanism could not be explained by differences in self-reported occupational factors.     

Back pain, disability, and radiographic vertebral fracture in European women: a prospective study

Vertebral fractures are associated with back pain and disability. There are, however, few prospective data looking at back pain and disability following identification of radiographic vertebral fracture. The aim of this analysis was to determine the impact of radiographically identified vertebral fracture on the subsequent occurrence of back pain and disability. Women aged 50 years and over were recruited from population registers in 18 European centers for participation in the European Prospective Osteoporosis Study. Participants completed an interviewer-administered questionnaire which included questions about back pain in the past year and various activities of daily living, and they had lateral spine radiographs performed. Participants in these centers were followed prospectively and had repeat spine radiographs performed a mean of 3.7 years later. In addition they completed a questionnaire with the same baseline questions concerning back pain and activities of daily living. The presence of prevalent and incident vertebral fracture was defined using established morphometric criteria. The data were analyzed using logistic regression with back pain or disability (present or absent) at follow-up as the outcome variable with adjustment made for the baseline value of the variable. The study included 2,260 women, mean age 62.2 years. The mean time between baseline and follow-up survey was 5.0 years. Two hundred and forty participants had prevalent fractures at the baseline survey, and 85 developed incident fractures during follow-up. After adjustment for age, center, and the baseline level of disability, compared with those without baseline prevalent fracture, those with a prevalent fracture (odds ratio [OR]=1.4; 95% confidence interval [CI] 1.0 to 2.0) or an incident fracture (OR=1.7; 95% CI, 0.9 to 3.2) were more likely to report disability at follow-up, though the confidence intervals embraced unity. Those with both a prevalent and incident fracture, however, were significantly more likely to report disability at follow-up (OR=3.1; 95% CI, 1.4 to 7.0). After adjustment for age, center, and frequency of back pain at baseline, compared with those without baseline vertebral fracture, those with a prevalent fracture were no more likely to report back pain at follow-up (OR=1.2; 95%CI, 0.8 to 1.7). There was a small increased risk among those with a preexisting fracture who had sustained an incident fracture during follow-up (OR=1.6; 95%CI, 0.6 to 4.1) though the confidence intervals embraced unity. In conclusion, although there was no significant increase in the level of back pain an average of 5 years following identification of radiographic vertebral fracture, women who suffered a further fracture during follow-up experienced substantial levels of disability with impairment in key physical functions of independent living.     

Sex differences in predictors of outcome in selected physical therapy interventions for acute low back pain

STUDY DESIGN: Secondary analysis of pooled data from 3 randomized trials. OBJECTIVE: This study investigated sex differences in response to physical therapy intervention for acute low back pain. BACKGROUND: Sex differences in experimental pain sensitivity have been consistently described in the literature. However, clinical consequences of these sex differences have not been widely reported. METHODS AND MEASURES: Subjects (n=165) were participants in 3 randomized trials of physical therapy interventions from outpatient physical therapy clinics in the general and military communities. Subjects were randomly assigned spinal manipulation with range-of-motion exercise, lumbar stabilization exercise, or directional-preference exercise. Outcomes were measured at 4 weeks through self-report of pain intensity and pain-related disability. Sex differences were investigated with independent t tests (baseline data), 2 x 3 analysis of variance (4-week reductions in pain and pain-related disability), and regression models (predictors of outcome). RESULTS: Men and women had similar reductions of pain intensity (raw mean difference, 0.5; 95% Cl, -1.4 to 0.4) and pain-related disability (raw mean difference, 5.3; 95% CI, -0.1 to 10.7) over 4 weeks. Baseline pain intensity, duration of symptoms, and baseline pain-related disability significantly predicted change in pain intensity for women (r2 = 26%, P < .01). Baseline pain intensity and stabilization exercise predicted change in pain intensity for men (r2 = 33%, P<.01). Baseline pain-related disability, duration of pain, and pain intensity predicted change in disability for women (r2 = 24%, P < .01). Baseline pain-related disability, fear-avoidance beliefs, stabilization exercise, and leg pain predicted change in disability for men (r2 = 32%, P < .01). CONCLUSION: For patients with acute low back pain, men and women had similar physical therapy outcomes for reductions in pain intensity and pain-related disability. However, men and women had different factors that predicted treatment outcome.     

Cross-sectional associations of urogenital pain and sexual function in a community based cohort of older men: olmsted county, Minnesota

PURPOSE: Increasing age has been associated with decreasing male sexual function. We evaluated the association of urogenital pain with sexual function in a community based cohort of older men. MATERIALS AND METHODS: In 2000, 1,764 white men with a median age of 60 years residing in Olmsted County, Minnesota completed a questionnaire that included questions from the National Institutes of Health Chronic Prostatitis Symptom Index to evaluate urogenital pain that is ejaculatory, penile, perineal, suprapubic and testicular pain, and pain on urination. Questions from the Brief Male Sexual Function Inventory were used to evaluate 5 domains of sexual function, including sexual drive, erectile function, ejaculatory function, assessment of sexual problems and overall sexual satisfaction. RESULTS: Of 1,248 men who reported a regular sexual partner there were significant associations of testicular pain with impaired sexual drive (OR 2.5, 95% CI 1.4 to 4.4) and sexual satisfaction (OR 1.8, 95% CI 1.1 to 3.2) after adjustment for age. A pain score of 4 or greater was associated with impaired sexual drive (OR 1.6, 95% CI 1.0 to 2.6) and impaired ejaculatory function (OR 1.7, 95% CI 1.0 to 2.7). Men with impaired mental health and penile pain were less likely to report impaired sexual drive (OR 0.4, 95% CI 0.04 to 3.2) than men without impaired mental health and penile pain (OR 5.2, 95% CI 1.3 to 20.8, interaction p = 0.03). CONCLUSIONS: Urogenital pain may be associated with impaired sexual function in older men. Furthermore, men with impaired mental health may be less likely to report pain associated impairment of sexual function, while the reverse may be true in the presence of comorbidity.     

The Health Consequences of Vertebral Deformity in Elderly Chinese Men and Women

The following health consequences of vertebral deformity in Hong Kong elderly Chinese men and women were studied: the prevalence of back pain, disability due to back pain, and low morale. Lateral X-ray films were taken of the thoracic and lumbar spine of 796 community-dwelling Chinese subjects (396 men, 400 women) (aged 70–79). Subjects with one or more definitely deformed vertebra (reduction in vertebral height 3 SD or more below the mean) were classified as definite cases, those with one or more mildly deformed vertebra (reduction in vertebral height 2–2.99 SD below the mean) as mild cases, and the rest as controls. The prevalence and consequences of back pain were measured by a standardized questionnaire, and morale was measured by the Geriatric Morale Score. The relative risk (RR) and 95% confidence interval (CI) of having back pain and being depressed were calculated by logistic regression. Classifications included 16% of men and 30% of women as definite cases, 37% of men and 35% of women as mild cases, and 47% of men and 35% of women as controls. The relative risk (RR) of back pain was 2.3 (95% CI 1.4–3.9) (P < 0.05) in women with definite deformity and 1.5 (95% CI 0.9–2.5) (P > 0.05) in women with mild deformity, as compared with controls. Sixty-four percent of all men had back pain. This prevalence was much higher than figures obtained in a previous survey on low back pain. The prevalence of back pain did not differ by deformity status, but more men with vertebral deformity were on analgesic. There was no significant association between disability due to back pain and vertebral deformity in women. The RR for having a low morale score (of 5 and below) was 2.3 (95% CI 1.3–4.1) (P < 0.05) in women with mild deformity; men with vertebral deformity did not have a low morale. It was concluded that vertebral deformity was associated with significant back pain and psychological morbidity in elderly Chinese women. Although men with vertebral deformity did not report more back pain, more were on analgesics than controls. Received: 2 July 1997 / Accepted: 8 January 1998     

Back pain's association with vertebral end-plate signal changes in sciatica

Background contextPatients with sciatica frequently experience disabling back pain. One of the proposed causes for back pain is vertebral end-plate signal changes (VESC) as visualized by magnetic resonance imaging (MRI).PurposeTo report on VESC findings, changes of VESC findings over time, and the correlation between VESC and disabling back pain in patients with sciatica.Study design/settingA randomized clinical trial with 1 year of follow-up.Patients samplePatients with 6 to 12 weeks of sciatica who participated in a multicenter, randomized clinical trial comparing an early surgery strategy with prolonged conservative care with surgery if needed.Outcome measuresPatients were assessed by means of the 100-mm visual analog scale (VAS) for back pain (with 0 representing no pain and 100 the worst pain ever experienced) at baseline and 1 year. Disabling back pain was defined as a VAS score of at least 40 mm.MethodsPatients underwent MRI both at baseline and after 1 year follow-up. Presence and change of VESC was correlated with disabling back pain using chi-square tests and logistic regression analysis.ResultsAt baseline, 39% of patients had disabling back pain. Of the patients with VESC at baseline, 40% had disabling back pain compared with 38% of the patients with no VESC (p=.67). The prevalence of type 1 VESC increased from 1% at baseline to 35% 1 year later in the surgical group compared with an increase from 3% to 11% in the conservative group. The prevalence of type 2 VESC decreased from 40% to 29% in the surgical group while remaining almost stable in the conservative group at 41%. The prevalence of disabling back pain at 1 year was 12% in patients with no VESC at 1 year, 16% in patients with type 1 VESC, 11% in patients with type 2 VESC, and 3% in patients with both types 1 and 2 VESC (p=.36). Undergoing surgery was associated with increase in the extent of VESC (odds ratio [OR], 8.6; 95% confidence interval [CI], 4.7–15.7; p<.001). Patients who showed an increase in the extent of VESC after 1 year did not significantly report more disabling back pain compared with patients who did not show any increase (OR, 1.2; 95% CI, 0.6–2.6; p=.61).ConclusionIn this study, undergoing surgery for sciatica was highly associated with the development of VESC after 1 year. However, in contrast with the intuitive feeling of spine specialists, those with and those without VESC reported disabling back pain in nearly the same proportion. Therefore, VESC does not seem to be responsible for disabling back pain in patients with sciatica.     

Outcome prediction in chronic unilateral lumbar radiculopathy: prospective cohort study

Background

Identification of prognostic factors for persistent pain and disability are important for better understanding of the clinical course of chronic unilateral lumbar radiculopathy and to assist clinical decision-making. There is a lack of scientific evidence concerning prognostic factors. The aim of this study was to identify clinically relevant predictors for outcome at 52 weeks.

Methods

116 patients were included in a sham controlled clinical trial on epidural injection of glucocorticoids in patients with chronic unilateral lumbar radiculopathy. Success at follow-up was ≤17.5 for visual analogue scale (VAS) leg pain, ≤22.5 for VAS back pain and ≤20 for Oswestry Disability Index (ODI). Fifteen clinically relevant variables included demographic, psychosocial, clinical and radiological data and were analysed using a logistic multivariable regression analysis.

Results

At follow-up, 75 (64.7%) patients had reached a successful outcome with an ODI score ≤20, 54 (46.6%) with a VAS leg pain score ≤17.5, and 47 (40.5%) with a VAS back pain score ≤22.5.Lower age (OR 0.94 (CI 0.89–0.99) for each year decrease in age) and FABQ Work ≥34 (OR 0.16 (CI 0.04-0.61)) were independent variables predicting a successful outcome on the ODI.Higher education (OR 5.77 (CI 1.46–22.87)) and working full-time (OR 2.70 (CI 1.02–7.18)) were statistically significant (P <0.05) independent predictors for successful outcome (VAS score ≤17.5) on the measure of leg pain. Lower age predicted success on ODI (OR 0.94 (95% CI 0.89 to 0.99) for each year) and less back pain (OR 0.94 (0.90 to 0.99)), while higher education (OR 5.77 (1.46 to 22.87)), working full-time (OR 2.70 (1.02 to 7.18)) and muscle weakness at baseline (OR 4.11 (1.24 to 13.61) predicted less leg pain, and reflex impairment at baseline predicted the contrary (OR 0.39 (0.15 to 0.97)).

Conclusions

Lower age, higher education, working full-time and low fear avoidance beliefs each predict a better outcome of chronic unilateral lumbar radiculopathy. Specifically, lower age and low fear avoidance predict a better functional outcome and less back pain, while higher education and working full-time predict less leg pain. These results should be validated in further studies before being used to inform patients.

Trial registration

Current Controlled Trials ISRCTN12574253. Registered 18 May 2005.     

The impact of multijoint symptoms on patient-reported disability following surgery for lumbar spine osteoarthritis

Background ContextIn the lumbar spine osteoarthritis (LS-OA) population having surgery for lumbar spinal stenosis (LSS) symptoms, a significant proportion of patients experience limited benefit following the intervention. Thus, identifying contributing factors to this is important. Individuals with OA often have multiple joint symptoms, yet this has received limited attention in this population.PurposeDocument the occurrence of joint symptoms among patients undergoing surgery for LS-OA, and investigate the influence of these symptoms on disability postsurgery.DesignProspective study of consecutive patients followed to 12-month postsurgery.Patient SamplePatients undergoing surgery (decompression surgery, with or without fusion) for neurogenic claudication with or without back pain due to LSS with a primary pathology diagnosis of LS-OA.Outcomes MeasuresPatient self-reported: Oswestry Disability Index (ODI), completed pre- and 12-month postsurgery; and, completed presurgery, age, sex, education, smoking, comorbid conditions, opioid use, short/long-term disability, depression and anxiety symptoms, back and leg pain intensity, presence of spondylolisthesis, procedure, prior spine surgery, and joints with arthritis and “pain/stiffness/swelling most days of the month” indicated on a homunculus (a joint site count was derived). Assessments: Height and weight, used to calculate body mass index; timed-up-and-go performance-based test.MethodsOutcome of interest was achieving a clinically important improvement (CII) in ODI by 12-month postsurgery (yes/no). The association between joint site count and achieving a CII was examined by multivariable logistic regression analyses, adjusted for other measures.ResultsIn all, 165 patients were included. The mean age was 67 years (range: 44–90) and 47% were female. Seventy-seven percent reported 1+ joint site other than the back, 62% reported 2+, and 25% reported 4+. Among those achieving a CII, 21% had 4+ joint sites, compared with 31% among those not achieving a CII. Adjusted analyses: Increasing joint site count was associated with increasing risk (odds ratio [OR]: 1.32, 95% confidence interval [CI]: 1.05, 1.66) of not achieving a CII; for those with 4+ joints, adjusted probability of not achieving a CII exceeded 50%. Also associated with an increased risk of not achieving a CII was presurgery anxiety (OR: 2.97, 95% CI: 1.02, 8.65), opioid use (OR: 2.89, 95% CI: 1.07, 7.82), and worse back pain intensity score (OR: 1.27, 95% CI: 1.05, 1.53).ConclusionsMultijoint involvement was highly prevalent in this LS-OA surgical sample. Its association with poorer postsurgery outcome supports a comprehensive approach to OA management and care. Knowledge of multijoint symptoms should inform patient education, shared decision-making, and recommendations for postsurgical rehabilitation and self-management strategies.     

Behavioral treatment for chronic low back pain: a systematic review within the framework of the Cochrane Back Review Group

STUDY DESIGN: A systematic review of randomized controlled trials. SUMMARY OF BACKGROUND DATA: The treatment of chronic low back pain is not primarily focused on removing an underlying organic disease but at the reduction of disability through the modification of environmental contingencies and cognitive processes. Behavioral interventions are commonly used in the treatment of chronic (disabling) low back pain. OBJECTIVES: To determine whether behavioral therapy is more effective than reference treatments for chronic nonspecific low back pain and which type of behavioral treatment is most effective. METHODS: The authors searched the Medline and PsychLit databases and the Cochrane Controlled Trials Register up to April 1999, and Embase up to September 1999. Also screened were references of identified randomized trials and relevant systematic reviews. Methodologic quality assessment and data extraction were performed independently by two reviewers. The magnitude of effect was assessed by computing a pooled effect size for each domain (i.e., behavioral outcomes, overall improvement, back pain-specific and generic functional status, return to work, and pain intensity) using the random effects model. RESULTS: Only six (25%) studies were high quality. There is strong evidence (level 1) that behavioral treatment has a moderate positive effect on pain intensity (pooled effect size 0.62; 95% confidence interval [CI] 0. 25, 0.98), and small positive effects on generic functional status (pooled effect size 0.35; 95% CI: 0.04, 0.74) and behavioral outcomes (pooled effect size 0.40; 95% CI: 0.10, 0.70) of patients with chronic low back pain when compared with waiting-list controls or no treatment. There is moderate evidence (level 2) that a addition of behavioral component to a usual treatment program for chronic low backpain has no positive short-term effect on generic functional status (pooled effect size 0.31; 95% CI: 0.01, 0.64), pain intensity (pooled effect size 0.03; 95% CI: 0.30,0.36), and behavioral outcomes (pooled effect size 0.19; 95% CI: 0.08, 0.45). CONCLUSIONS: Behavioral treatment seems to be an effective treatment for patients with chronic low back pain,but it is still unknown what type of patients benefit most from what type of behavioral treatment.     

Health Impact Associated with Vertebral Deformities: Results from the European Vertebral Osteoporosis Study (EVOS)

To study the association between vertebral deformities and subjective health outcome indicators, including back pain and disability, a cross-sectional survey with spinal radiographs and personal interviews was carried out in 36 study centres in 19 European countries on a total of 15570 men and women aged 50–79 years (population-based stratified random samples). No interventions were done. The main outcome measures were the presence and intensity of current and previous back pain, functional capacity (ADL questionnaire) and overall subjective health. The presence and intensity of back pain and functional and health impairments varied within wide ranges with no obvious regional pattern. However, the associations between negative health outcomes and vertebral deformity were homogeneous between countries and between centres within countries. In logistic regression analyses weak but significant associations between the presence of vertebral deformities and various health indicators were demonstrated. The magnitude of the associations increased with severity and number of deformities. Compared with subjects without deformities those with low-grade deformities had no or only a weakly elevated risk for back pain, disability and impaired subjective health (odds ratios (OR) 1.2–1.3). The odds ratios increased for individuals with single severe deformities (OR 1.3–2.1) and were highest in those with multiple severe deformities (OR 1.7–4.2). The associations between vertebral deformities and negative health outcomes were stronger in men than in women. In this cross-sectional study radiologically assessed vertebral deformities were therefore weakly associated with both current and previous back pain as well as with functional and health impairments in both women and men. Multiple severe deformities were associated with severe and disabling back pain with stronger effects in men. Received: 27 December1997 / Accepted: 31 December 1997     

全膝关节置换术后患者被动锻炼下恐动症及相关因素的调查

目的调查全膝关节置换术（TKA）后患者的恐动情况，以明确全膝关节置换术后恐动症的发生率。并通过对患者焦虑及疼痛评估确定其影响因素，为恐动症的进一步研究提供参考依据。 方法便利抽样选取2018年9月至2019年4月在内蒙古医科大学第二附属医院行TKA治疗的患者300例作为研究对象。采用自编的一般资料调查问卷、恐动症TSK评分表、社会支持评定量表等问卷对其进行调查，并且通过单因素和Logistic回归分析其影响因素。 结果所有患者中男性143例，女性157例，年龄45~83岁，平均（62±9）岁；139例患者（46.33%）存在恐动症，其TSK得分平均为（36±11）分。多重线性回归分析结果表明：受教育程度（标准回归系数=-0.345，P<0.01）与疼痛年限（标准回归系数=-0.276，P<0.01）为主要影响因素。Logistic回归分析结果表明：疼痛年限（OR=5.576，95% CI：2.213，15.453）、文化程度（OR=0.165，95% CI：0.071，0.324）、疼痛（OR=5.417，95% CI：2.203，13.385）及社会支持度（OR=0.560，95% CI：0.376，0.659）是TKA患者有恐动症的主要影响因素。 结论全膝关节置换术患者的恐动症心理与患者的疼痛年限、文化程度、疼痛经历与社会支持密切相关，在患者康复锻炼中应对这些产生恐动心理的因素予以干预，提高康复锻炼的依从性。     

Determinants of erectile dysfunction risk in a large series of Italian men attending andrology clinics

OBJECTIVE: To assess determinants of ED in men who asked for a free of charge andrologic consultation during a week focused on andrologic prevention in Italy. METHODS: Men were invited to attend 178 participating andrology centers for a free of charge visit for counselling about urologic or andrologic conditions. Data were recorded with a simple questionnaire used by all centers. RESULTS: 2499 (19.9%) were diagnosed having ED. The frequency of ED increased with age, ranging from 4.6% in men under 25 years, to 37.6% in men over 74. In comparison with men with primary education the OR of ED was 0.8 (95% CI 0.7-0.9) in men with secondary education and 0.7 (95% CI 0.6-0.9) in those with university degree. After adjusting for age, the risk of ED was significantly higher in men consuming more than 3 glasses/day of alcoholic drinking (OR 1.4, 95% CI 1.1-2.0), in subjects smoking more than 10 cigarettes/day (OR 1.2, CI 95% 1.1-1.4) and in former smokers (OR 1.2, CI 95% 1.1-1.4). Men performing at least two hours per week of physical activity had a decreased risk of ED (OR 0.8, CI 95% 0.7-0.9). We found an increased risk of ED in men with diabetes (OR 1.2, 95% CI 1.1-1.4), hypertension (OR 1.3, 95% CI 1.1-1.4), cardiopathy (OR 1.5, 95% CI 1.3-1.8) and hypercholesterolemia (OR 1.4, 95% CI 1.2-1.6). CONCLUSIONS: This study provides further data on determinants of ED risk in a large data set and underlines the relationship between ED and cardiovascular diseases.     

Women do not fare worse than men after lumbar fusion surgery: Two-year follow-up results from 4,780 prospectively collected patients in the Swedish National Spine Register with lumbar degenerative disc disease and chronic low back pain

Background Context

Proper patient selection is of utmost importance in the surgical treatment of degenerative disc disease (DDD) with chronic low back pain (CLBP). Among other factors, gender was previously found to influence lumbar fusion surgery outcome.

Association of Incident,Clinically Undiagnosed Radiographic Vertebral Fractures With Follow‐Up Back Pain Symptoms in Older Men: the Osteoporotic Fractures in Men (MrOS) Study

Prior data in women suggest that incident clinically undiagnosed radiographic vertebral fractures (VFs) often are symptomatic, but misclassification of incident clinical VF may have biased these estimates. There are no comparable data in men. To evaluate the association of incident clinically undiagnosed radiographic VF with back pain symptoms and associated activity limitations, we used data from the Osteoporotic Fractures in Men (MrOS) Study, a prospective cohort study of community‐dwelling men aged ≥65 years. A total of 4396 men completed spine X‐rays and symptom questionnaires at baseline and visit 2, about 4.6 years later. Incident clinical VFs during this interval were defined by self‐reported clinical diagnosis plus community imaging showing a centrally adjudicated ≥1 increase in semiquantitative (SQ) grade in any thoracic or lumbar vertebra versus baseline study X‐rays. Incident radiographic VFs (≥1 increase in SQ grade between baseline and visit 2 study X‐rays) were categorized as radiographic‐only (not clinically diagnosed) or radiographic plus clinical (also clinically diagnosed). Multivariable‐adjusted log binomial regression was used to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs). Men with incident radiographic plus clinical VF were most likely to have back pain symptoms and associated activity limitation at follow‐up. However, versus men without incident VF, those with incident radiographic‐only VF also were significantly more likely at follow‐up to report any back pain (70% versus 59%; PR, 1.2 [95% CI, 1.1 to 1.3]), severe back pain (8% versus 4%; PR, 1.9 [95% CI, 1.1 to 3.3]), bother from back pain most/all the time (22% versus 13%; PR, 1.7 [95% CI, 1.3 to 2.2]), and limited usual activity from back pain (34% versus 18%; PR, 1.9 [95% CI, 1.5 to 2.4]). Clinically undiagnosed, incident radiographic VFs were associated with an increased likelihood of back pain symptoms and associated activity limitation. Results suggest incident radiographic‐only VFs often were symptomatic, and were associated with both new and worsening back pain. Preventing these fractures may reduce back pain and related disability in older men. © 2017 American Society for Bone and Mineral Research.     

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.     

Predictors of recommendation and acceptance of intrapartum epidural analgesia

We conducted this prospective study to characterize the obstetric and sociodemographic variables that predict physicians' recommendations and patients' acceptance of intrapartum epidural analgesia. The study population consisted of 447 consecutive, low-risk parturients in early active labor. Epidural analgesia was recommended to 393 patients (87.9%), however only 164 (41.7%) consented to receive it. A multiple logistic regression analysis demonstrated that the severity of pain, as assessed by the medical staff (odds ratio [OR] = 1.5, 95% confidence interval [CI] 1.13, 1.93), low parity (OR = 0.57, 95% CI 0.44, 0.74), and low maternal age (OR = 0.89, 95% CI 0.79, 0.99) were significant factors affecting recommendations of epidural analgesia. In a multivariate analysis, severity of subjective pain (OR = 1.39, 95% CI 1.16, 1.68), low parity (OR = 0.80, 95% CI 0.73, 0.99), high education (OR = 90.09, 95% CI 27.02,257.06), and the patients' being secular compared with religious (OR = 2.14, 95% CI 1.08,4.21) were found to be independent predictors of acceptance of epidural analgesia. There are differences between patients offered and those not offered epidural analgesia and between parturients who accept and those who do not accept this analgesia. IMPLICATIONS: We studied the factors that influence the recommendation of epidural analgesia by obstetricians, as well as its acceptance by the laboring patients at a university hospital in Israel. Epidural analgesia was recommended more often to low parity, younger women exhibiting more pain. Parturients who perceived greater pain were more secular, had low parity, and had a higher level of education were more likely to accept it.     

Pain intensity and severe pain in young immigrant patients with long-standing back pain

The aim of this study was to explore if self-rated pain intensity and severe pain differed significantly between immigrants from different regions, and if other socio-economic, or clinical, characteristics could predict severe pain. A total of 129 men and 217 women at a primary health centre in Stockholm, Sweden, 27–45 years, on long-term sick leave, were recruited in consecutive order and grouped into a Turkish (n = 122), Southern European (n = 52), Middle East (n = 69) and one Mixed (n = 173) group of immigrants. All were employed in service jobs. Somatic status, depression and level of psychosocial stressors, including pain anxiety, were established by standardized procedures. All reported long-standing disabling back pain. Patients rated intensity of pain “right now” on a 0–100 mm visual analogue scale (VAS) as a last part of the consultation with two doctors. Severe pain was defined as VAS 75–100. Median values (md) with inter-quartile ranges (IQR) were calculated for interval and ordinal data. Non-parametric statistics were used to calculate significant differences between groups. Crude and age-standardized odds ratios (OR) with 95% confidence intervals (95% CI) as rating severe pain were calculated by binary and forward conditional logistic regression. Men and women were analyzed separately. Women had more tender points, (P < 0.001), and reported pain anxiety more often (P < 0.01). Frequency of depression did not differ between the immigrant groups. The VAS-values varied, but not significantly, between the immigrant groups of men and women. Men had lower VAS values than women (md 50, IQR 36–69 vs. md 72, IQR 51–85), (P < 0.001). Women had a three-fold risk to rate severe pain (OR 2.9, 95% CI 1.8–4.7). By sex, no immigrant group had significantly elevated OR to rate severe pain. Being 40–45 year old doubled the OR as rating severe pain. Men with depression, or little education, had high risks as rating severe pain (age-standardized ORs 4.1; 95% CI 1.7–10.0 and 2.7; 95% CI 1.1–6.8, respectively), and so had depressed women (age-standardized OR 1.9; 95% CI 1.1–3.4). Women with pain anxiety had a doubled, not statistically significant, elevated risk (age-standardized OR 2.0, 95% CI 0.95–4.3). The groups did not differ significantly in pain intensity or severe pain. Severe pain was predicted by depressed mood and probably linked to gender, age and sick roles.     

The sex-specific interrelationship between spinal pain and psychological distress across time in the general population. Results from the Stockholm Public Health Study

Background contextDetailed knowledge about the interrelationship between neck pain, back pain, and psychological distress is important from a public health prospective, but missing because of lack of large population-based cohort studies.PurposeTo assess and compare the sex-specific recovery rate of spinal pain and psychological distress as single and comorbid conditions, to describe the interrelationship between these conditions at the baseline (2002) and follow-up 5 years later, and to explore the questions of spinal pain as a risk factor for the onset of psychological distress and vice versa.Study designA prospective cohort study.Patient sampleGeneral population in Stockholm county aged 18 to 84 years, n=19,774.Outcome measuresSpinal pain (modified Nordic Pain Questionnaire) and psychological distress (General Health Questionnaire-12).MethodsA random sample of the population in Stockholm was approached with postal questionnaires at the baseline and at follow-up.ResultsComorbidity of spinal pain and distress was twice as common among women (11%) than among men (4%) (relative risk=2.4, 95% confidence interval [CI]: 2.1–2.7). Women also more commonly had spinal pain without psychological distress (women, 20%; men, 14%) and vice versa (women, 15%; men, 12%). Comorbidity makes recovery less probable (women, 26%; men, 27%) than having single conditions of spinal pain (women, 41%; men, 44%) or psychological distress (women, 49%; men, 52%). No statistical significant sex differences were seen. Twenty-four percent of the women and 17% of the men with spinal pain without psychological distress at the baseline had psychological distress at follow-up. Corresponding figures for spinal pain among participants with psychological distress without spinal pain at the baseline were 24% and 20%. Spinal pain was a determinant of psychological distress (odds ratio [OR]=2.6, 95% CI: 2.3–2.9) and vice versa (OR=2.0, 95% CI: 1.8–2.2).ConclusionsSpinal pain and psychological distress as comorbid and single conditions are common in the general population, especially among women. Comorbidity affects recovery negatively both in men and women. This study confirms the bidirectional association between spinal pain and psychological distress in the general population.     

Physical activity and dark skin tone: protective factors against low bone mass in Mexican men

A cross-sectional study was conducted on 268 Mexican men between the ages of 13 and 80 yr to evaluate the association of clinical factors related with bone mass. Men from high schools, universities, and retirement homes were invited to participate. Body mass index (BMI) was measured, and bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry for L1-L4 and total hip. Factors related to bone mass were assessed by questionnaire and analyzed using a logistic regression model. Demographic factors (age, education, and occupation), clinical data (BMI, skin tone, previous fracture, history of osteoporosis [OP], and history of fractures), and lifestyle variables (diet, physical activity, sun exposure, and smoking) were evaluated. Physical activity (≥ 60 min/5 times a week) reduced the risk for low BMD for age, osteopenia, and OP at the spine and total hip (odds ratio [OR]: 0.276; 95% confidence interval [CI]: 0.099-0.769; p=0.014; and OR: 0.184; 95% CI: 0.04-0.849; p=0.03, respectively). Dark skin tone was a protective factor, decreasing the risk by up to 70%. In this population of healthy Mexican men (aged 13-80 yr), dark skin and physical activity were protective factors against low bone mass.