Vergleich zweier Screening-Fragebogen für Patienten mit Rückenschmerzen

Background

Screening for risk factors for chronic low back pain (LBP) (yellow flags) is recommended by clinical guidelines. Various questionnaires to assess yellow flags have been proposed.

Objectives

The aim of this study was to compare the prognostic validity of two screening questionnaires.

Material and methods

This was a prospective observational study with 241 LBP patients from 9 general practitioners, 4 orthopedic surgeons and 2 pain clinics. We compared the Örebro musculoskeletal pain questionnaire (ÖMSPQ) and the Heidelberg short questionnaire (HKF-R10) which were completed by all patients at inclusion before the consultation. Primary outcomes were assessed after 3 months by mail. Clinical endpoints were pain intensity, disability and more than two follow-up consultations.

Results

The sensitivity of the HKF-R10 to predict the primary outcome ranged from 81 % to 88?%, while the specificity was much lower (37–47?%). The ÖMSPQ showed an opposite pattern with a low sensitivity ranging from 50 % to 58?% but a higher specificity (77–80?%). In patients initially classified as having chronic LBP (n?=?81), using the questionnaires as a diagnostic tool, the sensitivity of both questionnaires increased but specificity decreased. Single items may perform better with regard to primary outcome than the sum scores.

Conclusion

Both screening questionnaires for chronic LBP have insufficient diagnostic and prognostic validity for routine use in ambulatory care. Further studies are needed to improve diagnostic and prognostic validity and to elaborate criteria for a targeted use of screening questionnaires to guide therapeutic interventions.     

Die Behandlung von Rückenschmerzen

QUESTION: Which are the most effective treatments for acute and chronic low back pain? METHODS: Systematic reviews were conducted including identification and selection of relevant trials, assessment of the methodological quality, data extraction (study populations, interventions, and outcomes), and data analysis. RESULTS: acute low back pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants relieve pain more than placebo; advice to stay active speeds up recovery and reduces chronic disability; bed rest and specific back exercises are not effective. RESULTS: chronic low back pain. Exercise therapy, back schools, behavioral therapy, and multidisciplinary programs are effective. CONCLUSIONS: Scientific evidence shows that an active approach to low back pain patients is effective.     

Die fischschuppen als Testobjekt für die Melanophorenreaktion

Research in Experimental Medicine -     

Risikofaktoren für Rückenschmerzen bei Kindern und Jugendlichen in Industrienationen

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

Bewegungskontrolldysfunktion als Subgruppe von unspezifischen Rückenschmerzen

Low back pain (LBP) is in most cases non-specific, meaning that there is no clear medical cause for the problem. Subgrouping of these patients has been declared as one of main research areas of LBP. One possible subgroup of LBP is movement control dysfunction which means that patients cannot actively control movements of the lower back. A test battery consisting of six movement control tests was created to examine this dysfunction and was found to be reliable. The test battery can discriminate between patients with LBP and healthy controls. It was also shown that patients with movement control deficits have a distorted body image which can be measured with two-point discrimination tests. In a case series study (n?=?38) patients with movement control dysfunction could be extensively improved in their disability, pain and function. However, as there was no control group in the study no causal conclusions can be drawn.     

Qualitätsindikatoren für die Versorgung von Patienten mit Rückenschmerzen

Introduction

Low back pain (LBP) is an epidemiologically and economically relevant health care problem appropriate for quality assurance approaches. Therefore an expert panel (AQUIK) of the National Association of Statutory Health Insurance Physicians has proposed three quality indicators (QI) for monitoring the quality of ambulatory care for LBP. The aim of this article is to present and evaluate the proposed QIs.

Material and methods

The three proposed QIs relating to red flags, imaging and sick leave certificates were evaluated with regard to the underpinning evidence, epidemiology and feasibility. Guidelines and original research as well results from surveys and observational studies evaluating adherence to LBP guidelines were used for assessment.

Results

The expert panel concluded that only the recording of red flags is a relevant and feasible QI. Despite a two-stage expert method the epidemiology of LBP, feasibility and existing routine health care data were not sufficiently taken into account. The author’s conclusion differs in two instances. The red flag concept is not sufficiently clinically validated and recordable to be used as a QI. Otherwise imaging is considered a suitable QI given the observed overuse and the availability of billing data.

Conclusion

Deriving valid and pragmatic QI from LBP guidelines for evaluating care for LBP is difficult. The core messages of guidelines are only recommendations with limited precision and transferability to individual patients. For pragmatic reasons definition of an upper or lower proportion of patients receiving a given health care service is recommended instead of tedious individual evaluation. Reasonable estimates can be based on data from research on health care services. Because of this uncertainty QIs should be evaluated before they are used as a steering instrument.     

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

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

Chronische Rückenschmerzen als Folge eines retroperitonealen Lymphangioms

A 39-year-old female patient presented with a 3-year history of lower back pain which had not been alleviated by pain treatment combined with physiotherapy. Radiological findings were normal with the exception of a cystic paravertebral tumor in the left retroperitoneum. The cyst was primarily regarded as a coincidental finding because no criteria for malignancy were present. Magnetic resonance tomography, however, the cyst showed a progressive increase in size and the pain remained unchanged so that surgical resection was performed. The histopathological examination showed a lymphangioma and the pain was nearly completely resolved after surgery.     

Akupunktur bei Rückenschmerzen

BACKGROUND: Acupuncture is commonly used to treat back pain. A meta-analysis of clinical trials of acupuncture for this condition came to a positive conclusion whilst a qualitative review was negative. AIM: To compare our meta-analysis of trials of acupuncture for the treatment of back pain with a qualitative review and the most recent studies on the subject. METHODS: A systematic literature search was conducted to retrieve all randomised controlled trials of any form of acupuncture for any type of back pain in humans. The adequacy of the acupuncture was assessed by consulting six experienced acupuncturists. The main outcome measure for the meta-analysis was numbers of subjects who where improved at the end of treatment. These data are discussed in relation to the qualitative review and the most recent studies. RESULTS: Twelve studies were included of which nine presented data suitable for meta-analysis. The odds ratio of improvement with acupuncture compared with control intervention was 2.30 (95% confidence interval 1.28 to 4.13). For sham-controlled, evaluator-blinded studies, the odds ratio was 1.37 (95% confidence interval, 0.84-2.25). The results from the majority of the most recent studies also support the effectiveness of acupuncture in the treatment of back pain. CONCLUSIONS: Collectively, these data imply that acupuncture is superior to various control interventions, although there is insufficient evidence to state whether it is superior to placebo.     

Differenzialtherapie lumbaler Rückenschmerzen

Background

Back pain patients present with complex symptomatology. To demonstrate the possibilities of primary treatment viewed from the perspective of manual medicine, treatment data covering a period of 2.5 years of patients consulting a general practitioner for complaints of “lumbar back pain” were analyzed.

Results

In more than 90% of these patients, manual medical examination was able to detect conditions such as segment obstruction, myofascial trigger points, static imbalance, and psychosomatic disorders. Further paraclinical tests and imaging diagnostics were only needed in exceptional cases to distinguish potentially dangerous processes. It was not possible to prevent a decline in social status in only 1% of the cases due to lumbar back pain that was considerably influenced by psychosomatic factors.

Conclusion

Differential therapy of the findings based on aspects of manual medicine including psychosomatic interventions proved to be extraordinarily effective, long-lasting, and without side effects when applied for primary treatment in the family practice setting.     

Die Cortisol-Aufwachreaktion bei Patienten mit akuten und chronischen Rückenschmerzen

Background

Peculiarities of the hypothalamic-pituitary-adrenal axis activity in stress-related pain-disorders and potential relations with psychological risk factors of pain chronicity have been discussed controversially.

Material and methods

The cortisol awakening responses of 31 low back pain patients (14 acute, 17 chronic) and 14 healthy controls were compared. In addition the interrelations between awakening response and chronic stress as well as depressive mood and – for the first time – maladaptive painprocessing and -copingstrategies were investigated.

Results

The groups did not differ in their cortisol awakening responses. Chronic stress, depressive mood and maladaptive cognitive painprocessing did not correlate with the awakening response. There were, however, significant interrelations between awakening responses and the behavioral paincoping-strategies.

Conclusions

Behavioral paincoping-strategies should be considered as a potentially important contributing psychological factor in the relation between the activity of the hypothalamic-pituitary-adrenal axis and stress-related pain disorders.     

Geschlechtsspezifische Risikofaktoren akuter Rückenschmerzen

Background

Women complain about back pain more often than men, giving rise to the question of whether gender-specific risk profiles could be identified.

Methods

Secondary data analysis was done of the telephone health survey conducted by the Robert Koch Institute in 2003 (n=7,829). Bivariate (χ²) and gender-stratified multivariate tests were conducted (odds ratio, 95% confidence intervals).

Results

Women (28.5%) complained about acute low back pain significantly more often than men did (18%; p<0.001). The multivariate analysis found gender-specific risk estimates for the following factors: age, degenerative diseases of the joints, osteoporosis, depression, smoking, employment, municipality size, and impairment of daily work because of physical impairment.

Conclusion

The present examination is an attempt to deduce factors to be taken into account for gender-specific care of patients with acute low back pain. Preventive measures and therapy approaches could be influenced by these findings. To adequately address the problem, future analyses should specifically include psychosocial factors.     

Laserakupunktur bei chronischen Rückenschmerzen

Background

The goal of this study was to evaluate the efficacy of laser acupuncture for the clinical picture of chronic back pain under everyday conditions using a randomized, double-blind, placebo-controlled study design. A further aim was to analyze to what extent placebo effects also influence the outcome of acupuncture under these conditions.

Patients and methods

The study included male and female patients with chronic back pain (lasting longer than 6 months) aged between 30 and 77 years with a pain score of at least 5 on a visual analog scale. The main criterion was achieving alleviation of pain by at least 50% 3 months after the start of treatment. The assessment tools used were the Von Korff questionnaire supplemented by the FFbH, FABQ, and SF-12. In addition, the participants were questioned about whether they perceived anything during the treatment and how certain they were that they had received treatment with active or inactive lasers.

Results

A total of 111 patients were included in the study and were treated according to the randomization list in two groups each consisting of 51 subjects. The study was completed as scheduled by 102 participants. Analysis of the primary outcome measure, improvement of the pain score by more than 50% over baseline, revealed improvements in both treatment groups between the time points used for measurement. The placebo group exhibited better levels than the group that received laser treatment. No efficacy advantage of laser acupuncture over placebo treatment could be determined.

Conclusion

It was possible to completely blind the acupuncture forms with the study design employed. Perhaps the consistent exclusion of nonspecific treatment effects contributed to this result. It cannot be ruled out that the effects of acupuncture are based on a strong placebo effect.     

Stickstoffmonoxid-Mangel im Rückenmark als möglicher Faktor für die Entstehung von Spontanschmerzen

AIM OF THE STUDY: The role of nitric oxide (NO) in the processing of nociceptive information is controversely discussed. The present review aims at answering the questions how a spinal lack of NO influences the discharge behaviour of dorsal horn neurones, and if the NO-synthesising neurones exhibit a change in histologically visualised cell numbers under the influence of a nociceptive input from the body periphery. METHODS: The data were obtained from anaesthetised rats. The impulse activity of single sensory dorsal horn neurones was recorded with glass microelectrodes. In the spinal segments studied, the NO synthase (NOS) was blocked with L-NAME. The NO-synthesising cells were visualized histochemically with the diaphorase reaction or immunohistochemically with antibodies to the NOS. RESULTS: The inhibition of the NO synthesis by L-NAME was followed by a marked increase in the background activity almost exclusively in nociceptive neurones. In the histological evaluation, the NO-synthesising neurones reacted to a nociceptive input with an initial increase in cell number which was followed by a decrease. CONCLUSIONS: Normally, a tonic release of NO in the spinal cord appears to exist which inhibits the discharges of nociceptive dorsal horn neurones. Accordingly, a local lack of NO synthesis leads to an increase in the electrical activity in these neurones. Under chronic painful conditions there is a decrease in the number of NO-synthesising cells which is associated with a lack of NO in the dorsal horn. If such changes occur also in patients they are likely to cause spontaneous pain. Thus, NO could be an important factor for spontaneous pain in patients with chronic painful lesions in the body periphery.     

Die ESID-Online-Datenbank für prim?re Immundefekte

BACKGROUND AND METHODS: Over the past 3 years, with support by the European Union within the 6th Framework Programme and by the pharmaceutical industry, the ESID Online Database has collected data from 7,047 patients with primary immunodeficiencies (PIDs) in 30 countries. The system is available via a standard internet browser for users in registered documenting centers with their personal login. It comprises a common core dataset for 212 PIDs and large disease-specific data models for 33 diseases. These can be used for international studies on these cohorts. RESULTS: First analyses on the Therapy and Quality of Life section have shown that 42% of the registered living patients receive immunoglobulin replacement therapy. 76% of these receive intravenous immunoglobulins (IVIG), whereas 23% use the subcutaneous method of application (SCIG). In Germany, compared to the European figures, SCIG therapy is much more common, reaching 54%, whereas 46% of the patients receive IVIG. When analyzing the large cohort of patients with common variable immunodeficiency (CVID), patients on SCIG have less sick days and less days in hospital per year than those on IVIG. CONCLUSION: The acceptance of this new online system within Europe has been positive over the last few years and the database has now reached a state where it can be the basis for extensive international studies. However, with 551 patients, Germany only contributes 7.81% of the entered datasets. This is mainly due to a lack of time and manpower in the documenting centers and to time-consuming procedures for ethics approval.