Chronic Lumbar Pain Research Articles

Do Comorbid Fibromyalgia Diagnoses Change After a Functional Restoration Program in Patients With Chronic Disabling Occupational Musculoskeletal Disorders?

A retrospective study of prospectively collected data. To determine whether comorbid fibromyalgia, identified in patients with chronic disabling occupational musculoskeletal disorders (CDOMDs), resolves with a functional restoration program (FRP). Fibromyalgia involves widespread bodily pain and tenderness to palpation. In recent studies, 23% to 41% of patients with CDOMDs entering an FRP had comorbid fibromyalgia, compared with population averages of 2% to 5%. Few studies have examined whether fibromyalgia diagnoses resolve with any treatment, and none have investigated diagnosis responsiveness to an FRP. A consecutive cohort of patients with CDOMDs (82% with spinal disorders and all reporting chronic spinal pain) and comorbid fibromyalgia (N = 117) completed an FRP, which included quantitatively directed exercise progression and multimodal disability management. Diagnosis responsiveness, evaluated at discharge, created 2 groups: those who retained fibromyalgia and those who did not. These groups were compared with chronic regional lumbar pain only patients (LO group, n = 87), lacking widespread pain and fibromyalgia. Of the patients with comorbid fibromyalgia, 59% (n = 69) retained the fibromyalgia diagnosis (RFM group) and 41% (n = 48) lost the fibromyalgia diagnosis (LFM group) at discharge. Although all 3 groups reported decreased pain intensity, disability, and depressive symptoms from admission to discharge, RFM patients reported higher symptom levels than the LFM and LO groups at discharge. The LFM and LO groups were statistically similar. At 1-year follow-up, LO patients demonstrated higher work retention than both fibromyalgia groups (P < 0.03). Despite a significant comorbid fibromyalgia prevalence in a cohort of patients with CDOMDs entering an FRP, 41% of patients with an initial fibromyalgia diagnosis no longer met diagnostic criteria for fibromyalgia at discharge and were indistinguishable from LO patients on pain, disability, and depression symptoms. However, both fibromyalgia groups (LFM and RFM) had lower work retention than LO patients 1 year later, suggesting that an FRP may suppress symptoms of fibromyalgia in a subset of patients, but prolonged fibromyalgia-related disability may be more difficult to overcome. 2.

Controlled medial branch anesthetic block in the diagnosis of chronic lumbar facet joint pain: the value of a three-month follow-up

OBJECTIVES:To verify the incidence of facetary and low back pain after a controlled medial branch anesthetic block in a three-month follow-up and to verify the correlation between the positive results and the demographic variables.METHODS:Patients with chronic lumbar pain underwent a sham blockade (with a saline injection) and then a controlled medial branch block. Their symptoms were evaluated before and after the sham injection and after the real controlled medial branch block; the symptoms were reevaluated after one day and one week, as well as after one, two and three months using the visual analog scale. We searched for an association between the positive results and the demographic characteristics of the patients.RESULTS:A total of 104 controlled medial branch blocks were performed and 54 patients (52%) demonstrated >50% improvements in pain after the blockade. After three months, lumbar pain returned in only 18 individuals, with visual analogue scale scores >4. Therefore, these patients were diagnosed with chronic facet low back pain. The three-months of follow-up after the controlled medial branch block excluded 36 patients (67%) with false positive results. The results of the controlled medial branch block were not correlated to sex, age, pain duration or work disability but were correlated with patient age (p<0.05).CONCLUSION:Patient diagnosis with a controlled medial branch block proved to be effective but was not associated with any demographic variables. A three-month follow-up is required to avoid a high number of false positives.

Abdominal aortic aneurysm causing lumbar vertebral erosion in Behçet’s disease presenting by low back pain

Behçet's disease (BD) is a chronic multi-system disorder commonly seen in Mediterranean, middle east and far eastern populations. In this report, we describe a case of a 55-year-old male with Behçet's disease who presented with a low back pain and sciatica. Imaging studies showed that he had a destruction of the third lumbar vertebra because of abdominal aortic aneurysm-related Behçet's disease. Aortic aneurysms with vertebral body erosion have been rarely reported, but this vascular complication is a life-threatening clinical picture. Therefore, among the causes of chronic lumbar pain in a BD patient, abdominal aortic aneurysm should be remembered.

A comparison of pain levels after the Biering-Sorensen and the modified 20-metre shuttle test in patients with chronic low back pain

The Biering-Sorensen Test (BST) is a useful and well validated assessment tool in patients with chronic lumbar pain. However there is sometimes concern that it may lead to an unwarranted increase in pain. This study compared pain levels before and after the BST against a currently accepted functional assessment tool- the modified 20-metre shuttle test (MST)- in military patients with chronic low back pain. 56 patients with non-specific lumbar pain of more than three months duration were tested on admission and discharge from a three week in-patient rehabilitation programme using the BST and the MST. A questionnaire was used to assess pain levels before and after both tests on admission and discharge from the group. The BST was carried out before the MST, with a time delay of 30-60 minutes. There were significant increases in pain immediately after both the MST and the BST (range of mean increase: 2.2 to 3.2 points, p< 0.001). The mean absolute levels of pain after the BST on admission and discharge were 0.26 and 0.80 more than the levels after the MST. The mean increases were 0.36 and 1.16 more after the BST compared to that after the MST. Pain levels returned to normal within 60 minutes of the BST being completed. Using either comparison method, although the initial increases after the BST were slightly more, the amounts were comparable and much less that the minimal clinically important difference in pain which is 1.5.

Effects of Body Armor and Load Carriage on Lower Limb Joint Movement

This study investigated the impact of body armor weight and load magnitude and distribution on the lower extremities during walking. Range of motion (ROM) was assessed while seven healthy, male, right-handed, military university students walked while wearing seven different garments of varying weights (0.06 kg, 9 kg, 18 kg, and 27 kg) and load distributions. Decreased pelvic rotation found with an increase in weight implies decreased mobility by restricting the leg’s swing to propel the body forward. Increased ROM for pelvic tilt found with increased weight results from increased forward inclination suggesting an increased possibility for fatigue and musculoskeletal pain in the lower back. This study substantiated that a balanced weight distribution can minimize risk of chronic lumbar pain by reducing forward lean of the trunk or pelvic tilt; a balanced weight distribution around the torso at a level of 27 kg showed less change in ROM for pelvic tilt than an unbalanced weight distribution.

The active scar test: An innovative application of RAC/VAS signal for identifying scars associated with postural disorders in patients with chronic cervical and lumbar pain syndromes

The RAC/VAS signal is a technique, which belongs to the different methods of auricular diagnosis and is proposed by physicians working with Auriculomedicine. We applied a similar method on 132 actives scars carried by 67 patients with postural disorders associated with chronic cervical/lumbar pain syndromes. The Active Scar Test was performed on all visible scars using the light of a HEINE Finoff transilluminator (HFT). The decrease of the radial pulse amplitude, called RAC(−) signal, was taken into consideration in our study followed by palpation of the scar. Only scars, which showed an RAC(−) signal and which were sensitive on palpation were treated with neural therapy, which is the diagnostic and therapeutic use of local anesthetics. Two independent observers took the radial pulse on both sides and measured the following parameters of the RAC signal: its intensity (0 = no signal, 1 = light decrease; 2 = moderate decrease; 3 = evident decrease with the sensation of a collapse of the pulse); the number of pulses elapsed after lighting and before the onset of RAC(−); the number of pulsations during which the signal was perceivable. A third observer rated the sensitivity on palpation of the scar on a 4-grade scale (0 = no pain; 1 = slight pain; 2 = moderate pain; 3 = evident pain on palpation). RAC(−) signal intensity and sensitivity at palpation seem to be positively correlated and may be used in combination for identifying an active scar. In those scars (48.5 % of the total), in which the HFT evoked a bilateral RAC(−), the signal was perceived significantly more intensely, earlier and longer on the ipsilateral pulse than on the contralateral one.

Effects of Cervical Flexion on the Flexion-relaxation Ratio during Smartphone Use.

[Purpose] The purpose of this study was to measure the cervical flexion-relaxation ratio (FRR) and intensity of neck pain and identify the differences according to postures adopted while using smartphones. [Subjects] Fifteen healthy adults with no neck pain, spinal trauma, or history cervical surgery participated in this study. [Methods] The activity of the cervical erector spinae muscle was recorded while performing a standardized cervical flexion-extension movement in three phases (flexion, sustained full flexion, extension). And neck pain intensity was recorded using a visual analog scale (VAS) with values between 0 and 10. Postures held while using a smartphone are distinguished between desk postures and lap postures. The FRR was calculated by dividing the maximal muscle activation during the extension phase by average activation during the complete flexion phase. [Results] No significant differences were found in the FRR between desk posture, lap posture, and baseline, though the intensity of the neck pain increased in the lap posture. [Conclusion] The FRR could be a significant criterion of neuromuscular impairment in chronic neck pain or lumbar pain patients, but it is impossible to distinguish neck pain that is caused by performing task for a short time. Prolonged lap posture might cause neck pain, so the use of smartphones for a long time in this posture should be avoided.

Efficiency of trunk stabilizing exercises in treatment of patients with lumbar pain syndrome

Introduction: Lumbar pain syndrome is the most common cause of temporary work disability in people under 45 years of age. The aim of this study was to detect the frequency of acute and chronic lumbar painsyndrome in people of both gender, different age structures, different occupations and in active working population, and to determine the efficiency of trunk stabilizing exercises in its treatment.Methods: We analyzed 27 patients with acute and 33 patients with chronic lumbar pain syndrome from 01.01.2010 to 31.12.2012 which undergone trunk stabilizing exercises. We evaluated and scored 0 to 5the condition of respondents before treatment and after the treatment.Research results: The mean score of condition of respondents with acute lumbar pain syndrome before therapy is 2.96, whereas after treatment is 4.71. The mean score of condition of respondents with chroniclumbar pain syndrome before therapy is 3.76, whereas after treatment is 4.63.Conclusion: Treatment with trunk stabilizing exercises performed in the clinic "Praxis” leads to improved scores of condition of respondents after treatment.

PATIENTS' EXPERIENCES WITH SPINAL CORD STIMULATION FOR LUMBAR SPONDYLOTIC PAIN: COMFORT AT THE IMPLANTABLE PROGRAMMABLE GENERATOR SITE

ObjectiveSpinal cord stimulation (SCS) is an effective treatment for chronic lumbar and radicular pain resulting from lumbar spondylosis. However, a proportion of patients experience discomfort and complications related to the...

Paraparesis as the Presenting Form of a Lumbar Hemorrhagic Synovial Cyst: A Case Report and Review of the Literature.

Intraspinal synovial or ganglion cysts are uncommon lesions associated with degenerative lumbosacral spine disease. They have been reported with increasing frequency in part because of the availability of increasingly sensitive imaging studies1. These juxtafacet cysts are usually located in the lumbar spine and mostly present with back pain associated with progressive radiculopathy, or less often with spinal cord compression syndrome2-5. Hemorrhage into these cysts is uncommon but explains acute symptomatology caused by nerve root compression6. To our knowledge, there have been only sixteen cases of hemorrhagic juxtafacet cysts associated with motor deficit reported in the English-language literature2-5,7-17. We report a case in which hemorrhage into an L4-L5 juxtafacet cyst presented as paraparesis; we also describe its successful treatment and review the literature. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. An eighty-year-old man presented with a history of chronic intermittent bilateral lumbar pain. Five days before admission while exerting minor physical effort, he experienced a sudden exacerbation of lumbar pain radiating to both legs; he also noticed weakness and impaired sensation in both lower limbs that made it difficult to walk without help. He had no incontinence or bowel/bladder dysfunction. There had been no previous traumatic event, and he did not use anticoagulant medication. Findings at clinical examination revealed asymmetrical hyporeflexic paraparesis. The motor deficit was more pronounced in flexion and dorsiflexion of the ankle, was grade 3/5 in the left lower limb and grade 4/5 in the right, and there was hypesthesia in the left L4 and bilateral L5 and S1 territories. The straight leg-raising test was positive bilaterally. Computed tomography (CT) revealed an isodense left intracanalar extramedullary cystic mass adjacent to the …

Management of low back pain in general practice - is it of acceptable quality: an observational study among 25 general practices in South Tyrol (Italy).

BackgroundThere are several guidelines dealing with the management of low back pain (LBP), but only few studies on the quality of care provided within General Practices as judged against those guidelines.The objective of this study is to analyse the management of LBP in Italian General Practice and compare it with guideline recommendations.MethodsIn this observational study, all patients visiting their General Practitioners (GPs) for treatment of LBP within a 8-week period were monitored for at least four weeks with regard to symptoms and diagnostic and therapeutic interventions. Management of LBP was judged by pre-defined quality indicators based on guideline recommendations.ResultsTwenty-five of 114 eligible GPs participated in the study, representing a total of 43,012 registered patients. Of the 475 patients complaining of LBP and monitored for four weeks, 55.8% were diagnosed as having acute lumbar pain, 13.5% chronic lumbar pain, 17.1% acute sciatica, and 12.6% chronic sciatica; 76.0% underwent no technical investigations, 21.7% underwent x-rays, 5.5% MRI and 4% CT scans; 20.4% were referred to secondary care; 93.3% of all patients received some medication. In those receiving a medication, in 88.3% it was an NSAID, in 6.3% Paracetamol, in 10.4% Paracetamol combined with Codeine, and in 9% a muscle relaxants. When physiotherapy was prescribed (17,1%), it was mostly massage. Hardly more than 50% of GPs (partially) followed locally established guidelines, while the remainder seemed not to follow guidelines at all.ConclusionsOur study reveals gross deviations of GP management of LBP from current guidelines and points to two different types of deviators: those who partially follow guidelines, and those who do not follow them at all. Further research should evaluate whether these two types of deviation are best addressed by different foci of education, i.e. on knowledge versus attitudes, respectively.

Effect of Biphasic Electrical Current Stimulation on IL-1β–Stimulated Annulus Fibrosus Cells Using In Vitro Microcurrent Generating Chamber System

Human annulus fibrosus (AF) cells were stimulated in vitro with interleukin (IL)-1β and exposed to biphasic electrical currents. To identify the effect of biphasic electrical currents on the production of the extracellular matrix-modifying enzymes and inflammatory mediators in IL-1β-stimulated AF cells. Symptomatic disc degeneration is an important cause of chronic intractable lumbar pain and is associated with macrophage-mediated inflammation in the AF. The inflammatory reaction relationship has not been studied in the AF. Human AF cells were treated with 1 ng/mL IL-1β and cultured in a microcurrent generating chamber system. The levels of matrix metalloproteinase (MMP)-1, MMP-3, tissue inhibitor of metalloproteinase (TIMP)-1, TIMP-2, IL-6, IL-8, vascular endothelial growth factor (VEGF), insulin-like growth factor, and nitric oxide (NO) were measured. Expression of cyclooxygenase 2 and type I collagen mRNA was analyzed. Compared with unstimulated cells, IL-1β-stimulated AF cells produced significantly higher levels of MMP-1, MMP-3, IL-6, IL-8, NO, and VEGF, and lower levels of TIMP-1 and TIMP-2. Exposure to a 250-mV/mm field induced time-dependent increases in IL-6, NO, MMP-1, TIMP-1, VEGF, and insulin-like growth factor-1 production. The cells exposed to 500-mV/mm field produced significantly less MMP-1, TIMP-1, IL-6, and VEGF than unexposed cells (MMP-1, 17.2 ± 4.7 ng/mL vs. 27.3 ± 3.9 ng/mL, P< 0.05; TIMP-1, 12.4 ± 3.3 ng/mL vs. 22.3 ± 2.1 ng/mL, P< 0.02; IL-6, 2.5 ± 0.9 ng/mL vs. 6.39 ± 1.90 ng/mL, P< 0.05; and VEGF, 0.1 ± 0.04 ng/mL vs. 0.44 ± 0.15 ng/mL, P< 0.03). NO production was markedly increased at 500 mV/mm (P< 0.0001). We showed that exposure of IL-1β-stimulated AF cells to a 500 mV/mm inhibited MMP-1, IL-6, VEGF, and TIMP-1 production. The results suggest that biphasic electrical current stimulation may have efficacy in diminishing symptomatic disc degeneration. N/A.

SAT0426 Decreased Apprehension in Chronic Lumbar Pain : Accelerates Return to Work

BackgroundChronic lumbar pain is expensive according direct and indirect costs. The most costly patients are them with sick-leave of more than 6 months. Several studies have showed grooving interest in...

AB1103 Multidisciplinary rehabilitation in chronic lumbar pain: Long-term effect on work status

BackgroundChronic lumbar pain rests an expensive condition including direct and indirect costs. The most costly patients are them with a long sick-leave for more than 6 months, and with increasing...

AB0672 Articular hyper mobility in chronic lumbar pain : touching 10% of the patients

BackgroundChronic lumbar pain is a relative frequent pain problem, with different etiologies: a great part is of no specific origin. Another part of the problem, is the presence of increased...

Study of Relationship between Metabolic Syndrome and Bone Mineral Density on Post Menopausal Chronic Low Back Pain Patients Under Oriental Medicine Treatment

This study was performed from April, 2007 to August, 2012 with female patients who were being treated for and suffering from chronic lumbar pain for periods of 6 months and over. The 53 female patients were diagnosed with osteoporosis by having a T-Score of <-2.5 in a bone mineral density(BMD), as well as showing signs of metabolic syndrome. This was deduced by taking measurements of blood pressure, carrying out blood-chemical examinations and physical measurements such as weight, height, waist measurement and body mass index(BMI). After 5 minutes rest, the patient’s blood pressure, height and weight were measured. BMI was calculated using the equation BMI = weight (Kg)/height (m²). The patients had their blood taken in a fasted state(more than 12hours), the fasting blood sugar, total cholesterol, triglyceride, HDL-cholesterol were measured. The average BMD and T-score were calculated by measuring BMD(mg/cc) of L1-L3 using QCT. In a correlation analysis of the physical examinations, clinical character of metabolic syndrome and T-score, the result showed that age and T-score had a negative correlation(r=-0.699, p<0.01) as did triglyceride and T-score (r=-0.047, p<0.01), where as weight(r=0.239, p<0.05) and height(r-=0.329, p<0.01) and T-score had a positive correlation. There was no significant correlation with total cholesterol, HDL cholesterol, blood sugar, blood pressure and T-score. This study showed that there are significant correlations with age, weight, height and T-score. But there are no significant correlations with total cholesterol, HDL cholesterol, blood sugar, blood pressure and T-score and that these did not influence bone density. Further research with more subjects is required to determine whether there is a correlation of clinical character of metabolic syndrome and T-score.

Comparison of Contraction Rates of Abdominal Muscles of Chronic Low Back Pain Patients in Different Postures

[Purpose] This study examined the contraction rates of abdominal muscles in relation to the posture of chronic lumbar pain patients and normal subjects. [Subjects] The subjects were 17 chronic low back pain (CLBP) patients and 17 normal people between the ages of 20 and 59. [Methods] Experimental postures included a supine position, a sitting position, and a standing position. Measurements were taken at rest and during abdominal contraction. The measurement at rest was taken during expiration with comfortable breathing, and the measurement during contraction was taken at maximum expiration of forced expiration. Muscle contraction rates (on contraction and at relaxation) were calculated. [Results] There were significant differences between CLBP patients and normal subjects in the transversus abdominis (TrA) in the standing position. [Conclusion] Changes in contraction rates of the abdominal muscles of normal subjects and CLBP patients were examined in different postures at maximum expiration. It was found that the contraction rate of TrA in CLBP patients in a standing position, is significantly lower than that of normal subjects.

Bilateral lumbar hernias in a domestic shorthair cat

A 2.8-kg (6.1-lb) 4-month-old sexually intact female domestic shorthair cat was referred for evaluation of bilateral, subcutaneous lumbar masses that were presumed to be the kidneys. Physical examination findings included 2 mobile, nonpainful, 3×3-cm, bilaterally symmetric masses in the dorsolateral lumbar region. Abdominal radiography, ultrasonography, and CT confirmed bilateral body wall defects with renal herniation. Serum biochemistry profile, urinalysis, and excretory urography confirmed normal renal function. Exploratory laparotomy, reduction of the kidneys, repair of the body wall defects, bilateral nephropexy, and ovariohysterectomy were performed. There were no perioperative complications. Lumbar hernia has not been reported previously in a cat. It is important for veterinarians to be aware that although rare, lumbar hernia should be included in the list of differential diagnoses for a lumbar mass or signs of chronic lumbar pain in cats.

“Imaging” in anestesia loco-regionale e terapia del dolore: ecografia ed epiduroscopia

In the last few years imaging techniques have gained importance in locoregional anaesthesia and pain therapy. In locoregional anaesthesia, ultrasound (US) is now used together with electrical nerve stimulation (ENS). In single-shot and continuous peripheral blocks, US allows to achieve higher effectiveness and safety than older techniques (i.e. ENS only, etc.) by reducing local anaesthetic doses. Systemic toxicity risk is also reduced. Notably in orthopaedics, US is considered as the gold standard for peripheral blocks in arthroscopy (i.e. interscalene block, femoral-sciatic nerve block). Epiduroscopy is a surgical technique introduced in pain therapy at the end of the XXth century. The chance to identify and to visualize the causes of chronic lumbar pain is considered as essential in both diagnostic and therapeutic phases. It’s possible to discern between inflammatory areas, neovascularization phenomena, scar tissue and dural abnormalities. Epiduroscopy is a minimally invasive approach: a disposable endoscope is introduced through the sacral iatum and a Fogarty catheter balloon can be used both for diagnostic and therapeutic purposes: it can be used directly on scar tissue to gently cut it under direct visualization. Major indications to epiduroscopy are spinal canal stenosis and FBSS (failed back surgery syndrome).

Percutaneous intrarenal marsupialization of symptomatic peripelvic renal cysts: A single-centre experience in China

Objective.The aim of this study was to report the authors' experience with percutaneous intrarenal marsupialization of symptomatic peripelvic renal cysts. Material and methods. Thirty-one patients (16 male and 15 female, with a mean age of 49 years) with a peripelvic renal cyst associated with chronic flank or lumbar pain or urinary infection were selected for percutaneous intrarenal marsupialization with a 2 μm laser in the authors' centre from January 2005 to December 2010. Cyst size ranged from 4.5 to 10.5 (mean 6.0) cm. The cysts were punctured by a percutaneous technique guided by ultrasonography, a 20.8 F nephroscope was introduced and the whole internal surface of the cyst was inspected. Methylene blue was injected through the ureteral catheter to help identify the collecting system. A 1.5–4 cm incision was made at the avascular area of the cystic wall by the 2 μm laser to achieve intrarenal marsupialization of the cyst into the renal collecting system. One or two 6 F double-J stents were placed with the proximal end in the cyst for 2–3 months. Results.The mean operation time was 50 (25–120) min. No serious complications such as massive bleeding, urine leak or infected haematoma occurred. The patients were followed up for a mean of 12 (range 3–36) months. All patients were relieved of their symptoms. Eighteen cysts disappeared after surgery, while 13 cysts reduced in size by over one-third and communicated with the renal collecting system. No enlargement of cysts was observed. Conclusions.Percutaneous intrarenal marsupialization with a 2 μm laser is an effective and safe procedure and may offer a minimally invasive alternative for the management of symptomatic peripelvic renal cysts.