Unspecific Back Pain Research Articles

Nachhaltigkeit orthopädischer Rehabilitation bei chronischen Rückenschmerzen - Das Integrierte orthopädisch-psychosomatische Behandlungskonzept (IopKo)

Chronic diseases of the musculoskeletal system rank first as causes of early retirement in Germany. Therefore orthopaedic rehabilitation has to identify patients with work-related problems and to promote return to work through differential treatment and vocational counselling. In the framework of the IopKo-Project such measures were developed and evaluated. These measures encompass: (1) an intensive and multiprofessional diagnostic pathway which allows early detection and treatment of mental disorders and job related problems; (2) homogeneous treatment groups based on multiprofessional diagnostics; (3) differential treatments, among these a multidisciplinary programme for patients with chronic low back pain or high risk of chronification (Rückenfit); (4) interactive training modules which mediate principles of performance and disability expertise, the legal bases of retirement pensioning, and measures to support occupational rehabilitation; and (5) a work hardening training programme. To evaluate the effects of these measures in comparison to a control group with usual care, a prospective longitudinal study was conducted. A total of 307 patients were assigned to the multidisciplinary in-patient treatment programme, whereas 176 patients in the control group had a standard rehabilitation programme. The results show positive moderate and strong effects in the intervention group concerning function, pain, psychic strains as well as the number of sick days and return to work rates 10 months after discharge. The effects in the intervention group exceeded the effects achieved in the control group. PATIENTS WITH HIGH RISK OF CHRONIFICATION: Beside the full sample, a subgroup of patients with chronic pain or high risk of chronification was analyzed, who had received a multidisciplinary functional restoration treatment. Also for this subgroup we found moderate and strong effects of treatment for function, psychic strains and sick days superior to those in the control group. By this study we were able to show that orthopedic rehabilitation in a multimodal and multidisciplinary setting with a focus on activating and motivating therapy can have sustainable positive effects on pain, function and psychic well-being as well as on economic parameters. We interpret these persistent and superior effects in the treatment group (1) as a result of multiprofessional diagnosis and assignment which helps to subdivide the inhomogeneous group of patients with unspecific back pain into more homogeneous and thus more effective subgroups, (2) as a result of increased motivation by closed treatment groups, (3) as a result of intense and multilevel counselling of work related problems, (4) as a result of work hardening modules, and (5) as a result of direct and efficient treatment of psychic strains. The results also demonstrate the significance of inpatient rehabilitation, which will be efficient if differential treatment - adequate to the problems of the patient - is offered.

Comorbidity of low back pain: Representative outcomes of a national health study in the Federal Republic of Germany

Background Unlike other biopsychosocial risk factors, the role of comorbidity in low back pain is largely unknown. Aims The purpose is (1) to generate prevalence data on back pain in the total adult population and (2) to identify the most common physical comorbidities in subjects with back pain. This paper also (3) analyses the gender-specific and age-specific comorbidity structure. Methods The National German Health Survey is the first study to provide the basis for a representative nationwide analysis of back pain prevalence and the associated comorbidities. The net sample comprises a total of 7124 Germans aged 18–79. Results One in three Germans (34%) experienced back pain during the seven days prior to being interviewed. The one-year prevalence rate is 59%. All the morbidities investigated by us are more common in subjects with back pain than in individuals without back pain. The most common comorbidities associated with back pain are musculoskeletal disorders like rheumatoid arthritis, osteoarthritis and osteoporosis, followed by cardiovascular and cerebrovascular disease. Conclusions The present study investigating 31 physical diseases is the most extensive analysis to date on the topic of back pain and comorbidity. This is an attempt to cast light on the tangled relationships involved in developing and coping with back pain. In view of the large percentage of unspecific back pain, we believe it is important for physicians treating back pain to extend their history and diagnostic analysis skills to embrace comorbidities related to the back pain.

Allogeneic Transplantation from an HLA-Matched Family Donor in First Complete Remission of Acute Myeloid Leukemia Had an Adverse Impact on Quality of Life in Patients Followed for at Least Five Years after Treatment: A Survey of the German AML Intergroup on 525 Patients.

The impact of allogeneic blood stem cell transplantation (Allo-SCT) in comparison to conventional chemotherapy (CCT) in AML on quality of life remains unclear mainly due to a lack of studies with long term follow-up. Therefore the German AML-Intergroup initiated a survey on quality of life for patients treated within 1 of 8 German prospective multicenter treatment trials. All patients completed a self-report questionnaire either when they returned for follow-up outpatient visits or by mail. Patients completed the EORTC Quality of Life-Core Questionnaire (QLQ-C30) supplemented by self-assessed concomitant diseases, late treatment effects and demographic details including percentage of disability. 525 patients (median age: 46 years at diagnosis; median follow up period: 9 years) returned their questionnaires, 244 after SCT in 1. CR (189 allo; 55 auto) and 281 after CCT. Recovery-rate of the questionnaires was 55% ranging from 40% to 79% in the different trial cohorts. Due to low numbers after auto-SCT these patients were excluded from further analysis. The ECOG activity index revealed normal activity in 40% and 58% and disabled person card in 63% and 37% of the patients in the allo-SCT and CCT groups, respectively. Impaired vision, cataract surgery, chronic skin disorders and treatment of hormonal disorders were reported significantly more often in allo-SCT-patients, whereas osteoarthritis, cardiac insufficiency and unspecific back pain were slightly more frequent in CCT patients, mainly due to a higher median age in the CCT-group. All QLQC-30 functions except physical functioning and pain were in favor of CCT (p<0.001 in each variable). Problems in leisure-time activity, evenness and social life (friends and family) as well as financial management were significantly more frequent in patients after Allo-SCT than in patients after CCT, whereas the general assessment of positive attitude in life showed no difference between the two groups (62% CCT and 64% Allo-SCT). Multivariate logistic regression models on global health status and fatigue were performed. Actually concomitant disease (odds ratio 6.68 95%-CI 3.83–11.66), age > 45 years (odds-ratio 2.57 95%-CI 1.47–4.50) and Allo-SCT (odds ratio 2.10 95%-CI 1.20 – 3.69) showed significant adverse effect on global health status. Similarly unfavorable effects were evaluated for actually concomitant disease and Allo-SCT on fatigue. These results indicate that Allo-SCT compared to intensive chemotherapy had a significant negative impact on quality of life and this needs to be considered when reviewing treatment options.

Problems of diagnostic assessment in low back patients

Many different diagnostic procedures are used in patients with low back pain. Medical history and clinical examination, X-rays, computed tomography (CT)-scan, magnetic resonance imaging (MRI), diagnostic nerve root blocks and facet injections, functional tests in physiotherapy, strength tests of trunk muscles and work-related performance, and psychological and social evaluation including psychometric tests are only some of them. Despite this large number of procedures available, the scientific literature has not changed its conclusion that in about 80% of all back pain episodes the cause remains unknown. During the course of back pain episodes the relevant factors may change. The cause of the problem or the triggering factor of the pain episode may no longer be important during subacute stages, while others may be decisive for the transition to chronic stages. Thus, assessment of the cause is different from that of prognostic factors. There seems to be no consistent distribution of causes or ongoing factors in the population(s) of patients. While individual social factors may be the one important factor in one patient, functional and structural factors may be significant in another patient. Clinical examination is important, but several problems occur in the evaluation of patients with low back pain. Due to their anatomical location, important bony structures of the lumbar spine, e.g., disks or facet joints, are difficult to access by clinical examination. Additionally, there are only few diagnostic tests during clinical examination that do not rely on the patient's cooperation or communication. The term "unspecific back pain" for the majority of patients is scientifically sound, because it reflects the fact that the cause is unknown. It must be taken into consideration that this term enjoys only limited acceptance by both patients and physicians. Physicians are in charge of certifying work disability by assessing the interference of the patient's illness/disease with the specific requirements of his daily life or job. However, in clinical practice both the job tasks and the patient's abilities to perform these tasks with the given symptoms and signs is still difficult to evaluate and requires further definition.