Definition Of Low Back Pain Research Articles

Association Between Body Mass Index and Nonspecific Recurrent Low Back Pain in Over 600,000 Healthy Young Adults.

An association between body mass index (BMI; weight (kg)/height (m)2) and low back pain (LBP) has long been debated, but inconsistent measurements of BMI and varying definitions of LBP have produced conflicting findings. We explored this association using measured BMI and physician documentation of recurrent LBP among healthy young adults. Data were extracted from the Israel Defense Forces electronic medical record system. All Israeli citizens with compulsory military service during January 2008-March 2019 were included (n=705,840). Exclusion criteria were spine deformities, disc pathologies, spinal surgeries, arthropathies, connective tissue diseases, pain syndromes, low bone density disorders, cancers, and psychiatric illnesses. LBP was defined as electronic medical record system documentation of 1) 2 medical visits at least 6 weeks apart with a diagnosis of LBP or "LBP with radiation" or 2) 1 medical visit resulting in referral to an orthopedic surgeon. Logistic regression models were used to explore the association between BMI category and LBP; 619,969 (87.8%) individuals (meanage =18.9 (standard deviation, 0.97) years; 56.9% male) were included. LBP prevalence was 9.2% (n=56,918) and higher among males (9.7%) than females (8.5%). Overweight (odds ratio=1.123, 95% confidence interval: 1.096, 1.151) and obesity (odds ratio= 1.137, 95% confidence interval: 1.096, 1.179) were associated with LBP. The association remained significant after accounting for various sociodemographic factors. Maintaining a healthy BMI may aid in the prevention of LBP in young adults.

Sensitivity and specificity of algorithms for the identification of nonspecific low back pain in medico-administrative databases.

Identifying nonspecific low back pain (LBP) in medico-administrative databases is a major challenge because of the number and heterogeneity of existing diagnostic codes and the absence of standard definitions to use as reference. The objective of this study was to evaluate the sensitivity and specificity of algorithms for the identification of nonspecific LBP from medico-administrative data using self-report information as the reference standard. Self-report data came from the PROspective Québec Study on Work and Health , a 24-year prospective cohort study of white-collar workers. All diagnostic codes that could be associated with nonspecific LBP were identified from the International Classification of Diseases, Ninth and Tenth Revisions ( ICD-9 and ICD-10 ) in physician and hospital claims. Seven algorithms for identifying nonspecific LBP were built and compared with self-report information. Sensitivity analyses were also conducted using more stringent definitions of LBP. There were 5980 study participants with (n = 2847) and without (n = 3133) LBP included in the analyses. An algorithm that included at least 1 diagnostic code for nonspecific LBP was best to identify cases of LBP in medico-administrative data with sensitivity varying between 8.9% (95% confidence interval [CI] 7.9-10.0) for a 1-year window and 21.5% (95% CI 20.0-23.0) for a 3-year window. Specificity varied from 97.1% (95% CI 96.5-97.7) for a 1-year window to 90.4% (95% CI 89.4-91.5) for a 3-year window. The low sensitivity we found reveals that the identification of nonspecific cases of LBP in administrative data is limited, possibly due to the lack of traditional medical consultation.

KNOWLEDGE OF RURAL POPULATION ABOUT LOW BACK PAIN AND ITS RELATED RISK FACTORS- CROSS SECTIONAL STUDY

Background and purpose :Low back pain (LBP) has been reported as a worldwide health problem, affecting individuals physically, socio-economically and psychologically [1]. The global burden of low back pain is the highest ranked condition contributing to years of living with disability.The general public, including patients living with LBP, lack knowledge about the causes and contributing factors of LBP [22].This implies that during management of LBP, patients’ knowledge about their pain should be identified and followed by education regarding their pain.This study aims to find out knowledge of rural population about low back pain and its related risk factors Methodology :This was a cross sectional study conducted on villagers visiting VikhePatil Hospital, Ahmednagar, in a duration of 6 months. The sampling method was convenient sampling with sample size of 100. A self -administered questionnaire consisting of 4 sections in Marathi language was designed. In the first three section, participants were asked about definition of Low back pain. In the fourth section, participants have to answer a 15 question quiz, focusing on general facts, symptoms, risk factors, diagnosis and treatment options for low back pain. After approval of ethical committee, consent form were collected from the subjects. The questionnaire was given to subjects according to the inclusion criteria. Result & Conclusion:- The study had 100 subjects. Approximately 58% were males, with 31% between 30-39 age .66% of samples identified the underlying mechanism of low back pain as there is some compression of nerve passing through the vertebra,57% believed cartilage on the ends of vertebra wears down over time.The majority 58% had their source of information about low back pain from other patients suffering from low back pain,54% from the internet and social media, 48% had personal experience and 82% sample knew a relative or a friend suffering with low back pain. The result of the study concluded that the rural population visiting the VikhePatil Hospital exhibited good knowledge about Low back pain and its risk factors. Some misconceptions about the general facts and risk factors were identified.

Low back pain definitions: effect on patient inclusion and clinical profiles.

Numerous definitions of acute low back pain (aLBP) exist. The use of different definitions results in variability in reported prevalence or incidence, conflicting data regarding factors associated with the transition to chronic LBP (cLBP), and hampers comparability among studies. Here, we compare the impact of 3 aLBP definitions on the number of aLBP cases and participants' characteristics and explore the distribution of participants across definitions. A sample of 1264 participants from the Quebec Low Back Pain Study was included. Three definitions of aLBP were used: (1) not meeting the National Institutes of Health (NIH) cLBP definition ("nonchronic"), (2) pain beginning <3 months ago ("acute"), and (3) pain beginning <3 months with a preceding LBP-free period ("new episode"). There were 847, 842, and 489 aLBP cases meeting the criteria for the 3 definitions, respectively. Participants included in the "nonchronic" had lower pain interference, greater physical function scores, and fewer participants reporting >5 years of pain than in the other definitions. Half the participants meeting the "acute" definition and one-third of participants meeting the "new episode" definition were also classified as cLBP based on the NIH definition. Our results highlight the importance of the definition used for aLBP. Different definitions influence the sample size and clinical profiles (group's characteristics). We recommended that cohort studies examining the transition from aLBP to cLBP ensure that the definitions selected are mutually exclusive (ie, participants included [aLBP] differ from the expected outcome [cLBP]).

Cross-cultural adaptation of Delphi definitions of low back pain prevalence in French (Delphi DOLBaPP-F)

Aim: The high heterogeneity in the definitions of low back pain encountered in the literature has led to the development of standardized definitions of this condition called “Delphi definitions of low back pain prevalence (Delphi DOLBaPP)” by a group of international researchers. In order to be widely used, these definitions need to be adapted according to the cultural and linguistic context. The aim of this work was to perform the cross-cultural adaptation of the Delphi DOLBaPP definitions in Quebecc French and to pre-test them among French-speaking adults. Methods: In order to enable practical use of the Delphi DOLBaPP definitions in different contexts, their presentation was adapted in the form of a questionnaire (referred to as the “Delphi DOLBaPP questionnaire”). The process of cross-cultural adaptation of the Delphi DOLBaPP questionnaire in French was conducted according to the most recognized recommendations for the cultural adaptation of measuring instruments. The resulting questionnaire and an evaluation form were then submitted to a sample of 82 adults. Results: A total of 41 participants (50.0%) reported low back pain. A high proportion of participants (89.0%) stated that it took them less than 5 minutes to complete the questionnaire. More than 62.0% of them did not find any question poorly worded or confusing. Nearly 80.0% of the participants found the questionnaire easy to understand. The cross-cultural adaptation process suggested minor modifications to the original Delphi DOLBaPP questionnaire. Conclusions: This study has produced a cross-cultural adaptation of the Delphi DOLBaPP questionnaire in Quebec French that will enable French-speaking populations to share the benefits of using standardized definitions of low back pain in epidemiological studies.

Neck pain patterns and subgrouping based on weekly SMS-derived trajectories

BackgroundNeck and low back pain represent dynamic conditions that change over time, often with an initial improvement after the onset of a new episode, followed by flare-ups or variations in intensity. Pain trajectories were previously defined based on longitudinal studies of temporal patterns and pain intensity of individuals with low back pain. In this study, we aimed to 1) investigate if the defined patterns and subgroups for low back pain were applicable to neck pain patients in chiropractic practice, 2) explore the robustness of the defined patterns, and 3) investigate if patients within the various patterns differ concerning characteristics and clinical findings.MethodsProspective cohort study including 1208 neck pain patients from chiropractic practice. Patients responded to weekly SMS-questions about pain intensity and frequency over 43 weeks. We categorized individual responses into four main patterns based on number of days with pain and variations in pain intensity, and subdivided each into four subgroups based on pain intensity, resulting in 16 trajectory subgroups. We compared baseline characteristics and clinical findings between patterns and between Persistent fluctuating and Episodic subgroups.ResultsAll but two patients could be classified into one of the 16 subgroups, with 94% in the Persistent fluctuating or Episodic patterns. In the largest subgroup, “Mild Persistent fluctuating” (25%), mean (SD) pain intensity was 3.4 (0.6) and mean days with pain 130. Patients grouped as “Moderate Episodic” (24%) reported a mean pain intensity of 2.7 (0.6) and 39 days with pain. Eight of the 16 subgroups each contained less than 1% of the cohort. Patients in the Persistent fluctuating pattern scored higher than the other patterns in terms of reduced function and psychosocial factors.ConclusionsThe same subgroups seem to fit neck and low back pain patients, with pain that typically persists and varies in intensity or is episodic. Patients in a Persistent fluctuating pattern are more bothered by their pain than those in other patterns. The low back pain definitions can be used on patients with neck pain, but with the majority of patients classified into 8 subgroups, there seems to be a redundancy in the original model.

Does the heritability of chronic low back pain depend on how the condition is assessed?

Although the influence of genetics on chronic low back pain (LBP) has been previously examined, few studies have investigated whether the impact of genetic factors on LBP depends on how the condition is assessed. We investigated the contribution of genetics and environment on chronic LBP: lifetime prevalence, pain intensity (recent and worst) and activity limitation (anytime and recent) in a cross-sectional study with 1,598 adult twins. All twins answered a self-reported questionnaire about health-related questions. We conducted classic twin analyses using structural equation models to estimate the genetic and environmental influences in LBP phenotypes. We found a heritability of 26% (95%CI: 0.09-0.42) for lifetime chronic LBP; 36% (95%CI: 0.18-0.52) and 25% (95%CI: 0.03-0.46) for activity limitation due to chronic LBP, related to lifetime and most recent episode, respectively; and heritability of 35% (95%CI: 0.11-0.55) for pain intensity associated with the most recent episode. Genetics showed no significant influence in pain intensity experienced during the worst LBP episode. Genetic factors appear to significantly contribute to the variance in chronic LBP including lifetime chronic LBP, activity limitation and pain intensity associated with more recent episodes of LBP, but not for pain intensity associated with people's report of the worst pain episode. Heritability estimates was fairly similar across different LBP outcomes in a population-based twin sample, and not dependent on how it is assessed or experienced. However, we could not detect any significant heritability for a report of intensity experienced during the worst LBP episode experienced. Heritability estimates were similar for different low back pain definitions, and therefore not dependent on how chronic low back pain is experienced or assessed, in the same population-based sample.

Can We Trust the Literature on Risk Factors and Triggers for Low Back Pain? A Systematic Review of a Sample of Contemporary Literature.

Background Risk factors (RFs) for the “disease” of low back pain (LBP) are probably different from the triggers of new episodes of LBP. Investigating RFs for the onset of the “disease” and the triggers of LBP is problematic if researchers fail to discern the different types of pain-free status of participants at and before baseline. There is a difference between never having had LBP and having been pain-free for a certain period only. In this review, we assessed the dependability of contemporary literature on RFs and triggers of LBP, in relation to the “disease” and the episodes, respectively. Methods A literature search from 2010 until 2017 was performed. Information on the definitions of LBP, potential RFs/triggers, and study design was extracted. Studies were reclassified based on the type of LBP concerning the “disease,” episode, or mixed/unclear/chronic. RFs and triggers were grouped into major domains, and positive associations listed, respectively, for the “disease” and episodes. Results In 42 of the included 47 articles, it was not clear if the authors investigated RFs for the “disease” of LBP or triggers of new episodes. Only one study properly reported RFs for the onset of the “disease” of LBP, and four studies were deemed suitable to investigate triggers for a new episode of LBP. No study reproduced the results of other included studies. Conclusion Trustworthy information regarding RFs and triggers of LBP is rare in the current literature. Future research needs to use precise definitions of LBP (onset of the “disease” vs. episodes) and nominate the timing of the associated factors in relation to the types of LBP as these are two critical factors when studying causes of LBP.

Prevalence of low back pain among athletes: A systematic review.

The prevalence of low back pain (LBP) in athletes across a variety of time frames and sports is not known. To systematically collate and appraise studies on the prevalence of LBP in athletes and stratify by point, one year and life-time prevalence. A comprehensive search was conducted in February 2016. The following sources were individually searched: PubMed (1950 to present), Ovid SP Medline (1950 to present), ISI (1982 to present) and Google Scholar; Surveys were included if they aimed to report the prevalence of LBP amongst the athletes. Two reviewers independently evaluated the methodological quality of the studies. The literature search generated 4379 records. Title and/or abstracts were reviewed by two investigators and full-texts of 201 relevant articles were selected for further evaluation. Studies were included if they reported the prevalence of LBP in an athletic population (any level of participation in sports and any age range) and were written in English. Furthermore, to adequately assess the prevalence rate, studies had to report the number of athletes with LBP as a percentage of the total number of athletes. Studies that did not contain necessary data to calculate prevalence rate including case reports and non-original studies were excluded and 41 studies entered the bias assessment step. A bias assessment was applied to the methodology of 41 studies, and 36 with low to moderate risk for bias were included in this review. LBP in athletes was shown to have a point prevalence ranging from 10% to 67%, a one-year prevalence ranging from 17% to 94%, and a life-time prevalence ranging from 33% to 84%. The highest prevalence of LBP was found among skiers, floorball players and rowers and the lowest were found in shooters, golfers and triathletes. Like general population, LBP is quite prevalent among athletes. There is a lack of sound data on the prevalence and mechanism of LBP in some popular sports such as volleyball, swimming and track and field. The lack of standardization of research methods and outcome measurement tools are significant problems in literature. Researchers need to use standard and internationally acceptable definitions for LBP and related functional disability. Investigators are encouraged to conduct epidemiologic studies, along with search for possible mechanism of LBP, by recruitment of large sample population of the athletes who are selected through randomization of the national population and adopt recent recommendations for a standard definition of LBP.

Tracking low back pain in adolescent idiopathic scoliosis: a prospective cohort study protocol

BackgroundNumerous methodological limitations have constrained the findings of previous studies that have examined the prevalence of low back pain in adolescents with idiopathic scoliosis. This article presents a study protocol that has been designed to address the shortcomings of prior research in this area. In addition, it will establish the level of disease burden associated with acute, recurrent, and chronic low back pain in adolescents with idiopathic scoliosis.MethodsThis study will involve a prospective cohort of adolescents with idiopathic scoliosis presenting to an outpatient department in a paediatric hospital. Potential participants will be eligible for inclusion if they are aged 10–17 years, experience adolescent idiopathic scoliosis, own a mobile phone, and are able to communicate in either French or English adequately. The primary outcome measure is the presence of low back pain. The secondary outcome will be measures with the Brief Pain Questionnaire and the PedsQL questionnaire. Participants will be followed over a 12-month period reporting weekly, via SMS-tracking.DiscussionPrevious studies frequently established the prevalence of low back pain through asking participants to recall whether they experienced low back pain over certain periods. These periods often extended beyond many months, and hence were subject to recall bias. Our study addresses such bias through gathering data on a weekly basis using SMS-tracking providing detailed information about the progression of low back pain, which allows researchers to establish the prevalence of acute, recurrent, and chronic low back pain with a better certainty. Furthermore, the previous studies failed to use a standardised definition of low back pain. As such, it is not possible to determine whether the reported low back pain was experienced at the following standardised defined location: “pain in the space between the lower posterior margin of the rib cage and the horizontal gluteal fold”.ConclusionThis research protocol will be the first study to determine the proportion of adolescents with idiopathic scoliosis who experience acute, recurrent, and chronic low back pain, and establish the level of the burden associated with these subgroups of low back pain.

Prevalence of low back pain in emergency settings: a systematic review and meta-analysis

BackgroundLow back pain may be having a significant impact on emergency departments around the world. Research suggests low back pain is one of the leading causes of emergency department visits. However, in the peer-reviewed literature, there has been limited focus on the prevalence and management of back pain in the emergency department setting. The aim of the systematic review was to synthesize evidence about the prevalence of low back pain in emergency settings and explore the impact of study characteristics including type of emergency setting and how the study defined low back pain.MethodsStudies were identified from PubMed and EMBASE, grey literature search, and other sources. We selected studies that presented prevalence data for adults presenting to an emergency setting with low back pain. Critical appraisal was conducted using a modified tool developed to assess prevalence studies. Meta-analyses and a meta-regression explored the influence of study-level characteristics on prevalence.ResultsWe screened 1187 citations and included 21 studies, reported between 2000 and 2016 presenting prevalence data from 12 countries. The pooled prevalence estimate from studies of standard emergency settings was 4.39% (95% CI: 3.67-5.18). Prevalence estimates of the included studies ranged from 0.9% to 17.1% and varied with study definition of low back pain and the type of emergency setting. The overall quality of the evidence was judged to be moderate as there was limited generalizability and high heterogeneity in the results.ConclusionThis is the first systematic review to examine the prevalence of low back pain in emergency settings. Our results indicate that low back pain is consistently a top presenting complaint and that the prevalence of low back pain varies with definition of low back pain and emergency setting. Clinicians and policy decisions makers should be aware of the potential impact of low back pain in their emergency settings.

Do number of days with low back pain and patterns of episodes of pain have similar outcomes in a biopsychosocial prediction model?

We used two different methods to classify low back pain (LBP) in the general population (1) to assess the overlapping of individuals within the different subgroups in those two classifications, (2) to explore if the associations between LBP and some selected bio-psychosocial factors are similar, regardless which of the two classifications is used. During 1year, 49- or 50-year-old people from the Danish general population were sent fortnightly automated text messages (SMS-Track) asking them if they had any LBP in the past fortnight. Responses for the whole year were then classified into two different ways: (1) In relation to the number of days with LBP in the preceding year (0, 1-30, and >30), (2) In relation to the frequency and duration of episodes of LBP (more or less never pain, episodic, and more or less constant pain). Some bio-psychosocial factors, collected with a questionnaire at baseline 9years earlier, were entered into regression models to investigate their associations with the subgroups of the two classifications of LBP and the results compared. The percentage of agreement between categories of the two classification systems was above 68% (Kappa 0.7). Despite the large overlap of persons in the two classification groups, the patterns of associations with the two types of LBP definitions were different in the two classification groups. However, none of the estimates were significantly different when the variables were compared across the two classifications. Different classification systems of LBP are capable of bringing forth different findings. This may help explain the lack of consistency between studies on risk factors of LBP.

Low back pain and health-related quality of life in community-dwelling older adults.

Investigation of self-reported of low back pain (LBP) over the last month and associated health-related quality of life (HRQoL) in a sample of a community-dwelling population aged ≥65. Cross-sectional study including older adults selected randomly from population records. Data were collected within a sample stratified by age and sex. Physical and psychological healths were investigated using a standardized definition of LBP and the EuroQoL-5D for HRQoL. Analyses were first conducted on the entire sample (N=3042) and subsequently considering the subsample who reported LBP and a paired sample drawn from the pool of LBP-free respondents. 889 (29%) respondents reported LBP within the past month, present 'most days' or 'every day' in 52% and limiting activities in the same proportion. Average pain score was 4.6 (SD2.2; 0-10 scale). Age was associated with pain frequency and duration, with younger groups more often reporting pain 'some days' and 'dating back <3months'. Results of regression analyses showed that individuals suffering from LBP had significantly more problems than LBP non-sufferers on all EQ-5D subscales, except self-care: pain/discomfort (OR 5.33; 95% CI [4.19-6.79]), mobility (OR 2.66; 95% CI [2.04-3.46]), usual activities (OR 1.92; 95% CI [1.42-2.60]), anxiety/depression (OR 1.59; 95% CI [1.23-2.04]) and self-care (OR 1.29; 95% CI [0.84-1.98]). LBP appears to be a more permanent condition in the older groups. LBP may be a part of the definition of a subgroup of elderly at risk of becoming frail in relation with higher levels of functional limitations, psychological difficulties and social restrictions, hence globally impaired HRQoL.

Cross-cultural adaptation of the delphi definitions of low back pain prevalence (German DOLBaPP).

BackgroundAssessed dimensions of low back pain (LBP) vary in prevalence studies. This may explain the heterogeneity in frequency estimates. To standardize definitions of LBP, an English consensus with 28 experts from 12 countries developed the “Delphi Definitions of Low Back Pain Prevalence” (DOLBaPP). The optimal definition and the shorter minimal definition with the related questionnaires for online, paper, and face-to-face use and telephone surveys are suitable for population-based studies. The definitions have to be adapted to different languages and cultures to provide comparable frequency estimates. The objective was to culturally adapt and pre-test the English definitions and corresponding Delphi DOLBaPP questionnaire forms into German.MethodsThe German DOLBaPP adaptation was conducted using the systematic approach suggested by Beaton et al. A pre-test of the Delphi DOLBaPP optimal paper questionnaire including an additional evaluation form was conducted in a sample of 121 employees (mainly office workers). In order to evaluate the comprehensibility, usability, applicability, and completeness of the adapted questionnaire, response to the questionnaire and 6 closed evaluation questions were analyzed descriptively. Qualitative methods were used for the 3 open questions of the evaluation form.ResultsThe cultural adaptation of the DOLBaPP for a German-speaking audience required little linguistic adaptation. Conceptual equivalence was difficult for the expression “low back pain”. The expert committee considered the face validity of the pre-final version of the related Delphi DOLBaPP questionnaires as good. In the pre-test, most participants (95%) needed less than 5 minutes to fill in the optimal Delphi DOLBaPP questionnaire. They were generally positive regarding length, wording, diagram, and composition. All subjects with LBP (n = 61 out of 121 – 50.4%) answered the questions on functional limitation, sciatic pain, frequency and duration of symptoms as well as pain severity.ConclusionThe results indicate that the cross-cultural German adaptation of the DOLBaPP Definitions and the corresponding questionnaires was successful. The definitions can be used in epidemiological studies to measure the prevalence of LBP. Some critical issues were raised regarding the general features of the Delphi DOLBaPP questionnaires. Future research is needed to evaluate these instruments.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-397) contains supplementary material, which is available to authorized users.

Prevalence of Low Back Pain in Latin America: A Systematic Literature Review

Background: Chronic low back pain is considered as a high-impact condition that affects the working population of Latin America, with long reaching social and economic repercussions. Its true frequency is unknown due to the absence of well-designed clinical trials that use standardized definitions and criteria. Objectives: To evaluate the prevalence of chronic non-specific low back pain among the Latin American population. Study Design: A systematic review of chronic non-specific low back pain in Latin America. Setting: Meeting of Change Pain Latin America, Mexico. Methods: Data sources included relevant literature identified through searches of published studies between August 30, 2002, and August 30, 2012, in 7 electronic databases: Cochrane BVS, Pubmed, Medline, Lilacs, Scielo, Hinari, and MedCarib. Publications dealing with low back pain of a posttraumatic, infectious, or malignant origin were excluded. Two reviewers selected in an independent manner all eligible studies using the MOOSE checklist and extracted data on both prevalence and risk factors associated with low back pain. A narrative synthesis of the results was drafted, which was later validated by a panel of clinical experts on pain. Results: Twenty-eight studies were included in the review, comprising a total of 20,559 subjects from 7 countries in the region. Four of these studies, with significant methodological differences between them, measured the frequency of chronic low back pain with results that varied from 4.2% to 10.1%. Four studies are part of the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) program reports, and were pooled and analyzed separately because of their particular design. Their prevalence estimations varied between 1.8% and 11.3%. The remaining 20 studies evaluated a total population of 6,992 subjects, and found a prevalence of low back pain of 31.3%. Based on an epidemiological model constructed on both times to resolution and low back pain recurrence rates, the prevalence of chronic low back pain in Latin America was estimated to be around 10.5%. Some risk factors reported by the authors are long working hours with the worker in the sitting position, obesity and overweight, pregnancy, smoking, advanced age, lifting and carrying heavy loads, domestic work, sedentary lifestyles, and duration of current employment. A subgroup analysis of the population under study yielded an estimated prevalence of low back pain of 16.7% for the population exposed to a lower number of risk factors and 65% for the higher risk subgroup. In this review, we made an exhaustive search of studies evaluating the epidemiology of chronic low back pain in the Latin America region. Limitations: The large topographic and chronologic variability in definitions of low back pain, interviewer bias, and subject selection bias. Conclusions: Despite the sparse information and the methodological heterogeneity of the studies, pooled results allowed for an indirect estimation of the prevalence of low back pain in the region that was pretty consistent with the published results obtained from other settings. New studies need to be carried out to supplement and overcome the methodological weaknesses of those previously conducted. Key words: Prevalence, epidemiology, low back pain, Latin America, chronic pain

The natural course of low back pain: a systematic critical literature review

BackgroundMost patients in the secondary care sector consulting for low back pain (LBP) seem to have a more or less constant course of pain during the ensuing year. Fewer patients with LBP in the primary care sector report continual pain over a one-year period. However, not much is known about the long-term course of LBP in the general population. A systematic critical literature review was undertaken in order to study the natural course of LBP over time in the general population.MethodsA search of articles was performed in Pubmed, Cinahl and Psychinfo using the search terms ‘epidemiology’; ‘low back pain’ or ‘back pain’; ‘prospective study’ or ‘longitudinal study’; ‘follow-up’, ‘natural course’, ‘course’ or ‘natural history’; ‘general population’ or ‘working population’. Inclusion criteria were that one of the objectives was to study the course of (L)BP in the adult population, that the period of follow-up was at least 3 months, and that there were three points of observation or more. The review was undertaken by two independent reviewers using three checklists relating to description of studies, quality and outcomes. The course of LBP was established in relation to those who, at baseline, were reported not to have LBP or to have LBP. Would this course be stable, fluctuating, worsening, or improving over time? A synthesis of results in relation to common patterns was presented in a table and interpreted in a narrative form.ResultsEight articles were included. Articles were different on time span, the number of surveys, and the definition of LBP. In six of the seven relevant studies, for those with no LBP at baseline, relatively substantial stable subgroups of people who continued to be LBP free were identified. In six of the seven relevant studies, definite stable subgroups of continued LBP were noted and improvement (becoming pain free) was never reported to be a common finding.ConclusionThe status of LBP in individuals of the general population appears to be relatively stable over time, perhaps particularly so for those without LBP at baseline.

Yoga as an Alternative and Complementary Treatment for Patients With Low Back Pain

Low back pain is not only a leading cause of disability in the United States but also one of the most expensive to treat. Exercise proves to be inconsistent, and surgery often leads to disease reappearance. Yoga offers a holistic approach to overcome the psychological and physical aspects of low back pain. A systematic review was performed to determine the efficacy of yoga for low back pain. Study inclusion criteria were studies ( a) published in the English language, ( b) published between January 2000 and June 2012, ( c) included any form of yoga as an intervention, ( d) used any quantitative study design, and (5) measured low back pain as an outcome. Of the 13 studies included, 9 demonstrated a reduction in low back pain using yoga as part of the intervention. Limitations include lack of theory-based approaches, unclear definitions of low back pain, and multiple instruments used to measure the outcome.

A systematic review of the global prevalence of low back pain

To perform a systematic review of the global prevalence of low back pain, and to examine the influence that case definition, prevalence period, and other variables have on prevalence. We conducted a new systematic review of the global prevalence of low back pain that included general population studies published between 1980 and 2009. A total of 165 studies from 54 countries were identified. Of these, 64% had been published since the last comparable review. Low back pain was shown to be a major problem throughout the world, with the highest prevalence among female individuals and those aged 40-80 years. After adjusting for methodologic variation, the mean ± SEM point prevalence was estimated to be 11.9 ± 2.0%, and the 1-month prevalence was estimated to be 23.2 ± 2.9%. As the population ages, the global number of individuals with low back pain is likely to increase substantially over the coming decades. Investigators are encouraged to adopt recent recommendations for a standard definition of low back pain and to consult a recently developed tool for assessing the risk of bias of prevalence studies.

Individual Participant Data Meta-Analysis of Mechanical Workplace Risk Factors and Low Back Pain

We used individual participant data from multiple studies to conduct a comprehensive meta-analysis of mechanical exposures in the workplace and low back pain. We conducted a systematic literature search and contacted an author of each study to request their individual participant data. Because outcome definitions and exposure measures were not uniform across studies, we conducted 2 substudies: (1) to identify sets of outcome definitions that could be combined in a meta-analysis and (2) to develop methods to translate mechanical exposure onto a common metric. We used generalized estimating equation regression to analyze the data. The odds ratios (ORs) for posture exposures ranged from 1.1 to 2.0. Force exposure ORs ranged from 1.4 to 2.1. The magnitudes of the ORs differed according to the definition of low back pain, and heterogeneity was associated with both study-level and individual-level characteristics. We found small to moderate ORs for the association of mechanical exposures and low back pain, although the relationships were complex. The presence of individual-level OR modifiers in such an area can be best understood by conducting a meta-analysis of individual participant data.

Predictors of long-term pain and disability in patients with low back pain investigated by magnetic resonance imaging: A longitudinal study

BackgroundIt is possible that clinical outcome of low back pain (LBP) differs according to the presence or absence of spinal abnormalities on magnetic resonance imaging (MRI), in which case there could be value in using MRI findings to refine case definition of LBP in epidemiological research. We therefore conducted a longitudinal study to explore whether spinal abnormalities on MRI for LBP predict prognosis after 18 months.MethodsA consecutive series of patients aged 20-64 years, who were investigated by MRI because of mechanical LBP (median duration of current episode 16.2 months), were identified from three radiology departments, and those who agreed completed self-administered questionnaires at baseline and after a mean follow-up period of 18.5 months (a mean of 22.2 months from MRI investigation). MRI scans were assessed blind to other clinical information, according to a standardised protocol. Associations of baseline MRI findings with pain and disability at follow-up, adjusted for treatment and for other potentially confounding variables, were assessed by Poisson regression and summarised by prevalence ratios (PRs) with their 95% confidence intervals (CIs).ResultsQuestionnaires were completed by 240 (74%) of the patients who had agreed to be followed up. Among these 111 men and 129 women, 175 (73%) reported LBP in the past four weeks, 89 (37%) frequent LBP, and 72 (30%) disabling LBP. In patients with initial disc degeneration there was an increased risk of frequent (PR 1.3, 95%CI 1.0-1.9) and disabling LBP (PR 1.7, 95%CI 1.1-2.5) at follow-up. No other associations were found between MRI abnormalities and subsequent outcome.ConclusionsOur findings suggest that the MRI abnormalities examined are not major predictors of outcome in patients with LBP. They give no support to the use of MRI findings as a way of refining case definition for LBP in epidemiological research.