Roland-Morris Questionnaire Research Articles

Benefits of Back School in functional capacity and pain intensity of patients with chronic low back pain.

Introduction: Due to the high incidence of low back pain in the population, is very important to study methods of prevention and treatment for this disease. The Back School, an approach that aims to provide to participants the increase of self-care, associating primary prevention to health education, has been suggested for the treatment of patients with chronic low back pain. Objective: The aim of this study was to evaluate the benefits of Back School on functional capacity and pain intensity, in short and medium term, at patients with chronic low back pain. Methods: Fifty eight patients with chronic low back pain, selected at UniCesumar physical therapy's clinic, were evaluated, by an independent examiner, using Roland-Morris Questionnaire, Pain Visual Analogue Scale and asked about consumption of medications. In sequence, all the pacients were randomized into two groups: 1) School Program and 2) Control. The group 1 patients participated of Back School program, composed of theoretical-practical classes, twice per week, totaling ten classes of 60 minutes; and group 2 were followed only by phone calls. The data were statistically analyzed by Mann-Whitney U test, Friedman and Wilcoxon, using the significant values of p < 0,05. Results: Fifty three patients finished the study and were analyzed after the treatment protocol, as well as three and six months sequent. The improvement in pain intensity and functional capacity was statistically significant only in the Back School group. Conclusion: In this study, it was found effectiveness of Back School program in the improve of functional capacity and pain intensity of patients with chronic low back pain.

Type 1 Modic changes was a significant risk factor for 1-year outcome in sick-listed low back pain patients: a nested cohort study using magnetic resonance imaging of the lumbar spine

Background contextIt is not clear whether Modic changes (MC) is associated with low back pain (LBP) outcome. PurposeTo study associations between baseline degenerative manifestations and outcome in sick-listed LBP patients. Study designProspective nested cohort study based on a randomized controlled trial. Patient sampleOut of 325 sick-listed LBP patients, 141 were consecutively examined by magnetic resonance imaging (MRI) and included and 140 completed the study. Outcome measuresDegenerative manifestations of the lumbar spine were quantified; associations were studied in relation to the three primary outcomes: change of back+leg pain, change of function as measured by Roland-Morris questionnaire, and 1-year unsuccessful return to work (U-RTW). MethodsBy using a previously validated MRI protocol, a specialist in radiology, who had no access to clinical data, described the images. Associations were studied by linear and logistic regression with adjustment for previously identified prognostic factors for 1-year pain and function and for U-RTW. ResultsClinically, 43% of the patients had radiculopathy. Degenerative changes were prevalent with altered disc contours in 84%, high-intensity zones in 70%, and nerve root touch or impingement in 63% of the patients. MC was identified in 60% of the patients, 18% with Type 1 changes and 42% with Type 2 changes, Type 1 including both Type 1 and Type 1 in combination with Type 2. Patients with Type 1 changes reported more back pain and did not improve in pain or disability. They increased to include 30% of the patients with U-RTW at 1 year. Patients with Type 2 changes did not differ significantly from patients without MC but differed significantly from patients with Type 1 changes in all three outcomes. Other degenerative manifestations were not significantly associated with any of the three outcomes. ConclusionsThe only degenerative manifestation negatively associated with outcome was Type 1 MC that affected 18% of the cohort at baseline and implied an increased risk for no improvement in pain and function and for U-RTW, even after adjustment for other prognostic factors.

The study of the variability of anticipatory postural adjustments in patients with recurrent non-specific low back pain

Intrinsic variability is present in all actions, including repetitive tasks. The aim of this study was to evaluate the variability of anticipatory postural adjustments (APAs) of trunk muscles in participants with low back pain (LBP). The study included 21 participants with recurrent non-specific LBP (15 men, 6 women) and 21 healthy volunteers. Standard deviation of electromyographic activity of the external oblique (EO), transverse abdominis/internal oblique (TrA/IO), and erector spinae (ES) muscles onset relative to deltoid muscle onset was recorded in 75 rapid arm flexions, and the correlation with the participants' avoidance belief (the FABQ score) and disability (the Roland-Morris Questionnaire score) was statistically analyzed. participants with LBP exhibited less variability in timing of APAs of the TrA/IO muscle compared with the control group (P=0.047). The timing of APAs of the TrA/IO muscle was significantly correlated with the FABQ score (P=0.006). There was no significant correlation between this variable and disability (P=0.09). Decrease in variability of the timing of APA of the EO (P=0.45) and ES (P=0.6) muscles was not significant. The variability of the postural responses of participants with LBP decreased. Restoring variability in postural control responses might be a goal in rehabilitating these patients.

Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain

This longitudinal study investigated long-term effects of a multidisciplinary rehabilitation program consisting of resistance and sensorimotor training, patient education, and stress management over 6 months in patients with chronic low back pain. Ninety-six patients with chronic recurrent low back pain performed a multidisciplinary rehabilitation program. We assessed pain-free lumbar spine range of motion (ROM), strength of the lumbar extensor muscles, and pain by visual analog scale (VAS). Furthermore, the Roland-Morris (RM) questionnaire and SF-36 were used. The examinations were performed before and after rehabilitation, and a long-term follow-up was performed after 18 months. All outcome measurements (ROM, VAS, RM, muscle strength, and SF-36 scores) improved significantly from baseline to the post-rehabilitation evaluation. These improvements were found to persist until a follow-up evaluation 18 months after cessation of the intervention. Our findings confirm the results of former studies evaluating the short-term effects of multidisciplinary rehabilitation programs. In addition, our data demonstrate that well-balanced outpatient rehabilitation programs may induce persistent improvements in muscle strength, pain, function and quality of life in patients with chronic low back pain.

The mechanical and inflammatory low back pain (MIL) index: development and validation

BackgroundThe purpose of this study was the development of a valid and reliable “Mechanical and Inflammatory Low Back Pain Index” (MIL) for assessment of non-specific low back pain (NSLBP). This 7-item tool assists practitioners in determining whether symptoms are predominantly mechanical or inflammatory.MethodsParticipants (n = 170, 96 females, age = 38 ± 14 years-old) with NSLP were referred to two Spanish physiotherapy clinics and completed the MIL and the following measures: the Roland Morris Questionnaire (RMQ), SF-12 and “Backache Index” (BAI) physical assessment test. For test-retest reliability, 37 consecutive patients were assessed at baseline and three days later during a non-treatment period. Face and content validity, practical characteristics, factor analysis, internal consistency, discriminant validity and convergent validity were assessed from the full sample.ResultsA total of 27 potential items that had been identified for inclusion were subsequently reduced to 11 by an expert panel. Four items were then removed due to cross-loading under confirmatory factor analysis where a two-factor model yielded a good fit to the data (χ2 = 14.80, df = 13, p = 0.37, CFI = 0.98, and RMSEA = 0.029). The internal consistency was moderate (α = 0.68 for MLBP; 0.72 for ILBP), test-retest reliability high (ICC = 0.91; 95%CI = 0.88-0.93) and discriminant validity good for either MLBP (AUC = 0.74) and ILBP (AUC = 0.92). Convergent validity was demonstrated through similar but weak correlations between the ILBP and both the RMQ and BAI (r = 0.34, p < 0.001) and the MLBP and BAI (r = 0.38, p < 0.001).ConclusionsThe MIL is a valid and reliable clinical tool for patients with NSLBP that discriminates between mechanical and inflammatory LBP.

Validation of a Spanish version of the Spine Functional Index.

BackgroundThe Spine Functional Index (SFI) is a recently published, robust and clinimetrically valid patient reported outcome measure.ObjectivesThe purpose of this study was the adaptation and validation of a Spanish-version (SFI-Sp) with cultural and linguistic equivalence.MethodsA two stage observational study was conducted. The SFI was cross-culturally adapted to Spanish through double forward and backward translation then validated for its psychometric characteristics. Participants (n = 226) with various spine conditions of >12 weeks duration completed the SFI-Sp and a region specific measure: for the back, the Roland Morris Questionnaire (RMQ) and Backache Index (BADIX); for the neck, the Neck Disability Index (NDI); for general health the EQ-5D and SF-12. The full sample was employed to determine internal consistency, concurrent criterion validity by region and health, construct validity and factor structure. A subgroup (n = 51) was used to determine reliability at seven days.ResultsThe SFI-Sp demonstrated high internal consistency (α = 0.85) and reliability (r = 0.96). The factor structure was one-dimensional and supported construct validity. Criterion specific validity for function was high with the RMQ (r = 0.79), moderate with the BADIX (r = 0.59) and low with the NDI (r = 0.46). For general health it was low with the EQ-5D and inversely correlated (r = −0.42) and fair with the Physical and Mental Components of the SF-12 and inversely correlated (r = −0.56 and r = −0.48), respectively. The study limitations included the lack of longitudinal data regarding other psychometric properties, specifically responsiveness.ConclusionsThe SFI-Sp was demonstrated as a valid and reliable spine-regional outcome measure. The psychometric properties were comparable to and supported those of the English-version, however further longitudinal investigations are required.

Deep tissue massage and nonsteroidal anti-inflammatory drugs for low back pain: a prospective randomized trial.

Objective. To investigate whether chronic low back pain therapy with deep tissue massage (DTM) gives similar results to combined therapy consisting of DTM and non-steroid anti-inflammatory drugs (NSAID). Design. Prospective controlled randomized single blinded trial. Settings. Ambulatory care of rehabilitation. Participants. 59 patients, age 51.8 ± 9.0 years, with chronic low back pain. Interventions. 2 weeks of DTM in the treatment group (TG) versus 2 weeks of DTM combined with NSAID in the control group (CG). Main Outcome Measures. Visual analogue scale, Oswestry disability index (ODI), and Roland-Morris questionnaire (RM). Results. In both the TG and the CG, a significant pain reduction and function improvement were observed. VAS decreased from 58.3 ± 18.2 to 42.2 ± 21.1 (TG) and from 51.8 ± 18.8 to 30.6 ± 21.9 (CG). RM value decreased from 9.8 ± 5.1 to 6.4 ± 4.4 (TG), and from 9.3 ± 5.5 to 6.1 ± 4.6 (CG). ODI value decreased from 29.2 ± 17.3 to 21.4 ± 15.1 (TG) and from 21.4 ± 9.4 to 16.6 ± 9.4 (CG). All pre-post-treatment differences were significant; however, there was no significant difference between the TG and the CG. Conclusion. DTM had a positive effect on reducing pain in patients with chronic low back pain. Concurrent use of DTM and NSAID contributed to low back pain reduction in a similar degree that the DTM did.

Intravenous nonopioid analgesic drugs in chronic low back pain patients on chronic opioid treatment

Addition of nonopioid analgesic drugs reduces pain and opioid requirements in acute low back pain. In noncancer chronic low back pain (CLBP), the efficacy of a combined regimen to reduce breakthrough pain has not been proven so far. Evaluation of the effects of intravenous (i.v.) nonopioid analgesic drugs on pain intensity and lumbar mobility in CLBP patients on chronic opioid therapy. Randomised, placebo-controlled, double blinded, crossover study. Vienna General Hospital, Austria, from December 2002 to May 2004. Thirty-six adults with CLBP on chronic opioid therapy. Inclusion criteria are as follows: American Society of Anesthesiologists' physical status less than 3, visual analogue scale (VAS) more than 4 and no known allergy to any of the used drugs. After written informed consent and VAS assessment, any oral nonopioid analgesic drug (NSAIDs, metamizol, paracetamol) was replaced by placebo 10 days before the first test infusion as a washout period. Coanalgesics (anticonvulsants, antidepressants) were maintained. Each patient received randomly four i.v. test infusions of diclofenac 75 mg (and orphenadrine 30 mg), parecoxib 40 mg, paracetamol 1 g and isotonic saline. A washout time of 72 h was allowed between each infusion. Primary outcome was as follows: VAS pain intensity (0 to 100 mm) at inclusion, before and within 30 min after infusion. Secondary outcomes were as follows: Roland-Morris questionnaire, McGill pain questionnaire and a test panel of physical functioning for spinal mobility, muscular endurance, balance and coordination. The differences in means of the above assessments among the groups were analysed. We found an improvement in VAS from the day of inclusion to the day of each appointment. We observed no improvement in pain intensity (VAS) or in any of the physical functioning tests immediately before versus after administration of the four i.v. drugs. Reductions in sensory, affective and cognitive dimensions of the McGill pain questionnaire were statistically significant in the diclofenac group. A trend of McGill pain questionnaire improvement existed in the other groups. The present data show that the anticipation of an i.v. infusion of nonopioid analgesic drug improves VAS significantly, probably through expectation-related mechanisms. However, single dose i.v. infusions of nonopioid analgesic drugs fail to improve pain intensity and spinal mobility in CLBP patients on chronic opioid treatment, even immediately after the infusion.

Pain, kinesiophobia and quality of life of low back pain patients

BACKGROUND AND OBJECTIVES: Chronic low back pain is a musculoskeletal problem with high prevalence and frequent associated conditions, which causes major impact on patients' daily life and quality of life. This study aimed at evaluating pain perception, fear of movement and adherence to treatment of patients with low back pain and surgical indication. METHODS: This is a prospective study with convenience sample made up of low back pain patients, called test group: chronic non-cancer pain patients who were randomly selected and were waiting for surgery. Control group was made up of patients screened by the Pain Clinic, with low back pain, however asymptomatic. Tools were the visual analog scale, the Morisky & Green questionnaire to check adherence to treatment and the Roland-Morris questionnaire to evaluate functional incapacity. Fear of movement was evaluated by the Tampa Scale for Kinesiophobia and quality of life by the Study Short form 12 Health Survey (SF-12) (Medical Outcomes). RESULTS: Mean age of the test group was 38.8±6.5 years with prevalence of females, impaired labor situation and mean education of 8.5±3.8 years. Both mental and physical components had lower quality of life scores in the test group, in addition to more severe pain, functional incapacity and fear of movement. Non-adherence to treatment was seen in 65% of test group patients. CONCLUSION: Fear of movement, functional incapacity and pain observed in test group may have implications in the quality of life of low back pain patients who will be submitted to surgery and may be predictors for the incorporation of different strategies to contribute to more effective approaches.

Clinical and neurological characteristics of patients with somatic referred back pain at the lumbosacral level

Referred pain is a painful sensation in the peripheral regions during pathological processes in deep tissues or viscera. There are two types of referred pain: 1) somatic referred pain (from spinal structures to adjacent areas); 2) visceral referred pain (from pelvic and abdominal viscera). Patients and methods. The investigation enrolled 80 patients with nonspecific chronic and subacute lumbosacral spine pain. All the patients underwent standard neurological examination. Pain intensity was determined on a visual analog scale (VAS) using the DN4, PainDETECT, and short-form McGill questionnaires; the wind-up phenomenon was evaluated; the degree of muscular tonic syndrome was estimated applying the Khabirov questionnaire. The health-activity-mood (HAM), SF-36, and Roland-Morris questionnaires were used to assess quality of life. Results. Somatic referred pain was found in 62% of the examinees. In these patients, the clinical picture showed a set of characteristics for neuropathic (allodynia (31%), hyperesthesia (12%), and nociceptive (grades 1 and 2 muscular tonic syndrome 41 and 59%, respectively) pain; a high wind-up index was noted in 89% of the patients.

Myofascial Trigger Points, Pain, Disability, and Sleep Quality in Patients with Chronic Nonspecific Low Back Pain

To investigate the difference in the presence of trigger points (TrPs) between patients with chronic nonspecific low back pain (LBP) and healthy people, and to determine the relationship of TrPs with the intensity of ongoing pain, disability, and sleep quality. A cross-sectional study. The role of TrPs in LBP has not been determined. Forty-two patients with nonspecific LBP (50% women), aged 23-55 years old, and 42 age- and sex-matched controls participated. TrPs were bilaterally explored within the quadratus lumborum, iliocostalis lumborum, psoas, piriformis, gluteus minimus, and gluteus medius muscles in a blinded design. TrPs were considered active if the subject recognized the local and referred pain as familiar symptoms, and TrPs were considered latent if the pain was not recognized as a familiar symptom. Pain measures were collected with a numerical pain rate scale, disability was assessed with the Roland-Morris questionnaire, and sleep quality was determined with the Pittsburgh Sleep Quality Index. Patients with nonspecific LBP exhibited a greater disability and worse sleep quality than healthy controls (P < 0.001). Patients with nonspecific LBP exhibited a mean of 3.5 ± 2.3 active TrPs. Further, patients with nonspecific LBP showed a greater (P < 0.001) number of latent TrPs (mean: 2.0 ± 1.5) than healthy controls (mean: 1.0 ± 1.5). Active TrPs in the quadratus lumborum, iliocostalis lumborum, and gluteus medius muscles were the most prevalent in patients with nonspecific LBP. A greater number of active TrPs was associated with higher pain intensity (rs = 0.602; P < 0.001) and worse sleep quality (rs = 0.338; P = 0.03). The local and referred pain elicited by active TrPs in the back and hip muscles contributes to pain symptoms in nonspecific LBP. Patients had higher disability and worse sleep quality than controls. The number of active TrPs was associated with pain intensity and sleep quality. It is possible that a complex interaction among these factors is present in patients with nonspecific LBP.

Effect of Facet Joint Injection Versus Systemic Steroids in Low Back Pain

Randomized clinical trial. To compare the effectiveness of facet joint injection versus systemic steroid in patients with a diagnosis of facet joint syndrome. The term facet joint syndrome has been used to define back pain originating from the facet joints. Treatment is mainly conservative, although interventions, including intra-articular injections and medial branch nerve blocks are used to manage facet-mediated pain. Several studies have evaluated the effectiveness of these interventions. Results of facet joint injection, however, are conflicting. Sixty subjects with a diagnosis of facet joint syndrome were enrolled in the study. They were randomized into experimental and control groups. The experimental group was administered with intra-articular injection of 6 lumbar facet joints with triamcinolone hexacetonide; the control group was administered with triamcinolone acetonide intramuscular injection of 6 lumbar paravertebral points. Visits were taken at baseline and at 1, 4, 12, and 24 weeks after interventions. Outcome measures were used: pain visual analogue scale, pain visual analogue scale during extension of the spine, Likert scale, improvement percentage scale, Roland-Morris, 36-Item Short Form Health Survey, and accountability of medications taken.Homogeneity was tested using the Student t, Pearson χ, and Mann-Whitney tests. Analysis of variance was used to analyze differences in the groups over time and the Student t test to analyze differences between groups at each time evaluation. The groups were similar at baseline. Comparisons between the groups showed, in analysis of variance analysis, an improvement in the experimental group regarding diclofenac intake and quality of life, in the "role physical" profile, assessed by 36-Item Short Form Health Survey.In the analysis at each time point, an improvement in the experimental group was also found in the Roland-Morris questionnaire, in the improvement percentage scale and in the response to treatment, assessed by the Likert scale. Both treatments were effective, with a slight superiority of the intra-articular injection of steroids over intramuscular injection.

Validation of a French version of Roland–Morris questionnaire in chronic low back pain patients

ObjectiveTo validate a French version of the Roland–Morris Disability Questionnaire (RMDQ) in patients with chronic low back pain (LBP). Material and methodsFifty-eight patients due to participate in a functional rehabilitation programme for chronic low back pain were included prospectively. The RMDQ, the Quebec Back Pain Disability Scale (QBPDS) and the “daily activities” subscale of the Dallas Pain Questionnaire (DPQ) were administered. The RMDQ was assessed for internal consistency, reliability, criterion validity and sensitivity to change. ResultsCronbach's alpha for the RMDQ was 0.84. The intraclass correlation coefficient [95% confidence interval] was 0.89 [0.83–0.93]. The RMDQ score was correlated with the QBPDS score (r=0.713) and the DPQ's “daily activities” subscore (r=0.514). The results of assessments before and after functional rehabilitation showed that the French version of the RMDQ had very high sensitivity to change (effect size: 1.49) and was more sensitive than the QBPDS and the DPQ's “daily activities” subscore. ConclusionsOur study validated the French version of the RMDQ in patients suffering from chronic low back pain. Furthermore, we highlighted the questionnaire's very high sensitivity to change.

The usefulness of ICG video angiography in the surgical treatment of superior cluneal nerve entrapment neuropathy

Superior cluneal nerve (SCN) entrapment neuropathy is a known cause of low back pain. Although surgical release at the entrapment point of the osteofibrous orifice is effective, intraoperative identification of the thin SCN in thick fat tissue and confirmation of sufficient decompression are difficult. Intraoperative indocyanine green video angiography (ICG-VA) is simple, clearly demonstrates the vascular flow dynamics, and provides real-time information on vascular patency and flow. The peripheral nerve is supplied from epineurial vessels around the nerve (vasa nervorum), and the authors now present the first ICG-VA documentation of the technique and usefulness of peripheral nerve neurolysis surgery to treat SCN entrapment neuropathy in 16 locally anesthetized patients. Clinical outcomes were assessed with the Roland-Morris Disability Questionnaire before surgery and at the latest follow-up after surgery. Indocyanine green video angiography was useful for identifying the SCN in fat tissue. It showed that the SCN penetrated and was entrapped by the thoracolumbar fascia through the orifice just before crossing over the iliac crest in all patients. The SCN was decompressed by dissection of the fascia from the orifice. Indocyanine green video angiography visualized the SCN and its termination at the entrapment point. After sufficient decompression, the SCN was clearly visualized on ICG-VA images. Low back pain improved significantly, from a preoperative Roland-Morris Questionnaire score of 13.8 to a postoperative score of 1.3 at the last follow-up visit (p < 0.05). The authors suggest that ICG-VA is useful for the inspection of peripheral nerves such as the SCN and helps to identify the SCN and to confirm sufficient decompression at surgery for SCN entrapment.

Effect of functional lumbar stabilization exercises on pain, disability, and kinesiophobia in women with menstrual low back pain: a preliminary trial

ObjectiveThe purpose of this preliminary study was to investigate the effect of functional lumbar stabilization exercises on pain, disability, and kinesiophobia in women with menstrual low back pain (LBP). MethodsThirty women with menstrual LBP participated in the study. Subjects were assigned to a control group (n=10, mean age=25.1 ±4.7years) and an intervention group (n=20, mean age=21.7±2.4years). Treatment for the intervention group consisted of functional lumbar stabilization exercises, 10 repetitions each, 3 times a day, for 3 consecutive months. The women in the control group received no exercise and performed their regular activity daily living. Pain intensity using a Numeric Pain Scale (NPS), Oswestry Disability Index (ODI), Roland-Morris Questionnaire (RMQ), and Tampa Scale of Kinesiophobia (TSK) was collected at baseline and at the end of 3months in both groups. ResultsStatistical analysis (paired t test) revealed a significant decrease in NPS, ODI, RMQ, and TSK after treatment in the intervention group. No significant difference in NPS, ODI, RMQ, or TSK was found between pre- and postmeasurement scores in the control group. In the analysis of covariance, controlling for pretest scores, a significant difference was found between the 2 groups in the postmeasurement score of NPS (P=.01), ODI (P<.001), RMQ (P=.002), and TSK (P=.04). ConclusionLumbar stabilization exercises were shown to improve pain, disability, and kinesiophobia during menstrual LBP for subjects who participated in this preliminary study compared to those who did not receive the intervention.

AB0664 Global postural reeducation to treat chronic low back pain: randomized, controlled trial

BackgroundLow back pain (LBP) is a major cause of physical limitations and absenteeism at work throughout the world1. A number of studies have demonstrated the effectiveness of therapeutic exercises on...

SAT0438 Postural control in individuals with and without non-specific chronic low back pain: A comparative study

BackgroundChronic low back pain (CLBP) affects from 12-33% of the adult population and the cause of its chronicity still unknown. Change in postural control is a factor involved and studies...

Dynamic change and influence of osteoporotic back pain with vertebral fracture on related activities and social participation: evaluating reliability and validity of a newly developed outcome measure

The objective of this study was to record the clinical course of osteoporosis over time in Japanese women. We hypothesized that successful control of acute pain associated with osteoporosis will allow better treatment for health-related problems. To confirm this working hypothesis, we developed the Japan Questionnaire for Osteoporotic Pain (JQ22) to measure health status associated with osteoporosis. We examined the validity and reliability of the JQ22 compared with the current gold standard scale for back pain, the Roland Morris questionnaire (RDQ). A total of 125 women who were more than 65years old, had an acute back pain episode, and had a fragile vertebral fracture confirmed by X-ray and clinical signs, participated in this study. The psychometric analyses for validity and reliability were tested for the JQ22 and the RDQ. The time course up to 6weeks was observed by investigating both changes in pain characteristics and its influence on related activities and social participation. Cronbach's alpha coefficient was 0.979 and 0.919 for the JQ22 and RDQ, respectively. The Akaike Information Criterion (AIC) indicated that the JQ22 items were separated into four domains, which were sequentially arranged at the baseline and subsequently changed. This structure reflected osteoporotic back characteristics covering a range from pain to social activities. The JQ22 was shown to be a valid and reliable scale for patient-based measurement of osteoporotic back pain. It also revealed both changes in pain characteristics and the influence of pain on related activities and participation.

Percutaneous Vertebroplasty for Pain Management in Patients with Multiple Myeloma: Is Radiofrequency Ablation Necessary?

This study was designed to investigate the added role of radiofrequency ablation (RFA) to vertebroplasty on the pain management of patients with multiple myeloma (MM). Thirty-six patients (51-82 years) with vertebral localization of MM were randomly divided into two groups: 18 patients (group A) who underwent RFA and then vertebroplasty, and 18 patients (group B) who underwent only vertebroplasty. Primary endpoints were technical success and pain relief score rate measured by the visual analogue pain scores (VAS) and Roland-Morris Questionnaire (RMQ); secondary endpoint was the amount of administered analgesia. Survival and complications were compared. Technical success was 100 % in both groups. The VAS score (at 24 h and 6 weeks postprocedure) decreased in equal manner for both groups from a mean of 9.1-3.4 and 2.0 for group A and from a mean of 9.3-3.0 and 2.3 for group B; RMQ mean score was 19.8 for group A and 19.9 for group B and decreased to a mean of 9.6 and 8.2 for group A and 9.5 and 8.7 for group B. The amount of medication was equally decreased in the two groups. No statistically significant difference was noted. No major complication occurred and two patients died from other causes. The use of percutaneous vertebroplasty alone appears to be effective for the pain management of the patients with vertebral involvement of multiple myeloma. The use of RFA that includes cost and time does not offer any clear added benefit on the midterm pain management of such patients.

A Comparison of Intraarticular Lumbar Facet Joint Steroid Injections and Lumbar Facet Joint Radiofrequency Denervation in the Treatment of Low Back Pain

Lumbar facet joint degeneration is a source of chronic low back pain, with an incidence of 15% to 45% among patients with low back pain. Various therapeutic techniques in the treatment of facet-related pain have been described in the literature, including intraarticular lumbar facet joint steroid injections and radiofrequency denervation. In this study, we compared the effectiveness of intraarticular facet joint steroid injections and radiofrequency denervation. Our randomized, double-blind, controlled study included patients who received intraarticular steroid infiltrations in the lumbar facet joints (L3/L4-L5/S1) and patients who underwent radiofrequency denervation of L3/L4-L5/S1 segments. The inclusion criteria were based first on magnetic resonance imaging findings showing hypertrophy of the facet joints L3/L4-L5/S1 and a positive response to an intraarticular test infiltration of the facet joints L3/L4-L5/S1 with local anesthetics. The primary end point was the Roland-Morris Questionnaire. Secondary end points were the visual analog scale and the Oswestry Disability Index. All outcome assessments were performed at baseline and at 6 months. Fifty-six patients were randomized; 24 of 29 patients in the steroid injection group and 26 of 27 patients in the denervation group completed the 6-month follow-up. Pain relief and functional improvement were observed in both groups. There were no significant differences between the 2 groups for the primary end point (95% confidence interval [CI], -3 to 4) and for both secondary end points (95% CI for visual analog scale, -2 to 1; 95% CI for Oswestry Disability Index, -18 to 0). Intraarticular steroid infiltration or radiofrequency denervation appear to be a managing option for chronic function-limiting low back pain of facet origin with favorable short- and midterm results in terms of pain relief and function improvement, but improvements were similar in both groups.