Low Back Pain Conditions Research Articles

Proprioceptive neuromuscular facilitation approach for low back pain: A review study

Introduction: Proprioceptive Neuromuscular Facilitation (PNF) is an exercise based on neuromuscular control by stimulation of proprioceptors. The PNF exercise is more popular in the treatment of neurological problems than for musculoskeletal disorders. Numerous research has been done on its application on low back pain (LBP) condition. However, there is not many studies review the application of PNF approach on LBP condition. The aim of this study is to review the PNF approach and explore on its effect on LBP condition. Method: This research uses a simple research literature review method. Data were collected through searches on research article databases such as Google Scholar and health research databases, namely PubMed, Cochrane PEDro and other scientific journals databases. Result: After searching for articles from the Google Scholar, PubMed, Cochrane and PEDro databases, several research results were obtained on the use of PNF in LBP conditions with the following results. There were 19 researches that has been published provided by the databases. Conclusions: All studies have shown that the PNF approach in patients with LBP, whether chronic or not, is sufficient to provide beneficial effects in reducing pain, increasing functional ability, postural control, trunk stability, the flexibility of the lumbar and hip, increasing FEV1 and increasing trunk muscle activity. Furthermore, in general, PNF also appears to be more dominant than other exercises for the management of LBP conditions.

Assessment of Low Back Pain: Reliability and Minimal Detectable Change of the Brief Pain Inventory.

The Brief Pain Inventory (BPI) is one of the most widely used measures to assess pain and related impacts among patients with low back pain (LBP). However, its test-retest reliability and minimal detectable change (MDC) have rarely been examined in patients with LBP, interfering with its utility. To investigate the test-retest reliability and MDC of the BPI among patients with LBP. Repeated assessments design with a 1-wk interval. Department of Physical Medicine and Rehabilitation in a hospital in Taiwan. Fifty-four patients with stable LBP conditions. The BPI has two subscales-Intensity and Interference-that assess pain intensity and pain interference, respectively. Their test-retest reliability was examined using the intraclass correlation coefficient (ICC), and MDCs were calculated. The ICCs of the Intensity and Interference subscales were .62 and .76, respectively. The MDC values for the two subscales were 2.57 and 2.34, respectively. For the four Intensity items, the average-pain score had a higher ICC (.60) than scores on the other items (worst, least, and current pain, which had ICCs of about .40). The results suggest that although the BPI is a commonly used measure of pain intensity and pain interference among patients with LBP, caution should be exercised in interpreting the Intensity subscale score and its item scores. What This Article Adds: The BPI is widely used to assess pain and related impacts on daily occupation and functioning among patients with LBP. This study provides information regarding its test-retest reliability. Moreover, the MDC values provide clinicians and researchers with the thresholds for determining real improvement (beyond random measurement error).

STUDI DESKRIPTIF PEMBERIAN PHYSICAL THERAPY EXERCISE PADA KONDISI NYERI PUNGGUNG BAWAH MYOGENIC

Back pain is a musculoskeletal pain that is often expressed by clients. Back pain varies widely. Pain can be ordinary, stabbing and can even be radiating. One type of back pain is myogenic lower back pain. Myogenic lower back pain is a type of back pain caused by disturbance in the musculoskeletal system in the thoracal thoracic area 12 to the area around the buttocks without any neurological problems. Physiotherapy plays a role in the management of low back pain. Physiotherapy measure given can be in the form of modality therapy or exercise therapy. Exercise therapy given to low back pain conditions varies depending on the physical disorder complained of by the client/patient. This study aims to provide an overview of the provision of exercise therapy in conditions of myogenic low back pain. The research method is descriptive analytic. This study was followed by 40 respondents who are physiotherapists in the Cilacap-Banyumas-Purbalingga area. The research time was from March to November 2020. The research instrument used a questionnaire. The result showed a description of the provision of exercise therapy in conditions of myogenic low back pain.

Chiropractic Services and Diagnoses for Low Back Pain in 3 U.S. Department of Defense Military Treatment Facilities: A Secondary Analysis of a Pragmatic Clinical Trial

ObjectiveThe purpose of this study was to describe the diagnoses and chiropractic services performed by doctors of chiropractic operating within 3 military treatment facilities for patients with low back pain (LBP). MethodsThis was a descriptive secondary analysis of a pragmatic clinical trial comparing usual medical care (UMC) plus chiropractic care to UMC alone for U.S. active-duty military personnel with LBP. Participants who were allocated to receive UMC plus 6 weeks of chiropractic care and who attended at least 1 chiropractic visit (n = 350; 1547 unique visits) were included in this analysis. International Classification of Diseases and Current Procedural Terminology codes were transcribed from chiropractic treatment paper forms. The number of participants receiving each diagnosis and service and the number of each service on unique visits was tabulated. Low back pain and co-occurring diagnoses were grouped into neuropathic, nociceptive, bone and/or joint, general pain, and nonallopathic lesions categories. Services were categorized as evaluation, active interventions, and passive interventions. ResultsThe most reported pain diagnoses were lumbalgia (66.1%) and thoracic pain (6.6%). Most reported neuropathic pain diagnoses were sciatica (4.9%) and lumbosacral neuritis or radiculitis (2.9%). For the nociceptive pain, low back sprain and/or strain (15.8%) and lumbar facet syndrome (9.2%) were most common. Most reported diagnoses in the bone and/or joint category were intervertebral disc degeneration (8.6%) and spondylosis (6.0%). Tobacco use disorder (5.7%) was the most common in the other category. Chiropractic care was compromised of passive interventions (94%), with spinal manipulative therapy being the most common, active interventions (77%), with therapeutic exercise being most common, and a combination of passive and active interventions (72%). ConclusionFor the sample in this study, doctors of chiropractic within 3 military treatment facilities diagnosed, managed, and provided clinical evaluations for a range of LBP conditions. Although spinal manipulation was the most commonly used modality, chiropractic care included a multimodal approach, comprising of both active and passive interventions a majority of the time.

Sciatica: Treatment with a Blend of Maitland Mobilization, McKenzie Exercises along with NMES - A Case Study

Sciatica is referred to radiculopathy involving any of the lower extremity, caused by either inflammation or compression of the nerve roots L1-S1. It can be diagnosed majorly through an appropriate history taking and physical examinations to not be misdiagnosed with other chronic low back pain conditions. A conservative management is preferred when in an acute stage of 6-8 weeks after which a surgical approached is advised. Although various studies has shown evidences that a prolonged conservative care is most fitting than a short term surgical approach (discectomy). The prevalence of sciatic symptoms ranging from 1.6% to 43%, maximum noted in the working population, has drawn attention for the need of an effective and early conservative care to downsize the symptoms causing discomfort and pain. Thus, the aim of the case report was to present with an early and effective conservative care with a blend of Maitland Mobilization, McKenzie exercises along with Neuro-Muscular Electrical Stimulation (Interferential Current) to minimize the discomfort thus easing and bolstering the individual in activities of daily living followed by an uncomplicated returning back to recreational activities. The patient was managed with a blend of Maitland Mobilization, McKenzie exercises and Interferential current for 7 days consecutively along with an individually tailored Home exercise program according the patient tolerance. Outcomes measures namely numerical pain rating scale, lower extremity functional scale and Roland Morris Disability Questionnaire were evaluated before and after the 7 day intervention period to assess prognosis in pain and pain related disability. Thus the changes in pre and post intervention results stated positive outcomes in reducing pain and improving the functional activity and participation in social and recreational ventures. Keywords: Sciatica, Maitland Mobilization, Mckenzie exercise, Interferential Therapy, radicular pain.

Investigation of physiological stress shielding within lumbar spinal tissue as a contributor to unilateral low back pain: A finite element study

IntroductionThe pathomechanism of low back pain (LBP) remains unknown. Unilateral LBP patients have demonstrated ipsilateral morphological and material property changes within the lumbar soft tissues, potentially leading to asymmetric tissue loading. Through the comparison of healthy and unilateral LBP validated finite element models (FEMs), this study investigates potential stress shielding consequential of spinal tissue property augmentation. MethodsTwo FEMs of the musculoskeletal system – one demonstrating healthy and unilateral LBP conditions – were developed undergoing 30-degree flexion. FEMs included the vertebrae, intervertebral discs, and soft tissues from L1-S1. Material properties selected for the soft tissues were retrieved from published literature. To reflect unilateral LBP, the paraspinal morphology was atrophied, while the tissue moduli were increased. The symptomatic thoracolumbar fascia (TLF) was uniformly increased. Validation of the models preceded testing. ResultsModel validation in spinal flexion was accomplished through comparison to literature. Compared to the healthy model, the unilateral LBP multifidus (MF), longissimus thoracis (LT), and TLF exhibited average tension changes of +7.9, −5.1, and +9.3%, respectively. Likewise, the symptomatic MF, LT, and TLF exhibited tension changes of +19.0, −10.4, and +16.1% respectively, whereas the asymptomatic MF, LT, and TLF exhibited −4.0, −2.0, and +0.4% changes in tension, respectively. ConclusionRelative to the healthy tissues, the symptomatic LBP soft tissues demonstrated a 19.5 kPa increase in stress, with 99.8% of this increase distributed towards the TLF, suggesting a load allocation bias within the symptomatic unilateral LBP tissues. Consequentially, symptomatic paraspinal muscles may be unable to withstand loading, leading to stress shielding.

Cell-based strategies for IVD repair: clinical progress and translational obstacles.

Intervertebral disc (IVD) degeneration is a major cause of low back pain, a prevalent and chronic condition that has a striking effect on quality of life. Currently, no approved pharmacological interventions or therapies are available that prevent the progressive destruction of the IVD; however, regenerative strategies are emerging that aim to modify the disease. Progress has been made in defining promising new treatments for disc disease, but considerable challenges remain along the entire translational spectrum, from understanding disease mechanism to useful interpretation of clinical trials, which make it difficult to achieve a unified understanding. These challenges include: an incomplete appreciation of the mechanisms of disc degeneration; a lack of standardized approaches in preclinical testing; in the context of cell therapy, a distinct lack of cohesion regarding the cell types being tested, the tissue source, expansion conditions and dose; the absence of guidelines regarding disease classification and patient stratification for clinical trial inclusion; and an incomplete understanding of the mechanisms underpinning therapeutic responses to cell delivery. This Review discusses current approaches to disc regeneration, with a particular focus on cell-based therapeutic strategies, including ongoing challenges, and attempts to provide a framework to interpret current data and guide future investigational studies.

Different Electrophysiological Responses to Pain-Related Visual Stimuli Between Fibromyalgia and Chronic low Back Pain Women: A Pilot Case-Control Study

Background Fibromyalgia is a chronic pain syndrome which occurs in the absence of an organic damage, whom causes is still unclear. Aims of this pilot study were to investigate the neural correlates of fibromyalgia in response to pain-related visual stimuli and explore the psychological differences among fibromyalgia, chronic low back pain (CLBP) and healthy conditions. Methods After a clinical assessment, electrophysiological responses to pain-related visual stimuli were recorded using a 256-Hydrocel Geodesic-Sensor-Net. Event-related potentials (ERPs), standardised low-resolution electromagnetic tomography (sLORETA), and psychological (Symptom Checklist-90-Revised) data were analysed for a total sample of 23 women (5 healthy volunteers, 12 fibromyalgia patients, 6 CLBP patients). Results The main finding was that fibromyalgia women reported a different brain response to pain-related visual stimuli on the frontal montage compared to women with CLBP (p = .028). Moreover, fibromyalgia women showed an increased activity mainly on the hippocampus (p = .003) and the posterior cingulate cortex (p ≤ .001) in response to algic stimuli compared to not algic ones. Lastly, these women presented higher scores on the somatization (p = .002), obsession-compulsion (p = .045), depression (p = .043) and positive symptom distress (p = .023) dimensions compared to the healthy women. Conclusions These preliminary results suggest that although the painful symptoms are similar, the central elaboration of pain could be different between women with fibromyalgia and those with CLBP. Moreover, these findings provide preliminary evidences about the great alert and the central sensitivity to pain-related information regarding fibromyalgia patients.

The effectiveness of social media and in-person interventions for low back pain conditions in nursing personnel (SMILE).

AimTo compare two educational approaches to reduce low back pain in nurses.DesignA community randomized controlled clinical trial.MethodsData were collected with two interventions and a control arm between August 2018 and January 2019. Participants were recruited from three hospitals. Hospital 1 received an in‐person educational programme, Hospital 2 received via the website and Hospital 3 received nothing. Statistical analysis was carried out with a follow‐up of 3 and 6 months.ResultsA total of 180 female nurses with low back pain participated in the study. Dimensions of the quality of life improved over 3 and 6 months, pain and disability decreased over 3 months in both intervention groups and over 6 months in the social media group.ConclusionTwo educational approaches can be effective in decreasing pain, disability and improving quality of life. However, the findings suggest that the social media approach was more successful over the long‐term and might be a better way to present the programme.

Serious adverse events following lumbar spine mobilization or manipulation and potential associated factors: a systematic review protocol.

The objectives of this review are to describe the serious adverse events reported in the literature following lumbopelvic mobilization and manipulation, and identify patient, provider, and/or treatment factors that may be associated with serious adverse events after these interventions. Spinal mobilization and manipulation are types of conservative care commonly used to treat people with low back pain and other musculoskeletal conditions of the lumbar spine and pelvis. Although most adverse events following these interventions are benign and transient, serious adverse events have been reported mostly following spinal manipulative therapy. Given the significant impact serious adverse events can have on patients' lives, identifying factors that may be associated with serious adverse events following spinal mobilization and manipulation of the low back and pelvis would allow for a more specific pre-treatment screening, potentially reducing the occurrence of serious adverse events following these popular interventions and contributing to a safer treatment delivery. This review will consider interventional and observational studies that report serious adverse events following lumbopelvic spinal mobilization or manipulation experienced by people of any age. Examples of serious adverse events include disc herniation, cauda equina syndrome, and vertebral fracture. MEDLINE, Embase, CINAHL, PubMed, The Cochrane Database of Systematic Reviews/Central Register of Controlled Trials, and Index to Chiropractic Literature (ICL) databases will be searched as well as OpenGrey and ProQuest Dissertations and Theses. Two independent reviewers will screen titles and abstracts of identified references as well as the full text of identified studies, and extract data following a standardized data extraction form. Data will be summarized, categorized, and a comprehensive narrative summary will be presented. PROSPERO CRD42019122339.

Moderate Exercise and the Psycho-Neural and Bio-Mechanical Nature of Chronic Low Back Pain

Low back pain (LBP) is one of the most common health problems, which in 10-15% of patients progresses to develop into a chronic low back pain (CLBP) condition, bringing enormous psychological and financial costs to the affected individuals, their families and society as a whole. There are many theories – pure bio-medical, bio-mechanical, psychological, as well as poly-modal ones, attempting to explain the pathology and aetiology of CLBP and guide its treatment. Although there is a general consensus that CLBP, as many other chronic pain conditions, is heterogeneous in nature, involving both organic (bio-mechanical and physiological) and psycho-social factors, there is still not a definite answer to the exact interactions and causative links between these factors. The present study employed a 15 minutes moderate treadmill exercise intervention in 10 CLBP sufferers and 10 healthy controls in order to further clarify the interactions between these physiological, bio-mechanical and psychological factors. The results from the present study, in accordance with previous research confirmed that CLBP participants are clearly identifiable according to their affective and cognitive profile - CLBP participants reported significantly higher levels of Pain Catastrophising (t = 3.81, p = .003), as well as Depression (t = 2.35, p = .03). Although both Pain Catastrophising and Depression were significantly correlated with the background pain (r = .755, p < .001 and r = .559, p = .010 respectively) in the CLBP group alone, contrary to previous CLBP studies, there were no significant associations between the background pain level and duration, Depression, Anxiety, Stress and even Pain Catastrophising. The Negative affective (NA) state was measured dynamically throughout the experiment and was reduced non-significantly by the exercise in both groups. Surprisingly, The NA was very low – 18 to 20 on a scale of 15 to 75, in both groups (even lower in the CLBP) and there was no significant difference between the NA of the CLBP and Control groups at any time-point of the experiment. The ES and MF back muscles activity was measured using a static standing and fully bent forward ratio, as well as flexion-relaxation ratio (FRR) pre- and post-exercise. The present study's results, although less robust than the results from previous research, confirmed that both standing and fully bent forward ES and MF measures, as well as FRR distinguished CLBP from control participants – CLBP had a higher level of static muscle activity (significant for the pre-exercise right MF in fully bent down position t = -2.48, p = . 044) and reduced FRR (significant for the pre-exercise left ES – t = 3.09, p = .013 and post-exercise left ES and right MF – t = 2.33, p = .038; t = 2.73, p = .032 respectively). Although the exercise produced non significant improvement of the ES and MF muscle activity, it also produced a divergent pain intensity (PPI) response between different CLBP participants – 5 (55.56%) had a decrease in PPI, while 4 (44.44%) had an increase. The pain decrease sub-group exhibited only a mild back muscles dysfunction, characterised by increased activity of the ES and MF in resting state (muscle tension), combined with a higher negative cognitive and affective mental set. The main characteristics of the pain increase sub-group was abnormal ES and MF flexion-relaxation, which pointed to compensatory increased activity of the superficial back muscles due to possible intrinsic spinal instability. In conclusion, the moderate treadmill exercise, utilised in the present study, was capable of identifying the existence of CLBP sub-groups, which were otherwise undistinguishable by the rest of their background pain, psychological or muscle activity characteristics. The low back pain of one of the sub-groups was associated with primary psychological top-down dysfunction of the 'active system' (muscles), while in the second sub-group the principal underlying factor identified was primary organic bio-mechanical dysfunction of the 'passive system'. The possible mechanisms and implications of this dichotomous nature of CLBP in respect to its aetiology, diagnosis, treatment and further research are discussed.

Contribution of COMT and BDNF Genotype and Expression to the Risk of Transition From Acute to Chronic Low Back Pain

Objectives:A number of factors, including heritability and the environment, contribute to risk of transition from acute low back pain to chronic low back pain (CLBP). The aim of this study was to (1) compare somatosensory function and pain ratings at low back pain (LBP) onset between the acute low back pain and CLBP conditions and (2) evaluate associations between BDNF and COMT polymorphisms and expression levels at LBP onset to acute and chronic pain burden and risk for transition to the chronic pain state.Methods:In this longitudinal study, 220 participants were enrolled following recent onset of LBP and data were collected until the LBP resolved or until the end of the study at 6 months. Forty-two participants’ pain resolved before 6 weeks from onset and 42 participants continued to have pain at 6 months. Patient-reported pain burden, somatosensory function (quantitative sensory testing), and blood samples were collected at each study visit.Results:CLBP is associated with greater pain burden and somatosensory hypersensitivity at the time of LBP onset. COMT rs4680 genotype (GG) was associated with acute cold pain sensitivity and with the risk for transition to CLBP while COMT expression was independently associated with risk for transition.Discussion:CLBP was characterized by higher reported pain burden and augmented hypersensitivity at LBP onset. COMT expression and genotype were associated with acute pain burden and likelihood of transition to CLBP.

AAPT Diagnostic Criteria for Chronic Low Back Pain

Chronic low back pain (CLBP) conditions are highly prevalent and constitute the leading cause of disability worldwide. The Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION) public-private partnership with the US Food and Drug Administration and the American Pain Society (APS), have combined to create the ACTTION-APS Pain Taxonomy (AAPT). The AAPT initiative convened a working group to develop diagnostic criteria for CLBP. The working group identified 3 distinct low back pain conditions which result in a vast public health burden across the lifespan. This article focuses on: 1) the axial predominant syndrome of chronic musculoskeletal low back pain, 2) the lateralized, distally-radiating syndrome of chronic lumbosacral radicular pain 3) and neurogenic claudication associated with lumbar spinal stenosis. This classification of CLBP is organized according to the AAPT multidimensional framework, specifically 1) core diagnostic criteria; 2) common features; 3) common medical and psychiatric comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors. PerspectiveAn evidence-based classification of CLBP conditions was constructed for the AAPT initiative. This multidimensional diagnostic framework includes: 1) core diagnostic criteria; 2) common features; 3) medical and psychiatric comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors.

Core Stability and Hip Exercises Improve Physical Function and Activity in Patients with Non-Specific Low Back Pain: A Randomized Controlled Trial

Approximately 90% of low back pain (LBP) diagnoses are non-specific (NSLBP; i.e. with unknown cause). In NSLBP patients, the hamstrings, iliopsoas, piriformis, and tensor fasciae latae are overactive due to weak hip abductor, extensor, and core muscles. Core stability is essential for proper load balance within the pelvis, spine, and kinetic chain, and core stability exercise (CSE) is an exercise treatment regimen for LBP conditions. We investigated how core stability and hip muscle stretching exercises affected NSLBP patients' physical function and activity. Patients were randomly allocated to three groups. The Stretch group (n = 24) performed exercises for hip muscle stretching for maximal motion; the Strengthen group (n = 22) performed exercises for hip muscle strengthening while maintaining the maximal isometric contraction. The Sham group (n = 20) received gentle palpation of the skin. Therapy was conducted thrice weekly for 6 weeks. Pain intensity, lower back instability, and hip muscle flexibility were measured to assess physical function. Disability level, balance ability, and quality of life were measured to assess physical activity. Data were collected prior to intervention and at 6-week follow-up. There were significant within-group changes for all measurements (P < 0.05). The Stretch and Strengthen groups had greater improvements in pain intensity, disability level, balance ability, and quality of life than the Sham group. Lower back instability and hip muscle flexibility had the greatest improvement in the Stretch group. In conclusion, CSE and hip muscle stretching are effective at improving physical function and activity in NSLBP patients.

Validity of increasing the number of motor control tests within a test battery for discrimination of low back pain conditions in people attending a physiotherapy clinic: a case–control study

ObjectivesTo develop a time-efficient motor control (MC) test battery while maximising diagnostic accuracy of both a two-level and three-level classification system for patients with non-specific low back pain (LBP).DesignCase–control study.SettingFour...

Effective Recovery and Control of Chronic Low Back Pain by using Rehabilitation Exercises Therapy

Exercise is a commonly recommended treatment for chronic low back pain due to its effectiveness in enhancing work and function. This study aims to review numerous crucial phases of the usefulness and safety of exercise in order to provide vital information for treating chronic low back pain. An online literature search of Medline was performed using “exercise,” “fitness,” “low back pain,” “backache” and “rehabilitation” as search words abstracts that identified using this method were carefully read, and relevant articles were considered for further analysis. Additional materials were gathered by sourcing relevant research articles. The articles were carefully examined for relevance. There is no evidence that exercise increases low back pain problems, particularly for people with acute, subacute or chronic low back pain. Current studies indicate that exercise has either a neutral effect or might reduce the risk of future back injuries to some extent. Exercise might be suggested for patients with chronic low back pain for three purposes. The first and most recognized purpose is to enhance or decrease deficiencies in back flexibility and strength and improve the performance of endurance activities. It is evident that this purpose can be achieved for most patients suffering from chronic low back pain. The second purpose of exercise is to decrease the severity of low back pain. Many studies reported an overall decrease in the intensity of low back pain ranging from 10% to 50% subsequent to exercise treatment. The third purpose of the exercise is to decrease low back pain–related incapacity by desensitizing worries and anxieties and changing pain attitudes and beliefs. The exercise mechanisms that can be employed to achieve the aforementioned purposes have been the subject of extensive study. The relevance of using exercise as a therapeutic method to decrease deficiencies in back flexibility and strength has been established. Several studies reported enhancements in global pain ratings subsequent to exercise programs. Exercise can also reduce the cognitive, behavioral, and disability effects of low back pain conditions.

A study of the correlation between low back pain and occupational stress in coal miners

Objective: To study the correlation between low back pain (LBP) and occupational stress in coal miners. Methods: From January 2015 to December 2016, a total of 472 front-line workers in a mining area of a large-scale coal mining enterprise in Shanxi, China were enrolled in the study. The general information, condition of LBP, and occupational stress level of the subjects were obtained by questionnaire survey. Dichotomous logistic regression (DLR) was used to analyze the correlation between LBP and occupational stress. Results: Of the 472 subjects, 186 subjects experienced LBP in the past year; the prevalence rate of LBP was 39.41%. The scores of the Occupational Role Questionnaire were significantly higher for workers in the LBP group than in the non-LBP group (P<0.01) . As revealed by the DLR analysis, age, marital status, length of service, occupational stress role, labor intensity, keeping single posture during work, and working in shifts were risk factors of LBP (P<0.01) , while smoking may be a protective factor against LBP (P<0.01) . Conclusion: Occupational stress role is a potential risk factor for LBP in coal miners (P<0.01) . Reasonable work assignment and timely alleviation of occupational stress may be one of the effective approaches to prevent LBP.

The Effects of Pain Severity, Pain Catastrophizing, Depression, and Exercise on Perceived Disability in Acute Low Back Pain Patients.

Background/Purpose: The effectiveness of cognitive treatments for low back pain, a prevalent and costly condition, are commonly based on the principles of the Cognitive Behavioral Model of Fear of Movement/(Re)injury. In this model, persons with a painful injury/experience who also engage in pain catastrophizing are most likely to avoid activity leading to disability. The validation of this model in patients with acute low back is limited. The purpose of this project was to examine the relationship of perceived disability with variables identified in the Cognitive Behavioral Model of Fear of Movement/(Re)injury such as, pain severity, pain catastrophizing, depression, and exercise in persons with acute low back pain. Methods: A multiple linear regression model was used to assess the association of perceived disability with pain severity, pain catastrophizing, depression, and exercise at baseline among subjects with acute low back pain (N = 44) participating in a randomized clinical trial to prevent transition to chronic low back pain. Results: Controlling for age, the overall model was significant for perceived disability (F[5, 35] = 14.2; p < .001). Higher scores of pain catastrophizing (p = .003) and pain severity (p < .001) were associated with higher perceived disability levels. Exercise and depression were not significantly associated with perceived disability. Implications: The use of the Cognitive Behavioral Model of Fear of Movement/(Re)injury in acute LBP patients is appropriate; because this model is commonly used as rationale for the effectiveness of cognitive treatments, these findings have clinical relevance in the treatment of this condition.

Comorbidity Subgroups Among Medicare Beneficiaries Seeking Health Care for Musculoskeletal Pain.

Treatment of musculoskeletal pain in older adults may be more effective if it incorporates integrated management of comorbid health conditions. The purpose of this study was to define empirically derived comorbidity subgroups among Medicare beneficiaries with an index condition of osteoarthritis (OA) or low back pain (LBP) as a precursor to the development of comorbidity-specific pain treatment pathways. This study included Medicare beneficiaries participating in the Medicare Current Beneficiary Survey (MCBS) and seeking care for OA (n = 723) or LBP (n = 617) with data available for 3 years after entry into the survey. We identified 30 comorbidity diagnoses using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes in claims data during beneficiaries' first year in the survey. Latent class analysis defined comorbidity subgroups, and posterior probabilities were used to assign subgroup classification. Self-reported disability was compared over three consecutive years for each subgroup. We identified similar comorbidity subgroups for OA and LBP. The subgroups included (range of percent prevalence) low comorbidity (47.6%-54.4%), nonvascular (21.8%-28.6%), diabetes (12.2%-15.0%), renal disease with complicated hypertension (5.5%-5.8%), and complex cardiac disease/high comorbidity (3.3%-5.8%). OA and LBP subgroups with more complex comorbidity burden generally demonstrated higher disability over 3 years. Five comorbidity subgroups were identified, with a large proportion of older adults classified into the subgroup defined by a low probability of most comorbidities. These findings provide direction for the development of pain treatment pathways that are tailored to address common comorbidity profiles among older adults.

Correlates of a Recent History of Disabling Low Back Pain in Community-dwelling Older Persons

To investigate the correlates of a recent history of disabling low back pain (LBP) in older persons. The Pain in the Elderly (PAINEL) Study was derived from the Frailty among Brazilian Older Adults (FIBRA) Network Study. Data were collected through face-to-face/telephone interviews and clinical examination. A series of logistic regressions assessed associations between a recent history of disabling LBP and sociodemographic, physical/lifestyle, and psychological factors. Of the 378 community-dwelling elders included in the study (age±SD, 75.5±6.1), 9.3% experienced LBP that was bad enough to limit or change their daily activities during the past year. Those reporting a recent history of disabling LBP were more likely to be women and under financial strain, to present poor self-rated health, overweight, multimorbidity, low physical activity level, fatigue, depressive symptomatology/diagnosis and fear beliefs, and to report decreased sleep time, prolonged sitting time, chronic pain (in location other than lower back), and frequently recurring LBP. The multivariate logistic regression analysis indicated that overweight (odds ratio [OR], 29.6; 95% confidence interval [CI], 2.3-391.0), low physical activity level (OR, 4.4; 95% CI, 1.3-15.4), fatigue (OR, 10.3; 95% CI, 2.4-43.4), depression diagnosis (OR, 4.9; 95% CI, 1.3-18.4), and frequently recurring LBP (OR, 4.6; 95% CI, 1.0-20.1) were independently associated with a recent history of disabling LBP. Our study supports the link between disabling LBP and other age-related chronic conditions in a middle-income country with a rapidly aging population.