Back Pain Of Mechanical Origin Research Articles

A RANDOMIZED CONTROLLED CLINICAL TRIAL TO EVALUATE THE EFFICACY OF PUNARNAVADI PINDA SVEDA IN KATIGRAHA

Introduction: Low back ache is a common orthopaedic condition and has a ubiquitous distribution. It is said to affect about 60-80% of the population at least once in a lifetime. Low back pain of mechanical origin is usually confined to the lumbosacral region, buttock or thigh and does not radiate beyond the knee. Katigraha is vatajananatmaja vyadhi having pain and stiffness as prominent features. Due to its resemblance in clinical characteristics, Katigraha may be paralleled to non-specific or mechanical low back aches. Materials and methods: Forty patients between 20-70 years of either sex, satisfying inclusion and exclusion criteria, were randomly selected from OPD and IPD of the department of Panchakarma Alva’s Ayurveda Medical College.20 Patients each were randomly allocated into two groups, Group KP and Group PP, and were treated with kolakulathadi pinda sveda and punarnavadi pinda sveda, respectively. Result: Both punarnavadi pinda sveda and kolakulathadi pinda sveda has shown highly significant result on the Numerical Pain Rating Scale (NPRS), stiffness, pain intensity, and pain affecting the activity of daily living such as personal care, lifting weight, walking, sitting, standing, and travelling, changing the degree of pain, forward bending, RLF and LLF

Low back pain – a diagnostic approach

ABSTRACT BACKGROUND AND OBJECTIVES: Low back pain is a problem that affects 80% of adults at some point in life, it is among the top 10 primary causes of consultation with internists and, every year, workers are absent from work for more than seven days due to this disease, causing a great impact in productivity and economy. The objective of this study was to provide the clinician working at the primary care with an adequate approach to the patient with chronic low back pain, emphasizing the differential diagnosis of this disease. CONTENTS: The etiological characterization of low back pain is a process that requires a propaedeutic approach that includes the clinical history, physical and complementary exams. The approach to low back pain of mechanical origin, and others less common such as those with a neuropathic component or resulting from inflammation, infection or neoplasia was developed, based on the literature. CONCLUSION: The diagnosis of low back pain is essential, yet challenging for the primary care physician. Most patients with back pain can be treated at the primary care setting, provided that the GP has the proper knowledge to elaborate the differential diagnosis of this disease.

Low back pain as seen in orthopedic clinics of a Nigerian Teaching Hospital.

Low back pain is not a specific disease though a common health concern worldwide. There is regional variation in its etiology and patterns of presentation. In West African sub-region, there are very limited data on this important aspect of low back pain. We aimed to determine the etiology and pattern of presentation of low back pain among patients seen in our orthopedic outpatient clinics. This was a retrospective review of database of all new patients with low back pain seen at the orthopedics clinics of Federal Teaching Hospital, Abakaliki between 2003 and 2013. There were 2914 new patients seen in the orthopedic clinics -291 (10%) of them presented with low back pain. The female to male ratio was 1:1.04 and the mean age was 45.8 ± 1.67 years. The mechanical low back pain was involved in 82.1% of the patients, and the incidence was significantly higher in females than males (53.1% vs. 46.9%, P < 0.003). The males were significantly more afflicted than females by pain from spinal infections (58.3% vs. 41.7%) and tumors (92.3% vs. 7.7% P <0.003). Low back pain associated with radiculopathy was observed in 75 (25.7%) patients and the incidence was significantly higher in the married than the singles (30.2% vs. 13.9%, P < 0.005). Lifting of heavy object was the most common predisposing factor of low back pain. Hypertension and peptic ulcer disease were two top medical co-morbidities while osteoarthritis of hip and knee was the most common associated musculoskeletal disorders. Low back pain of mechanical origin (recurrent and chronic in a significant proportion of patients) is predominant in our environment. This pattern calls for prevention as well as the early and appropriate care of the patient with low back pain.

ABBREVIATED MEASURED VERTICAL TRACTION FOR THE TREATMENT OF MECHANICAL LOW BACK PAIN: REPORT OF FOUR CASES

Abbreviated Measured Vertical Traction (Abbr.M.V.T.) and modified Abbr.M.V.T. are two techniques of lumbar traction, which in contrast to conventional traction, appear to have very promising results. These techniques apply strong traction forces once for very short time, and in one therapeutical session accomplish palliation of low back pain symptoms and increase spinal mobility. We present four cases of patients with low back pain of mechanical origin, successfully treated by these techniques. The patients had four different pathologies, yet showed a uniform response to treatment. The possible pathophysiology of this phenomenon is discussed.

Role of Diffusion-Weighted MRI in the Detection of Early Active Sacroiliitis

This study proposed to evaluate the value of diffusion-weighted MRI (DWI) to detect active inflammatory changes in the sacroiliac joints of patients with early axial spondyloarthritis (also spelled spondylarthritis). Forty-two patients with chronic low back pain underwent clinical and MRI evaluation for axial spondyloarthritis or early ankylosing spondylitis. STIR, contrast-enhanced T1-weighted, fat-saturated T2-weighted, and diffusion-weighted (b values: 100, 600, 1,000 s/mm(2)) images were obtained. The presence of subchondral bone marrow edema, subchondral fatty marrow infiltration, or contrast enhancement in the sacroiliac joints or adjacent enthesitis sites was considered a marker for active inflammatory changes. All MRI sequences were evaluated for the presence of acute inflammatory changes and inter- and intrarater reliability of the sequences. Mean apparent diffusion coefficient (ADC) values of diffusion-weighted images were calculated from normal and involved iliac and sacral bones of sacroiliac joints. ADC values measured from the lesions at b values of 1,000 and 600 s/mm(2) in patients with sacroiliitis (n = 13) were significantly higher than values measured from iliac and sacral bones in patients with low back pain of mechanical origin (n = 29). DWI showed sensitivity for detecting acute lesions in early sacroiliitis similar to that of T1-weighted gadolinium images (area under the curve, 0.843-0.971). Intra- and interrater reliability of DWI was acceptable. DWI is a sensitive, fast sequence and does not require a contrast agent, which makes it a good and cost-effective alternative for imaging sacroiliac joints. DWI also offers the possibility of quantifying diffusion coefficients of the lesions, which helps to discriminate between normal and involved subchondral bone.

Cost-Effectiveness of Medical and Chiropractic Care for Acute and Chronic Low Back Pain

To identify relative provider costs, clinical outcomes, and patient satisfaction for the treatment of low back pain (LBP). This was a practice-based, nonrandomized, comparative study of patients self-referring to 60 doctors of chiropractic and 111 medical doctors in 51 chiropractic and 14 general practice community clinics over a 2-year period. Patients were included if they were at least 18 years old, ambulatory, and had low back pain of mechanical origin (n = 2780). Outcomes were (standardized) office costs, office costs plus referral costs for office-based care and advanced imaging, pain, functional disability, patient satisfaction, physical health, and mental health evaluated at 3 and 12 months after the start of care. Multiple regression analysis was used to correct for baseline differences between provider types. Chiropractic office costs were higher for both acute and chronic patients (P < .01). When referrals were included, there were no significant differences in either group between provider types (P > .20). Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction (P < .01); clinically important differences in pain and disability improvement were found for chronic patients only. Chiropractic care appeared relatively cost-effective for the treatment of chronic LBP. Chiropractic and medical care performed comparably for acute patients. Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulation efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis. This evidence can guide physicians, payers, and policy makers in evaluating chiropractic as a treatment option for low back pain.

CD4 CD25 high regulatory T cells are not impaired in patients with primary Sjögren's syndrome

In animal models of autoimmunity, CD4 CD25 high T cells play a key role in the control of the autoimmune process. Few studies have investigated the role of these cells in human autoimmune diseases. We aimed to investigate CD4 CD25 high T cells in the peripheral blood of patients with primary Sjögren's syndrome (pSS). The proportion of blood CD4 CD25 high T cells was determined by flow cytometry in 21 patients with pSS as determined by the American–European consensus group criteria and two groups of controls (18 patients with lumbar back pain of mechanical origin and 15 healthy blood donors). The suppressive function of CD4 CD25 cells was assessed using co-culture assays. The Vbeta repertoire of CD4 CD25 T cells was examined by flow cytometry. The proportion of CD4 CD25 T cells depended on age in patients and controls. In an age-matched comparison, no significant difference was observed in the proportion of total CD4 CD25 low T cells between patients with pSS and controls ( P=0.36). In contrast, the pool of CD4 CD25 high was significantly increased in patients with pSS (8.5% vs 4.1% in controls, P=0.04). There was a slight but not significant higher proportion of CD4 CD25 high cells in patients with a more active disease. CD4 CD25 T cells in patients with pSS effectively suppressed the proliferation of CD4 CD25 − autologous responder T cells. The Vbeta repertoire of regulatory T cells from patients with pSS was polyclonal and was not significantly restricted as compared with that in controls. Functional CD4 CD25 high regulatory cells are increased in patients with established pSS, through a reactive feedback, despite ongoing autoimmunity. These results suggest that pSS does not occur as a result of reduced level of CD4 CD25 high regulatory T cells, nor as a defect of inhibition of proliferation of responder cells.

Dose-response for chiropractic care of chronic low back pain

Background context There have been no trials of optimal chiropractic care in terms of number of office visits for spinal manipulation and other therapeutic modalities. Purpose To conduct a pilot study to make preliminary identification of the effects of number of chiropractic treatment visits for manipulation with and without physical modalities (PM) on chronic low back pain and disability. Study design/setting Randomized controlled trial with a balanced 4×2 factorial design. Conducted in the faculty practice of a chiropractic college outpatient clinic. Patient sample Seventy-two patients with chronic, nonspecific low back pain of mechanical origin. Main outcome measures Von Korff pain and disability (100-point) scales. Methods Patients were randomly allocated to visits (1, 2, 3 or 4 visits/week for 3 weeks) and to treatment regimen (spinal manipulation only or spinal manipulation with PM). All patients received high-velocity low-amplitude spinal manipulation. Half received one or two of the following PM at each visit: soft tissue therapy, hot packs, electrotherapy or ultrasound. Results Pain intensity: At 4 weeks, there was a substantial linear effect of visits favoring a larger number of visits: 5.7 points per 3 visits (SE=2.3, p=.014). There was no effect of treatment regimen. At 12 weeks, the data suggested the potential for a similar effect of visits on patients receiving both manipulation and PM. Functional disability: At 4 weeks, a visits effect was noted (p=.018); the slope for group means was approximately 5 points per 3 visits. There were no group differences at 12 weeks. Conclusions There was a positive, clinically important effect of the number of chiropractic treatments for chronic low back pain on pain intensity and disability at 4 weeks. Relief was substantial for patients receiving care 3 to 4 times per week for 3 weeks.

A descriptive study of medical and chiropractic patients with chronic low back pain and sciatica: Management by physicians (practice activities) and patients (self-management)

Background: A practice-based study of ambulatory patients with low back pain noted a long-term outcome advantage for self-referred chiropractic (DC) patients over medical (MD) patients within a subgroup of patients with chronic low back pain and radiating pain below the knee. The frequency of self-care education by physicians in both provider cohorts coupled with current thinking on management of chronic low back pain led to an exploration and description of physicians' noncore practice activities and patients' self-management attitudes and behaviors. Methods: A longitudinal, practice-based, observational study was undertaken in 14 general practice and 51 chiropractic community-based clinics. We enrolled 2945 consecutive patients with ambulatory low back pain of mechanical origin; of these, 268 comprised the subgroup of patients with chronic low back pain and radiating pain below the knee. The patients' low back status was followed for 1 year. Data on physicians' practice activities were obtained from doctor questionnaires completed at each patient visit and from chart abstraction. Patient data obtained from self-administered questionnaires at enrollment included sociodemographics, complaint characteristics, health status, and health encounter preferences. Questionnaires mailed at 2 weeks, 1 month, 3 months, 6 months, and 12 months collected data on low back complaint status and satisfaction with treatment. At 1 to 3 years follow-up, mailed questionnaires collected data on patients' self-management attitudes and behaviors. Results: Physicians' core practice activities were as expected. Exercise plans and self-care education (>55%) were conspicuous in the frequency of their use in the DC cohort. MD patients appeared to rely more on family and friends for support during periods of back trouble. DC patients were characterized by greater self-efficacy motivation (P = .000). Both groups showed evidence of self-care activities during and between bouts of back pain, although MD patients were far more likely to choose bed rest (P = .007). Conclusions: The chiropractic encounter may have enhanced patients' self-efficacy motivation, leading to better coping abilities and better pain and disability outcomes. Understanding, respecting, and capitalizing on the role and influence of psychosocial factors can help all physicians become more effective healers and counselors for their patients with back pain. (J Manipulative Physiol Ther 2001;24:543-51)

Pain, disability, and satisfation outcomes and predictors of outcomes: A practice-based study of chronic low back pain patients attending primary care and chiropractic physicians

Background: Few studies exist on the prognostic value of demographic, clinical, or psychosocial factors on long-term outcomes for patients with chronic low back pain. Objective: This study reports on long-term pain and disability outcomes for patients with chronic low back pain, evaluates predictors of long-term outcomes, and assesses the influence of doctor type on clinical outcome. Methods: Sixty chiropractic (DC) and 111 general practice (MD) physicians participated in data collection for a prospective, longitudinal, practice-based, observational study of ambulatory low back pain of mechanical origin. The primary outcomes, measured at 6 months and 12 months, were pain (by using the Visual Analog Scale), and functional disability (by using the Revised Oswestry Disability Questionnaire). Satisfaction was a secondary outcome. Results: Overall, long-term pain and disability outcomes were generally equivalent for patients seeking care from medical or chiropractic physicians. Medical and chiropractic care were comparable for patients without leg pain and for patients with leg pain above the knee. However, an advantage was noted for chronic chiropractic patients with radiating pain below the knee after adjusting for baseline differences in patient and complaint characteristics between MD and DC cohorts (adjusted differences = 8.0 to 15.2; P < .002). A greater proportion of chiropractic patients were satisfied with all aspects of their care ( P = .0000). The strongest predictors of primary outcomes included an interaction of radiating pain below the knee with provider type and baseline values of the outcomes. Income, smoking, comorbidity, and chronic depression were also identified as predictors of outcomes in this study. Conclusion: Chiropractic care compared favorably to medical care with respect to long-term pain and disability outcomes. Further study is required to explore the advantage seen for chiropractic care in patients with leg pain below the knee and in the area of patient satisfaction. Identification of patient and treatment characteristics associated with better or worse outcomes may foster changes in physicians' practice activities that better serve these patients' needs.

Patient characteristics and physicians' practice activities for patients with chronic low back pain: A practice-based study of primary care and chiropractic physicians

Background: Chronic low back pain sufferers are among those who account for the greatest usage of health care resources. Primary care medical (MD) physicians and chiropractic (DC) physicians treat most of these patients. Objectives: To study patient characteristics and physician practice activities for patients with chronic low back pain treated by DC physicians and MD physicians. Methods: A longitudinal, practice-based observational study was undertaken in 14 general practice and 51 DC community-based clinics. A total of 2945 consecutive patients with ambulatory low back pain of mechanical origin were enrolled; 835 patients were in the chronic subgroup. Patients were followed for 12 months. Data were obtained on all of the following: patient demographics, health status, and psychosocial characteristics; history, duration, and severity of low back pain and disability; physicians' practice activities; and low back complaint status at 1 year. Results: Patients treated by MD physicians were younger and had lower incomes; their care was more often paid for by a third party; their baseline pain and disability were slightly greater. In addition, patients treated by MD physicians had one fourth as many visits as patients treated by DC physicians. Utilization of imaging procedures by enrolling physicians was equivalent for the two provider groups. Medications were prescribed for 80% of the patients enrolled by MD physicians; spinal manipulation was administered to 84% of patients enrolled by DC physicians. Physical modalities, self-care education, exercise, and postural advice characterized low back pain management in both provider groups. Patients' care-seeking was not exclusive to one provider type. Most patients experienced recurrences (patients treated by MD physicians, 59.3%; patients treated by DC physicians, 76.4%); 34.1% of patients treated by MD physicians and 12.7% of patients treated by DC physicians reported 12 months of continuous pain. Only 6.7% of patients treated by MD physicians and 10.9% of patients treated by DC physicians reported 1 resolved episode during the year. Conclusions: Differences in sociodemographics, present pain intensity, and functional disability may distinguish patients with chronic low back pain seeking care from primary care medical physicians from those seeking care from DC physicians. Although the primary treatment modality differs, the practice activities of MD physicians and DC physicians have much in common. Long-term evaluation suggests that chronic back pain is persistent and difficult to treat for both provider types. (J Manipulative Physiol Ther 2001;24:92-100)

Manipulation in the Treatment of Acute Low Back Pain

Study Design. This prospective research project statistically analyses the difference between two randomized groups of patients, one receiving manipulation plus exercises for acute low back pain of mechanical origin, the other receiving an exercise program alone. Objectives. To determine if orthopaedic manipulation is beneficial in treating acute low back pain of mechanical origin. Summary of Background Data. Orthopaedic manipulative physiotherapists have frequently observed dramatic results including elimination of pain and restoration of pain-free range of movement following manipulation of the acute locked back. Spinal manipulative therapy is a widely used method of treating lower back pain with millions of patient treatments performed each year, the majority in Western societies. Trials have emphasized the immediate and short-term symptomatic relief of low back pain following manipulation; however, the longterm difference in effects between manipulated and control groups has required further evaluation. Methods. A sample of convenience of acute low back pain participants were randomly assigned to two groups. A pre-test/post-test experimental design approach was used with 29 participants. This design included three dependent variables (pain, range of movement, and disability assessment) and one independent variable (15 participants in Group I received an exercise program with manipulation and 14 participants in Group II received an exercise program only). Participants were assessed for pain, range of movement, and disability before treatment. Participants were reassessed weekly for four weeks, then at two months and three months after initiation of treatment. Results. The findings of this study illustrate a statistically significant difference between the two treatments (p = <0.0005). Univariate post hoc tests concluded that the two treatment regimens had significantly different effects at three months on disability (p = 0.001), pain (p = <0.0005), and ROM (p = <0.0005). As well as being statistically significant, the magnitude of the relationships was strong, with 42.8% of the variability attributed to the disability measure, 64.3% of the variability attributed to the pain measure, and 65.9% of the variability attributed to the ROM measure. Conclusion. Patients who receive orthopaedic manipulation with an exercise program for acute low back pain of mechanical origin are likely to improve more than patients who receive an exercise program alone.

Low back pain of mechanical origin: randomised comparisonof chiropractic and hospital outpatient treatment: Meade TW, Dyer S, Browne W, Townsend J, Frank AO

Low back pain of mechanical origin: randomised comparisonof chiropractic and hospital outpatient treatment: Meade TW, Dyer S, Browne W, Townsend J, Frank AO

Research Study Analysis

Meade TW, Dyer S, Browne W, Townsend J, Frank AO: Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. Br Med J 300:1431–1437, 1990

Low Back Pain of Mechanical Origin: Randomized Comparison of Chiropractic and Hospital Outpatient Treatment

Reprinted with permission from the British Medical Journal 300:1431-1437.1990. Objective - To compare chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin.Design - Randomized controlled trial. Allocation to chiropractic or hospital management by minimization to establish groups for analysis of results according to initial referral clinic, length of current episode, history, and severity of back pain. Patients were followed up for up to two years.Setting - Chiropractic and hospital outpatient clinics in 11 centers.Patients - 741 patients aged 18-65 who had no contraindications to manipulation and who had not been treated within the past month.Interventions - Treatment at the discretion of the chiropractors, who used chiropractic manipulation in most patients, or of the hospital staff, who most commonly used Maitland mobilization or manipulation, or both.Main outcome measures - Changes in the score on the Oswestry pain disability questionnaire and in the results of tests of straight leg raising and lumbar flexion.Results - Chiropractic treatment was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain. A benefit of about 7 percent points on the Oswestry scale was seen at two years. The benefit of chiropractic treatment became more evident throughout the follow-up period. Secondary outcome measures also showed that chiropractic was more beneficial.Conclusions - For patients with low back pain in whom manipulation is not contraindicated, chiropractic almost certainly confers worthwhile, long-term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing chiropractic into NHS practice should be considered.J Orthop Sports Phys Ther 1991;13(6):278-287.

Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment.

To compare chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin. Randomised controlled trial. Allocation to chiropractic or hospital management by minimisation to establish groups for analysis of results according to initial referral clinic, length of current episode, history, and severity of back pain. Patients were followed up for up two years. Chiropractic and hospital outpatient clinics in 11 centres. 741 Patients aged 18-65 who had no contraindications to manipulation and who had not been treated within the past month. Treatment at the discretion of the chiropractors, who used chiropractic manipulation in most patients, or of the hospital staff, who most commonly used Maitland mobilisation or manipulation, or both. Changes in the score on the Oswestry pain disability questionnaire and in the results of tests of straight leg raising and lumbar flexion. Chiropractic treatment was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain. A benefit of about 7% points on the Oswestry scale was seen at two years. The benefit of chiropractic treatment became more evident throughout the follow up period. Secondary outcome measures also showed that chiropractic was more beneficial. For patients with low back pain in whom manipulation is not contraindicated chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing chiropractic into NHS practice should be considered.

Comparison of chiropractic and hospital outpatient management of low back pain: a feasibility study. Report of a working group.

This is the report of a feasibility study of a randomised controlled trial of chiropractic and hospital outpatient management for low back pain of mechanical origin. Preparations for the study included an approach to the General Medical Council for guidance about the intended collaboration between medically qualified and heterodox practitioners, detailed communication with local general practitioners, and the provision of a Medical Research Council (MRC) grant to cover payments to the chiropractors for work carried out in the course of the study. A total of 238 patients were considered, 197 of whom had initially presented to Northwick Park Hospital and the remaining 41 to the chiropractic clinic in Harrow. Only 6% of the patients presenting to the hospital refused to enter. The single most frequent reason for ineligibility in the hospital patients was freedom from pain at the time of the first hospital visit (23%). A variety of medical contraindications accounted for the exclusion of a further 24% of hospital patients. Patients presenting to the chiropractic group tended to have had shorter current episodes of back pain but to have had more NHS treatment in the past than those presenting to hospital. The commonest reason for exclusion among those presenting to the chiropractic clinic was refusal to enter (34%). Only 5% of the chiropractic patients were ineligible for medical reasons. Overall, 16% of those presenting to hospital and 44% of those presenting to the chiropractors were eligible and willing to enter the randomised treatment phase of the study. Of the 50 patients who entered the treatment phase, all but seven completed treatment and the six weekly self-completed assessments of progress. Patients whose current episodes had lasted less than a month progressed significantly more rapidly than those with longer current episodes. It is likely that sufficient numbers of patients with low back pain are prepared to take part in a formal randomized controlled trial. The organization and working methods for such a trial appear to be feasible. A full scale multicentre trial should aim to include about 2000 patients.