Predictors of low back pain disability

Low back pain has major socioeconomic implications; much of the costs relate to disability and compensation. Theoretically, the early identification of patients at risk to become disabled from a low back episode would lead to more aggressive intervention and reduction of subsequent disability. Low back disability is related to occupational, psychosocial, diagnostic, demographic, anthropometric, health behavior, and injury factors that have been reported in the literature. The multiattribute utility model is a new experimental approach to prediction of disability. The relative weights of the various factors that might be predictive of low back disability are determined by a panel of experts. Although this model is not yet scientifically proven, it offers a promising method of answering the question, "Can low back disability be predicted?"     

Therapeutic ultrasound in chronic low back pain treatment

The purpose was to determine the efficacy of therapeutic ultrasound in patients with chronic low back pain. Thirty-one patients, age 38-77, with low back pain lasting more than three months and the intensity of pain on visual analogue scale at least 50 mm, are randomly divided in two groups. Ultrasound is applied on the lumbar paravertebral muscle in 16 patients and in 15 patients the machine was not switched on. All patients also underwent kinesitherapy. Pharmacological treatment was not changed during the research (except the possibility of using paracetamol as the "rescue drug"). Following parameters were measured at the beginning and at the end of the research: pain intensity on the visual analogue scale/mm, modified Schober measure/cm, patient's and physician's global assessment of treatment efficacy (1-5 scale). The intensity of pain in the ultrasound group before the treatment was 82,7+/-14,0 and after the treatment 79,8+/-12,2 (p<0,05). The intensity of pain in the placebo group before the treatment was 81,7+/-12,1 and at the end of the treatment 78,9+/-12,1 (p>0,05). The value of the modified Schober measure for the ultrasound group were 5,7+0,8 cm vs. 5,8+/-0,9 cm (p>0,05) and in the placebo group were 5,4+/-0,9 cm vs. 5,6+/-1,0 cm (p>0,05). There was no significant statistical difference between ultrasound and placebo group regarding the efficacy of the treatment (patients p>0,05, physicians p>0,05). Therapeutic ultrasound was effective in decreasing the pain intensity in this research, but showed no improvement regarding the functional ability of the lumbar spine in patients with chronic low back pain.     

Effective physical treatment for chronic low back pain

It is now feasible to adopt an evidence-based approach when providing physical treatment for patients with chronic LBP. A summary of the efficacy of a range of physical treatments is provided in Table 1. The evidence-based primary care options are exercise, laser, massage, and spinal manipulation; however, the latter three have small or transient effects that limit their value as therapies for chronic LBP. In contrast, exercise produces large reductions in pain and disability, a feature that suggests that exercise should play a major role in the management of chronic LBP. Physical treatments, such as acupuncture, backschool, hydrotherapy, lumbar supports, magnets, TENS, traction, ultrasound, Pilates therapy, Feldenkrais therapy, Alexander technique, and craniosacral therapy are either of unknown value or ineffective and so should not be considered. Outside of primary care, multidisciplinary treatment or functional restoration is effective; however, the high cost probably means that these programs should be reserved for patients who do not respond to cheaper treatment options for chronic LBP. Although there are now effective treatment options for chronic LBP, it needs to be acknowledged that the problem of chronic LBP is far from solved. Though treatments can provide marked improvements in the patient's condition, the available evidence suggests that the typical chronic LBP patient is left with some residual pain and disability. Developing new, more powerful treatments and refining the current group of known effective treatments is the challenge for the future.     

Predictors of isokinetic back muscle strength in patients with low back pain

STUDY DESIGN: Testing for trunk muscle strength was performed on 105 patients with chronic low back pain. OBJECTIVES: To investigate prediction of isokinetic back muscle strength in patients with low back pain. SUMMARY OF BACKGROUND DATA: The clinical evaluation of patients with chronic low back pain often in difficult because of discrepancy between disability and impairment. The isokinetic trunk device was developed as a tool for objective assessment of back muscle strength. However, the performance of patients depends on radiologic abnormalities of the spine, conditions of the back muscles, and various psychosocial factors. Studies are warranted that address how these variables influence back muscle strength. METHODS: The patients with chronic low back pain were tested by an isokinetic trunk muscle strength test (Cybex TEF, Ronkonkoma, NY). In addition, the following variables were recorded: gender, age, body mass index, emotional distress, pain on exertion, self-efficacy for pain, degenerative changes of the lumbar spine, cross-sectional area, and density of the erector spinae muscles. The three latter variables were estimated by computed tomography scans. The sum of the total work performed during isokinetic extension strength test was the dependent variable in a multiple regression analysis, and anthropometric, demographic, psychological, and radiologic factors were independent variables. RESULTS: Gender, cross-sectional muscle area, and pain on exertion were the most powerful predictors of isokinetic back muscle strength. The final regression model, which included these variables, could account for approximately 40% of the variability in back muscle strength. CONCLUSION: For assessing the results of an isokinetic trunk muscle strength test, cross-sectional muscle area, gender, and pain on exertion should be taken into account.     

Surface EMG in chronic low back pain

Chronic low back pain (CHLBP) occupies first place among factors restricting people’s life activity under the age of 45. Frequency of CHLBP occurrence oscillates between 60 and 80%. Dysfunction of the erector trunci is a fundamental cause of CHLBP. The aim of the study was to evaluate the usefulness of surface electromyography (EMG) as an identification method in CHLBP. EMG apparatus was connected to a PC equipped with the EMG-LAB programme. This programme allows the registration, transformation, analysis and projection of results on-line. A summary of complete examination is presented in the form of statistical values of parameters such as mean amplitude, mean density, background amplitude, background density, and upper amplitude and upper density. Plain, surface electrodes were attached to the skin overlying the erector spinae at the T7 and L4 vertebrae, approximately 3–4 cm from the midline of the back. Electrodes were positioned unilaterally on the right side. A reference electrode was positioned on the skin overlying the right arm. Sixty-two patients with CHLBP were examined (30 men and 32 women, mean age 41 ± 8 years). The control group consisted of 31 people without back problems (16 men and 15 women, mean age 39 ± 6 years). The statistical values of mean amplitude, mean density and upper amplitude were found to be higher in the control group at the T7 level. At the L4 level, mean amplitude, mean density, background amplitude, background density and upper amplitude were significantly higher in control group. The findings of this study show that (1) dysfunction of the erector spinae plays a significant role in CHLBP, and (2) this process applies to small and large motor units, but the character of these changes is different in particular muscles. Surface EMG is an objective, non-invasive method of examining function of the erector spinae in the author’s opinion. Received: 12 November 1998 Accepted: 5 January 2000     

Exercise as a treatment for chronic low back pain.

BACKGROUND CONTEXT: Exercise is a widely prescribed treatment for chronic low back pain, with demonstrated effectiveness for improving function and work. PURPOSE: The goal of this article is to review several key aspects about the safety and efficacy of exercise that may help clinicians understand its utility in treating chronic back pain. STUDY DESIGN/SETTING: A computerized literature search of MEDLINE was conducted using "exercise," "fitness," "back pain," "backache" and "rehabilitation" as search words. Identified abstracts were scanned, and useful articles were acquired for further review. Additional references were acquired through the personal collections of research papers possessed by the authors and by reviewing prior review articles on this subject. These final papers were scrutinized for data relevant to the key aspects about exercise covered in this article. RESULTS: For people with acute, subacute or chronic low back pain, there is no evidence that exercise increases the risk of additional back problems or work disability. To the contrary, current medical literature suggests that exercise has either a neutral effect or may slightly reduce risk of future back injuries. Exercise can be prescribed for patients with chronic low back pain with three distinct goals. The first and most obvious goal is to improve or eliminate impairments in back flexibility and strength, and improve performance of endurance activities. There is a large body of evidence confirming that this goal can be accomplished for a majority of patients with chronic low back pain. The second goal of exercise is to reduce the intensity of back pain. Most studies of exercise have noted overall reduction in back pain intensity that ranges from 10% to 50% after exercise treatment. The third goal of exercise is to reduce back pain-related disability through a process of desensitization of fears and concerns, altering pain attitudes and beliefs and improving affect. The mechanisms through which exercise can accomplish this goal have been the subject of substantial research. CONCLUSIONS: Exercise is safe for individuals with back pain, because it does not increase the risk of future back injuries or work absence. Substantial evidence exists supporting the use of exercise as a therapeutic tool to improve impairments in back flexibility and strength. Most studies have observed improvements in global pain ratings after exercise programs, and many have observed that exercise can lessen the behavioral, cognitive, affect and disability aspects of back pain syndromes.     

退变性慢性腰痛的诊治

慢性腰痛 (chronic low back pain,CLBP)系指疼痛持续半年以上 ,迁延不愈 ,且经正规保守治疗无效 ,而不能手术或手术无效者。是临床诊疗中最难处理的一组腰背痛 ,由于患者久病 ,对治疗失去耐心 ,且多数对止痛药物有依赖性 ,过去说的“病人腰痛 ,医生头痛”,大概就是指的这一类。慢性腰痛所致的伤残仅次于心力衰竭与肿瘤 ,居第 3位[1] 。如何治疗慢性腰痛是对从事经腰痛防治者的挑战 ,慢性腰痛的疾病包括两大类 ,退变性疾病 ,及手术后失败综合征。本文只讨论退变性慢性腰痛。1　退变性慢性腰痛的病理基础退变性慢性腰痛的病理基础主要是椎…     

Outcome measures in chronic low back pain

The purpose of this prospective, single site cohort quasi-experimental study was to determine the responsiveness of the numerical rating scale (NRS), Roland–Morris disability questionnaire (RMDQ), Oswestry disability index (ODI), pain self-efficacy questionnaire (PSEQ) and the patient-specific functional scale (PSFS) in order to determine which would best measure clinically meaningful change in a chronic low back pain (LBP) population. Several patient-based outcome instruments are currently used to measure treatment effect in the chronic LBP population. However, there is a lack of consensus on what constitutes a “successful” outcome, how an important improvement/deterioration has been defined and which outcome measure(s) best captures the effectiveness of therapeutic interventions for the chronic LBP population. Sixty-three consecutive patients with chronic LBP referred to a back exercise and education class participated in this study; 48 of the 63 patients had complete data. Five questionnaires were administered initially and after the 5-week back class intervention. Also at 5 weeks, patients completed a global impression of change as a reflection of meaningful change in patient status. Score changes in the five different questionnaires were subjected to both distribution- and anchor-based methods: standard error of measurement (SEM) and receiver operating characteristic (ROC) curves to define clinical improvement. From these methods, the minimal clinically important difference (MCID) defined as the smallest difference that patients and clinicians perceive to be worthwhile is presented for each instrument. Based on the SEM, a point score change of 2.4 in the NRS, 5 in the RMDQ, 17 in the ODI, 11 on the PSEQ, and 1.4 on the PSFS corresponded to the MCID. Based on ROC curve analysis, a point score change of 4 points for both the NRS and RMDQ, 8 points for the ODI, 9 points for the PSEQ and 2 points for the PSFS corresponded to the MCID. The ROC analysis demonstrated that both the PSEQ and PSFS are responsive to clinically important change over time. The NRS was found to be least responsive. The exact value of the MCID is not a fixed value and is dependent on the assessment method used to calculate the score change. Based on ROC curve analysis the PSFS and PSEQ were more responsive than the other scales in measuring change in patients with chronic LBP following participation in a back class programme. However, due to the small sample size, the lack of observed worsening of symptoms over time, the single centre and intervention studied these results which need to be interpreted with caution.     

Referred limb symptoms in chronic low back pain

Referred limb symptoms (RLS) in chronic low back pain patients without signs of root affections were studied in 212 men and 126 women, aged 36-55 years, who were at work, but suffered from chronic or recurrent low back pain. RLS during the past few months were experienced by 17% daily and 22% occasionally. Previous RLS were reported by 34%, whereas 27% had never had such symptoms. There was a 3:4 distribution between symptoms in right and left legs, and 30% claimed symptoms in both legs. The distal extension of RLS into the limbs was as follows: thigh 18%, leg 37%, foot 20%, and toes 26%. The nature of RLS comprised the following: pain 56%, numbness 50%, cramps 22%, sharp pain 15%, and weakness 10%. Occurrence of RLS was not related to age. In both men and women, RLS correlated with subjective disability as well as with pain on bendings and palpation of lumbar spine and muscles. Men with previous and present RLS had greater external rotation of the hips, but otherwise no specific physical measurements were related with RLS. RLS of both legs in women and of distal extension in men showed more findings related with back pain.     

Core stability exercise in chronic low back pain

In conclusion, core stability exercise is an evolving process, and refinement of the clinical rehabilitation strategies is ongoing. Two major foci are addressed in contemporary core stability programs: motor control and muscle capacity. Both of these factors have considerable foundation in the literature and can be seen as a progression of exercise rather than conflicting approaches. Importantly, the clinical efficacy of these approaches is being realized in clinical trials. Further work is required, however, to refine and validate the approach, particularly with reference to contemporary understanding of the neurobiology of chronic pain.     

Treatment strategy for chronic low back pain

The management of non-specific low back pain relies chiefly on analgesics, education, and physical exercises. Of the many risk factors for chronicity, the most relevant are psychosocial and occupational. Identifying homogeneous patient subgroups helps to develop personalized treatment strategies, thus improving the outcomes. Current clinical research is focusing on subgroup identification via simple validated questionnaires that are suitable for use in everyday practice. We suggest a management approach leading from the individual patient profile to the treatment strategy.     

The treatment of chronic back pain

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

硫酸氨基葡萄糖钾片治疗腰痛的临床疗效观察

目的分析应用硫酸氨基葡萄糖钾片治疗慢性腰痛的临床疗效。方法选择2014年10月至2017年1月在我院进行治疗的腰椎骨质退行性改变患者伴腰痛80例,分成对照组及观察组,对照组(n=40)给予口服洛索洛芬钠片,60 mg,共2周;治疗组(n=40)给予硫酸氨基葡萄糖钾片(留普安片),1.5 g/日,共4周。比较两组临床效果。结果洛索洛芬钠组40例中,完全缓解患者有30例(75.0%),有效缓解8例(20.0%),无效2例(5.0%);留普安组40例中,完全缓解患者有24例(60.0%),有效缓解11例(27.5%),无效5例(12.5%),对比两组患者临床疗效相当。洛索洛芬钠组例出现不良反应8(8/40)例,占20.00%,留普安组40例没有出现不良反应,两组数据差异明显(P0.05)。结论硫酸氨基葡萄糖治疗腰椎骨质退行性改变伴腰痛患者这种慢性腰痛有效,可作为辅助用药服用。