Cases Of Low Back Pain Research Articles

Effect of Vatari Guggulu in the management of Gridhrasi (sciatica).

Introduction:Low back pain is one of the common conditions of loco motor system disorder, affects people during their productive life. About 40% cases of low back pain are of radicular in origin and considered under the umbrella of sciatic syndrome. It is a pain dominant disease and reduces human activity considerably in terms of personal as well as social and professional life. The condition resembles disease Gridhrasi mentioned in Ayurveda under the umbrella of Vatavyadhi, and here piercing type of pain which restricts the movement of the affected leg, make his walking pattern-like bird vulture and put him in disgraceful condition.Aim:To assess the effect of Vatari Guggulu on the management of Gridhrasi.Materials and Methods:A total of 40 patients of Gridhrasi were registered and Vatari Guggulu 3 tablet (500 mg each) twice a day was administered before meal with lukewarm water for 30 days.Results and Conclusions:About 32.35% of the patient improved moderately while mild improvement was observed in 47.09% of the patients. The drug has shown better effect on patients of Vata Kaphaja type of Gridhrasi in comparison of Vataja type of Gridhrasi.

A Brief Review of Physical and Psychosocial Factors Involved in Chronic Low Back Pain

There is a high incidence of low back pain (LBP) in developed countries. Researchers have investigated potential occupation setting(s) that increase the risk of LBP and have reported numerous job related adaptations to reduce the various identified risks. However, chronic LBP results in approximately 10% of all reported LBP cases which can result in frustrating prolonged disability and extensive financial costs to the healthcare system. In the absence/successful treatment of medical and neurological pathology, biopsychosocial interventions may assist chronic LBP sufferers regain their personal and professional lifestyle. Following the biopsychological intervention model, recent research indicates that following ‘normal’ clinical practice guidelines for LBP and the feedback/recommendations made by healthcare practitioners (physicians’ and therapists’) plays a crucial role in chronic LBP patients treatment and recovery duration.

Lower back pain

Lower back pain (LBP) is one of the most common and costly medical problems today [1, 2]. Pain is usually transitory and can arise from the intervertebral discs, bones, ligaments and muscles of the spine. Risk factors for LBP include genetic, environmental, psychosocial and biomechanical influences [3]. However, although 85% of LBP cases have no clear etiology, 97% may be due to musculoskeletal issues [4]. Lumbar curvature (lordosis) is one factor that generates shearing between adjacent vertebrae and at intervertebral joints. People with high degrees of lumbar lordosis, including pregnant women, can experience excessive shearing (Fshear) and compression (Fcompression) forces between lumbar vertebrae, most often between the last lumbar and the sacrum [3, 5]. In addition to other factors, including age-related spinal degeneration, high levels of Fshear and Fcompression can lead to painful muscle strain, joint capsule pain, disc herniation, inflammation (spondylitis), bone degeneration (spondylolysis) and vertebral displacement (spondylolisthesis) [3–5]. Evolutionary perspectives

Non-specific low back pain in adolescents from the south of Portugal: prevalence and associated factors

Background Low back pain (LBP) is a common condition in children and adolescents, and the prevalence has been increasing over the years. Most cases of LBP are due to non-specific causes; however, the role of these risk factors is still controversial. This study determined the prevalence of LBP in Portuguese adolescents and characterized the associated factors.Methods The design of this study was observational, analytical and cross-sectional. The sample included 966 adolescents from southern Portugal, aged between 10 and 16 years. The assessments included a questionnaire to characterize the presence of LBP, postural habits, body mass index (BMI) and backpack weights and to use a scoliometer to evaluate the presence of scoliosis.Results One hundred fifty-two (15.7 %) students had LPB at the present time, 456 (47.2 %) had experienced it in the last year, and 600 (62.1 %) had lifetime prevalence of LBP. Girls have 2.05 more probability of presenting LBP than boys (95 % CI 1.58–2.65; p < 0.001), and older students have a 1.54 greater probability (95 % CI 1.19–1.99; p = 0.001). Students who sit with the spine incorrectly positioned presented 2.49 greater probability of having LBP (95 % CI 1.91–3.2; p < 0.001), students using improper positions for watching TV or playing games have 2.01 greater probabilities (95 % CI 1.55–2.61; p < 0.001), and those who adopt an incorrect standing posture have a 3.39 greater chance of experiencing LBP (95 % CI 2.19–5.23; p < 0.001).Conclusions This study found a high prevalence of LBP in adolescents, with higher values in older students, female students and those who adopted incorrect positions when sitting or standing.

Minimally invasive facet restoration implant for chronic lumbar zygapophysial pain: 1-year outcomes.

BackgroundThe zygapophysial (facet) joint is the primary pain generator in one third of chronic low back pain cases. Current treatment options include temporarily palliative nonsurgical approaches, facet injections, radiofrequency denervation, and, rarely, lumbar arthrodesis. The purpose of this study was to assess the safety and effectiveness of a minimally invasive implant intended to restore facet joint function in patients with chronic lumbar facetogenic pain.MethodsThis prospective, multi-center feasibility study enrolled patients with confirmed lumbar facetogenic joint pain at 1 or 2 levels who underwent at least 6 months of unsuccessful nonoperative care. Patients received a minimally invasive implant (Glyder® Facet Restoration Device, Zyga Technology, Inc., Minnetonka, MN) intended to restore facet joint function while preserving the native anatomy. Main outcomes included back pain severity using a visual analogue scale, back-specific disability using the Oswestry Disability Index (ODI), and adverse events adjudicated by an independent Clinical Events Committee.ResultsOf 40 enrolled patients, 37 patients received the facet restoration implant and 34 patients had complete 1-year follow-up data available. Over the 1-year follow-up period, back pain severity decreased 41% and ODI decreased 34%, on average. Freedom from a device- or procedure-related serious adverse event through 1 year was 84%. Implant migration was observed in 3 patients and implant expulsion from the facet joint occurred in 3 patients. In total, 2 (5.4%) patients underwent implant removal through 1 year post-treatment.ConclusionsA minimally invasive facet restoration implant is a promising treatment option in select patients with chronic lumbar zygapophysial pain who have exhausted nonsurgical treatments, with therapeutic benefit persisting at 1 year follow-up.

Multidimensional pain profiles in four cases of chronic non-specific axial low back pain: An examination of the limitations of contemporary classification systems

Classifying patients with chronic low back pain (CLBP) may facilitate targeted treatment, and optimise outcomes. Most classification systems (CS) do not consider multiple, interacting dimensions (for example, psychological or movement dimensions) involved in the lived experience of people with CLBP. A framework incorporating these multiple dimensions, and acknowledging individual variability, could provide a pathway to better assess and treat people with CLBP. Here we explored this proposition, presenting four cases (P1–4), profiling their clinical presentations within a multidimensional framework.P1's profile was characterised by localised lumbar sensitisation consistent with dominant peripheral nociception. P2 presented a ‘mixed’ profile characterised by localised lumbar hypersensitivity, combined with factors suggestive of centrally-mediated facilitation of nociception. P3's profile suggested widespread hypersensitivity possibly reflective of dominant centrally-mediated pain mechanisms. P4's profile was characterised by dominant psychosocial factors and comorbidities.These cases are discussed in relation to contemporary CLBP CS, highlighting the complexity of these disorders and limitations of CS for people with CLBP and their treating health professionals. This paper reinforces the need for a consensus CS for people with CLBP that is flexible, has clinical utility and considers all relevant dimensions.

Transforaminal Epidural Injections in Chronic Lumbar Disc Herniation: A Randomized, Double-Blind, Active-Control Trial

Background: The estimated prevalence of lumbar radiculopathy has been described as 9.8 per 1,000 cases of low back pain. There are various surgical and nonsurgical modalities for treating lumbar disc herniation or radicular pain, including epidural injections. Epidural injection administration routes include transforaminal, interlaminar, and caudal approaches. The transforaminal approach requires the smallest volume to reach the primary site of pathology. Systematic reviews have yielded highly variable results, but a recent systematic review showed no significant difference among the 3 approaches. Study Design: A randomized, controlled, double blind, active control trial. Setting: An interventional pain management practice, a private specialty referral center in the United States. Objectives: To assess the effectiveness of transforaminal epidural injections of local anesthetic with or without steroids in managing chronic low back and lower extremity pain in patients with disc herniation and radiculitis. Methods: One hundred twenty patients were randomly assigned to 2 groups: Group I received 1.5 mL of 1% preservative-free lidocaine, followed by 0.5 mL of sodium chloride solution. Group II received 1% lidocaine, followed by 3 mg, or 0.5 mL of betamethasone. The sodium chloride solution and betamethasone were either clear liquids or were provided in opaquecovered syringes. Outcomes Assessment: The primary outcome measure was significant improvement (at least 50%) measured by the average Numeric Rating Scale (NRS) and the Oswestry Disability Index 2.0 (ODI). Secondary outcome measures were employment status and opioid intake. Results: At 2 years there was significant improvement in all participants in 65% who received local anesthetic alone and 57% who received local anesthetic and steroid. When separated into non-responsive and responsive categories based on initial relief of at least 3 weeks with 2 procedures, significant improvement (at least 50% improvement in pain and function) was seen in 80% in the local anesthetic group and 73% in the local anesthetic with steroid group. Limitations: Presumed limitations of this evaluation include the lack of a placebo group. Conclusion: Transforaminal epidural injections of local anesthetic with or without steroids might be an effective therapy for patients with disc herniation or radiculitis. The present evidence illustrates the lack of superiority of steroids compared with local anesthetic at 2-year follow-up. Key words: Chronic low back pain, transforaminal epidural injections, disc herniation, radiculitis, lower extremity pain, local anesthetic, steroids

Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis.

BackgroundClinicians commonly examine posture and movement in people with the belief that correcting dysfunctional movement may reduce pain. If dysfunctional movement is to be accurately identified, clinicians should know what constitutes normal movement and how this differs in people with low back pain (LBP). This systematic review examined studies that compared biomechanical aspects of lumbo-pelvic movement in people with and without LBP.MethodsMEDLINE, Cochrane Central, EMBASE, AMI, CINAHL, Scopus, AMED, ISI Web of Science were searched from inception until January 2014 for relevant studies. Studies had to compare adults with and without LBP using skin surface measurement techniques to measure lumbo-pelvic posture or movement. Two reviewers independently applied inclusion and exclusion criteria, and identified and extracted data. Standardised mean differences and 95% confidence intervals were estimated for group differences between people with and without LBP, and where possible, meta-analyses were performed. Within-group variability in all measurements was also compared.ResultsThe search identified 43 eligible studies. Compared to people without LBP, on average, people with LBP display: (i) no difference in lordosis angle (8 studies), (ii) reduced lumbar ROM (19 studies), (iii) no difference in lumbar relative to hip contribution to end-range flexion (4 studies), (iv) no difference in standing pelvic tilt angle (3 studies), (v) slower movement (8 studies), and (vi) reduced proprioception (17 studies). Movement variability appeared greater for people with LBP for flexion, lateral flexion and rotation ROM, and movement speed, but not for other movement characteristics. Considerable heterogeneity exists between studies, including a lack of detail or standardization between studies on the criteria used to define participants as people with LBP (cases) or without LBP (controls).ConclusionsOn average, people with LBP have reduced lumbar ROM and proprioception, and move more slowly compared to people without LBP. Whether these deficits exist prior to LBP onset is unknown.

Use of Department of Veterans Affairs administrative data to identify veterans with acute low back pain: a pilot study.

This work compared administrative data obtained from the Department of Veterans Affairs (VA) databases with structured chart review. We set out to determine whether a decision tool using administrative data could discriminate acute from nonacute cases among the many patients seen for a low back pain (LBP)-related diagnosis. Large health care systems' databases present an opportunity for conducting research and planning operations related to the management of highly burdensome conditions. An efficient method of identifying cases of acute LBP in these databases may be useful. This was a retrospective review of all consecutive Iraq and/or Afghanistan Veterans seen in a VA primary care service during a 6-month period. Administrative data were extracted from VA databases. Patients with at least 1 encounter that was coded with at least 1 LBP-related ICD-9 code were included. Structured chart review of electronic medical record free text was the "gold standard" to determine acute LBP cases. Logistic regression models were used to assess the association of administrative data variables with chart review findings. We obtained complete data on 354 patient encounters, of which 83 (23.4%) were designated acute upon chart review. No diagnostic code was more likely to be used in acute cases than nonacute. We identified an administrative data model of 18 variables that were significant and positively associated with an acute case (C-statistic = 0.819). A reduced model of 5 variables including a lumbar magnetic resonance imaging order, tramadol prescription, skeletal muscle relaxant prescription, physical therapy order, and addition of a new LBP-related ICD-9 code to the electronic medical record remained reasonable (C-statistic = 0.784). Our results suggest that a decision model can identify acute from nonacute LBP cases in Veterans using readily available VA administrative data. N/A.

THU0350 Ultrasonographic Study of the Piriformis Muscle and Sonographic Features of the Piriformis Syndrome in Chronic Low Back Pain

BackgroundPiriformis Syndrome is thought to account for about 5 to 10 percent of the cases of chronic low back and gluteal pain and could cause debilitating chronic suffering. However as...

A Case of Severe Low Back Pain After Surgery

ABSTRACTThe etiology of chronic back pain is often unknown but can include failed spinal surgery. Pain can often be of mixed type and it is important to evaluate pain mechanisms.Comorbid factors often contribute to pain chronicity. Multimodal treatment, including opioid rotation where indicated, may offer a successful management approach. Other rehabilitative procedures such as physiotherapy, exercise therapy, and good sleep hygiene may have a profound impact on patient quality of life. Spinal cord stimulation may be an effective option for some patients with failed spinal surgery syndrome. A case of severe low back pain after surgery in a 45-year-old man is presented to illustrate this.This report is adapted from paineurope 2013; Issue 4, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be accessed via the Web site: http://www.paineurope.com, at which European health professionals can register online to receive copies of the quarterly publication.

Prevention and Treatment of Intervertebral Disc Degeneration with Bone Marrow Derived Stem (Stromal) Cells—An in Vivo Study in Sheep

Introduction Intervertebral disc degeneration (IVDD) is implicated in 40% of low back pain (LBP) cases. A total of 80% of people will be affected by LBP some time in their lifetime. LBP has a considerable socioeconomic impact, costed at $100 billion in the United States in 2006 and $9.17 billion in Australia in 2001. LBP was designated a National Health Priority in Australia in 2009. Current options for the treatment of IVDD is by surgical intervention (spinal fusion) no disease modifying drug treatments are currently available. Recent studies suggest that mesenchymal stem cells (MSCs) offer therapeutic promise in IVDD, preclinical studies. In the present study, we have examined the efficacy of bone marrow derived mesenchymal stem cells (BMMSCs) for the treatment of IVDD in an ovine large animal model of IVDD.1 Materials and Methods A single pool of heterologous ovine BMMSCs was isolated and culture expanded up to passage 8. These BMMSCs were CD44 and CD106 +ve and CD34, CD45 and CD11b −ve by FACS analysis and capable of undergoing adipogenesis, osteogenesis, or chondrogenesis in appropriate selection medias. Disc degeneration was induced using a controlled 6 × 20 mm annular lesion in the L1L2, L3L4, and L5L6 IVDs of 3-year-old merino wethers. BMMSCs (10 million cells/0.2 mL PBS/disc) or PBS carrier (0.2 mL) were injected into the NP of these IVDs in which degeneration was induced for 4 (short- and long-term acute groups) or 12 weeks (established IVDD group) ( n = 6 sheep/group), animal sacrifice undertaken 8, 14, or 22 weeks later. The outcome measures used in this study were histology, gene profiling by qRT-PCR, biomechanical testing, and biochemical composition. The spines were also imaged by MRI and by radiography to assess changes in the IVDs. Results A re-attainment of 90 to 95% of the prelesion disc height was evident in MSC injected but not PBS carrier injected discs. The MSC injected lesion discs also recovered their GAG contents close to those evident in age matched NOC IVDs. MSC injection either normalized or inhibited MMP2, 3, 13 or ADAMTS4 or 5 expression in all tissue zones of the lesion affected discs. Histology clearly showed a significant reduction in the propagation of the annular lesions in the MSC injected discs. Conclusion (1) MSCs promoted repair of annular lesions and reduced degenerative IVD pathology. (2) A 90 to 95% recovery in disc heights was obtained in the MSC injected lesion discs. (3) MMP2, 3, 13, ADAMTS4, and 5 were all downregulated in lesion affected IVDs by MSC injection. (4) The GAG content of the AF and NP zones of MSC injected lesion discs were close to that of NOC IVDs at sacrifice. (5) MSCs display considerable therapeutic promise not only for the regeneration of a degenerate disc but also as a preventative measure to reduce progressive deleterious changes in established annular lesions. A potential mechanism of action of BMMSCs through modulation of metalloproteinase expression was identified. This study has shown for the first time in a large animal model relevant to the human condition that BMMSC represent a clinically relevant therapy for IVDD. Disclosure of Interest None declared Reference Melrose J, Shu C, Young C, et al. Mechanical destabilization induced by controlled annular incision of the intervertebral disc dysregulates metalloproteinase expression and induces disc degeneration. Spine 2012;37(1):18–25

Pathological End Plate Alterations in Disc Degeneration

Discogenic pain accounts for approximately 40% of chronic low back pain cases, affecting 1 to 2 million adults between age 45 and 64 years in the United States. The putative pain generator in discogenic pain patients is usually considered intrinsic to the disc. Crock defined internal disc disruption as damage of internal disc structures while the external shape remains essentially normal, and no nerve root compression is present. However, the vertebral end plate is also a source of pain. It is the weak link during spinal compression, can sustain damage at loads well below those that cause disc herniation or vertebral fracture, and is innervated comparable to the outer annulus. Further evidence of the clinical importance of the vertebral end plate is the association between vertebral marrow abnormalities and discogenic pain. Data from multiple independent studies suggest that Modic Types I and II adjacent to the end plate are among the most specific of all MRI observations for predicting concordant discography-induced pain. In one prospective study, moderate-to-severe Modic Types I or II end plate abnormalities correlated 100% of the time with positive concordant pain at the adjacent disc. Recently, increased end plate innervation has also been reported for end plates with Modic changes. End plates serve as the interface between rigid vertebral bodies and pliant intervertebral discs. Because the lumbar spine carries significant forces and discs do not have a dedicated blood supply, end plates must balance conflicting requirements of being strong to prevent vertebral fracture and porous to facilitate transport between disc cells and vertebral capillaries. Consequently, end plates are particularly susceptible to damage, which can increase communication between proinflammatory disc constituents and vascularized vertebral bone marrow. End plate damage regions can be sites of reactive bone marrow lesions that include proliferating nerves, which are susceptible to chemical sensitization and mechanical stimulation. While several lines of evidence indicate that innervated end plate damage can be a source of chronic low back pain, its role in patients is likely underappreciated because innervated damage is poorly visualized with diagnostic imaging. This literature review summarizes end plate biophysical function and aspects of pathologic degeneration that can lead to vertebrogenic pain. Disclosure of Interest Consultant for Relievant MedSystems Consultant for Nocimed, LLC

Human Degenerate Discs Show Increased Activation of Intracellular Signalling Pathways of IL-1

Introduction Intervertebral disc degeneration is implicated in 40% of low back pain cases. Interleukin 1 (IL-1) is known to be important in the pathogenesis of intervertebral disc (IVD) degeneration, here we investigated the intracellular signaling pathways activated by IL-1 and determined the activation status of these pathways in native IVD tissues highlighting potential pathways for new therapies. Materials and Methods Human nucleus pulposus cells (NP) removed during discetomy for nerve root pain were stimulated with IL-1 for 30 minutes. The activation of ERK1/2, p38, c-jun, and IκB were determined using cell-based enzyme-linked immunosorbent assays, in addition pNFκB localisation in stimulated cells was determined using immunohistochemistry. Localisation of phosphorylated c-jun, p38, ERK1/2, and NFκB together with IL-1 was investigated within paraffin embedded sections of human IVD to investigate the presence of active pathways in vivo . Pretreatment with inhibitors of p38, c-jun, and NFκB for 30 minutes before stimulation with IL-1 (10 ng/mL) for 48 hours was investigated to determine the ability of individual signaling inhibitors to block the catabolic responses induced by IL-1. Results IL-1-induced activation of p38, MAPK, ERK ½, JNK/c-jun, and NFκB signaling pathways in human NP cells. IVD tissue samples displayed immunopositive staining for phosphorylated c-jun, ERK1/2, NFκB, and p38, immunopositivity was significantly increased within degenerate discs, particularly in those discs which also expressed high levels of IL-1. Inhibition of individual signaling pathways demonstrated differential regulation of the pleathora of IL-1-induced catabolic events, with different signaling molecules shown to regulate matrix metalloproteases, cytokines, and factors involved in innervation and angiogenesis of the disc. Conclusion Here, we have shown that the signaling pathways activated by IL-1 in vitro display increased activation in vivo during disc degeneration. Inhibitors of these pathways demonstrated multiple signaling pathways were involved in the pleathora of IL-1 actions. Thus, inhibition of signaling pathways could be a novel mechanism to inhibit catabolic processes which could hold promise to inhibit degeneration at early stages of disease but also create the correct tissue niche to promote regeneration of the disc. Disclosure of Interest None declared

English

Piriformis syndrome is a painful musculoskeletal condition resembling sciatica, secondary to sciatic nerve entrapment in piriformis muscle at the greater sciatic notch and responsible for 6%cases of low back pain, also called back pocket sciatica or wallet sciatica, first described in 1928 by Yeoman. It usually occurs due to abnormalities in piriformis muscle such as hypertrophy, inflammation and anatomic variations resulting in irritation and entrapment of sciatic nerve. The diagnosis of piriformis syndrome is made by clinical features, electromyography and nerve conduction velocity, computed tomography, magnetic resonance imaging and bone scan. Management of piriformis syndrome includes nonsurgical and surgical interventions. Non-surgical management includes- nonsteroidal anti-inflammatory drugs, physical therapy, ultrasound, correction of biomechanical abnormality, lifestyle modifications, local anesthetic and/or steroid injection into the piriformis muscle. Surgical management includes-surgical release of piriformis muscle and decompression of the sciatic nerve. Piriformis Syndrome- a review.

(327) Cognitive modulation of pain before and after real-time fMRI neurofeedback training: Improving brain state classification

Many chronic low back pain (cLBP) cases show no skeletal pathology. Because of this, investigation of brain structure and function can give insights into the mechanisms underlying the chronic pain. Our group has previously found that patients can be trained to control activation of localized brain regions by using feedback derived from real-time functional MRI.1 Further, control of activation in the rostral anterior cingulate cortex region can change perception of pain and may provide a clinical approach to treatment of severe pain associated with cLBP.

Heavy physical work and low back pain: the reality in urban cleaning.

Low back pain (LBP) is a major public health issue. There is lack of research on this disorder affecting urban cleaning workers. A cross-sectional study was conducted to describe the prevalence of LBP, occupational and extra-occupational characteristics, as well as associated factors in these workers. A census was performed with 624 workers in Salvador, Brazil, using a questionnaire administered by an interviewer in 2010. Cases of LBP were defined by reported symptoms of pain in the previous 12 months, lasting more than a week or with monthly minimum frequency, which led to restrictions at work or to seeking medical attention, or in cases when respondents had a severity score > 3 on a numerical scale from 0 to 5. Physical demands at work were measured on a numerical 6-point scale with 14 variables. Psychosocial demands were measured using the Job Content Questionnaire. Sociodemographic factors, lifestyle habits and domestic work were evaluated. Multiple logistic regression (LR) was used to identify factors associated with LBP, for which the prevalence was 37.0%. Among them, 62.8% of workers felt pain in the last 7 days. LBP was associated with longer working hours, flexion and trunk rotation, psychosocial demands, working directly in collection and low schooling. Dynamic work (walking, running) served as a protective factor. It was concluded that many workers develop their activity at the presence of pain. The results emphasize the need for preventive measures through multifactorial approach encompassing adaptations in physical environment and changes in work organization.

Heavy physical work and low back pain: the reality in urban cleaning

Low back pain (LBP) is a major public health issue. There is lack of research on this disorder affecting urban cleaning workers. A cross-sectional study was conducted to describe the prevalence of LBP, occupational and extra-occupational characteristics, as well as associated factors in these workers. A census was performed with 624 workers in Salvador, Brazil, using a questionnaire administered by an interviewer in 2010. Cases of LBP were defined by reported symptoms of pain in the previous 12 months, lasting more than a week or with monthly minimum frequency, which led to restrictions at work or to seeking medical attention, or in cases when respondents had a severity score > 3 on a numerical scale from 0 to 5. Physical demands at work were measured on a numerical 6-point scale with 14 variables. Psychosocial demands were measured using the Job Content Questionnaire. Sociodemographic factors, lifestyle habits and domestic work were evaluated. Multiple logistic regression (LR) was used to identify factors associated with LBP, for which the prevalence was 37.0%. Among them, 62.8% of workers felt pain in the last 7 days. LBP was associated with longer working hours, flexion and trunk rotation, psychosocial demands, working directly in collection and low schooling. Dynamic work (walking, running) served as a protective factor. It was concluded that many workers develop their activity at the presence of pain. The results emphasize the need for preventive measures through multifactorial approach encompassing adaptations in physical environment and changes in work organization.

Diagnostic Labels Assigned to Patients With Orthopedic Conditions and the Influence of the Label on Selection of Interventions: A Qualitative Study of Orthopaedic Clinical Specialists

A variety of diagnostic classification systems are used by physical therapists, but little information about how therapists assign diagnostic labels and how the labels are used to direct intervention is available. The purposes of this study were: (1) to examine the diagnostic labels assigned to patient problems by physical therapists who are board-certified Orthopaedic Clinical Specialists (OCSs) and (2) to determine whether the label influences selection of interventions. A cross-sectional survey was conducted. Two written cases were developed for patients with low back and shoulder pain. A survey was used to evaluate the diagnostic label assigned and the interventions considered important for each case. The cases and survey were sent to therapists who are board-certified OCSs. Respondents assigned a diagnostic label and rated the importance of intervention categories for each case. Each diagnostic label was coded based on the construct it represented. Percentage responses for each diagnostic label code and intervention category were calculated. Relative importance of intervention category based on diagnostic label was examined. For the low back pain and shoulder pain cases, respectively, "Combination" (48.5%, 34.9%) and "Pathology/Pathophysiology" (32.7%, 57.3%) diagnostic labels were most common. Strengthening (85.9%, 98.1%), stretching (86.8%, 84.9%), neuromuscular re-education (87.6%, 93.4%), functional training (91.4%, 88.6%), and mobilization/manipulation (85.1%, 86.8%) were considered the most important interventions. Relative importance of interventions did not differ based on diagnostic label (χ2=0.050-1.263, P=.261-.824). The low response rate may limit the generalizability of the findings. Also, examples provided for labels may have influenced responses, and some of the label codes may have represented overlapping constructs. There is little consistency with which OCS therapists assign diagnostic labels, and the label does not seem to influence selection of interventions.

Self-Management of Non-Specific Low Back Pain

Copyright: © 2014 Oliveira VC. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Low back pain (LBP) is the number one cause of years lived with disability globally [1]. The specific pathoanatomical causes are unclear for 85% of all cases of LBP and these cases are classified as non-specific [2]. The most consistently recommended treatments for non-specific LBP in clinical guidelines (e.g., supervised exercise therapy and cognitive behavioural therapy) [3] have at best moderate effects on patients’ clinical outcomes (85% of treatments had point estimates of ≤ 20 points on 100-point scale) [4]. A major problem for currently recommended treatments is that people with incomplete recovery of LBP or with recurrent episodes often seek further treatment [5], initiating a process of dependence on health care services, and increasing the economic burden of the condition [6]. A potential solution for the process of dependence on health care services is to shift from traditional models of care where the patient is a passive recipient of treatment, to models where patients are actively involved in the management of their LBP [7]. Self-management has been described as a model of care where patients use strategies to manage and monitor their own health, retaining a primary role in management, and where they learn skills to be used in the daily management of their health condition [7]. Written information, discussion sessions and audiovisual resources (audiotape, videotape and web site) have been used as self-management strategies for LBP, and the amount of support given by health care providers varies from one to thirteen sessions [8]. Furthermore, self-management has been advocated for LBP [7,9]. There is a growing awareness that LBP is a long term condition and self-management could decrease dependence and the burden of this condition [7,9].