BACK PAIN AND THE POSTURAL AND BEHAVIORAL HABITS OF STUDENTS IN THE MUNICIPAL SCHOOL NETWORK OF TEUTÔNIA, RIO GRANDE DO SUL

to investigate the prevalence of back pain during a prior three-month period; to identify postural and behavioral habits; to assess whether a relationship exists between back pain and the postural and behavioral habits of elementary school students in the municipal school network in the city of Teutônia, Rio Grande do Sul (RS). METHODS: this was an epidemiological population study in which 833 5th to 8th grade students from schools in the municipal school network in Teutônia participated. The students completed a Back Pain and Body Posture Evaluation Instrument (BackPEI) questionnaire that assessed back pain and postural and behavioral habits. The analysis was performed using descriptive statistics, calculating prevalence ratios (PR) and confidence intervals at the 95% level. The dependent variable was back pain, and the independent variables were postural and behavioral habits. The PR was calculated using a multivariate analysis with robust variance (α = 0.05). RESULTS: the prevalence of back pain in the previous three months was 54.1%. The majority of students reported feeling pain once per month, and 17.4% of the students reported that pain impaired their performance of daily activities. The multivariate analysis showed a correlation between back pain and time spent per day watching television (p = 0.046), sleeping posture (p = 0.048) and sitting Down to write (p = 0.032). CONCLUSIONS: these results demonstrate a high prevalence of back pain in schoolchildren, suggesting an urgent need to develop educational and preventative programs in schools

A randomized placebo-controlled pilot study of the efficacy and safety of D-cycloserine in people with chronic back pain.

BACKGROUND: Few effective pharmacological treatment options exist for chronic back pain, the leading cause of disability in the US, and all are associated with significant adverse effects. OBJECTIVE: To determine the efficacy and safety of D-cycloserine, a partial agonist to the N-methyl-D-aspartate receptor, in the treatment of chronic low back pain. METHODS: A total of 41 participants with chronic back pain who met all inclusion and exclusion criteria were enrolled in a double-blind, placebo-controlled randomized pilot trial of D-cycloserine. Treatment was administered orally for six weeks at escalating daily doses of 100 mg, 200 mg, and 400 mg, each for two weeks. The primary outcome measure was back pain intensity using the Numeric Rating Scale (0-10). Secondary measures were back pain-related questionnaires: McGill Pain Questionnaire short form, painDETECT, PANAS, and BDI. The pre-specified analysis was a two-way repeated measures analysis of variance. RESULTS: A treatment difference was observed between groups treated with D-cycloserine and placebo at six weeks of 1.05 ± 3.1 units on the Numeric Rating Scale, with an effect size of 0.4 and p = 0.14. This trend of better chronic back pain relief with D-cycloserine was also observed in the secondary measures. No safety issues were seen. CONCLUSION: The difference in mean pain between the D-cycloserine and placebo groups did not reach statistical significance. However, a clinically meaningful effect size in the magnitude of pain relief was observed with a consistent pattern across multiple outcome measures with good safety, supporting further research into the effectiveness of D-cycloserine for chronic back pain

Segmental stabilizing exercises and low back pain: What is the evidence?

Study design: A systematic review of randomized controlled trials. Objectives: To evaluate the effectiveness of segmental stabilizing exercises for acute, subacute and chronic low back pain with regard to pain, recurrence of pain, disability and return to work. Methods: MEDLINE, EMBASE, CINAHL, Cochrane Controlled Trials Register, PEDro and article reference lists were searched from 1988 onward. Randomized controlled trials with segmental stabilizing exercises for adult low back pain patients were included. Four comparisons were foreseen: (1) effectiveness of segmental stabilizing exercises versus treatment by general practitioner (GP); (2) effectiveness of segmental stabilizing exercises versus other physiotherapy treatment; (3) effectiveness of segmental stabilizing exercises combined with other physiotherapy treatment versus treatment by GP and (4) effectiveness of segmental stabilizing exercises combined with other physiotherapy treatment versus other physiotherapy treatment. Results: Seven trials were included. For acute low back pain, segmental stabilizing exercises are equally effective in reducing short-term disability and pain and more effective in reducing long-term recurrence of low back pain than treatment by GP. For chronic low back pain, segmental stabilizing exercises are, in the short and long term, more effective than GP treatment and may be as effective as other physiotherapy treatments in reducing disability and pain. There is limited evidence that segmental stabilizing exercises additional to other physiotherapy treatment are equally effective for pain and more effective concerning disability than other physiotherapy treatments alone. There is no evidence concerning subacute low back pain. Conclusion: For low back pain, segmental stabilizing exercises are more effective than treatment by GP but they are not more effective than other physiotherapy interventions

Educating Patients about Behavioral Interventions and Exercises for Musculoskeletal Lower Back Pain

Low back pain (LBP) is a common problem which affects all genders and most ages. It results in considerable direct and indirect costs, and these costs are financial, workforce and social. The majority of lower back pain occurs due to a musculoskeletal etiology and often presents to the primary care physician. We worked with local physicians, chiropractors, physical therapists, and athletic trainers to develop exercises and behavioral modifications that patients can do to improve lower back pain symptoms.https://scholarworks.uvm.edu/fmclerk/1273/thumbnail.jp

Using geographical information systems for management of back-pain data

This is the post-print version of the Article. The official published version can be accessed from the link below - Copyright @ 2002 MCB UP LtdIn the medical world, statistical visualisation has largely been confined to the realm of relatively simple geographical applications. This remains the case, even though hospitals have been collecting spatial data relating to patients. In particular, hospitals have a wealth of back pain information, which includes pain drawings, usually detailing the spatial distribution and type of pain suffered by back-pain patients. Proposes several technological solutions, which permit data within back-pain datasets to be digitally linked to the pain drawings in order to provide methods of computer-based data management and analysis. In particular, proposes the use of geographical information systems (GIS), up till now a tool used mainly in the geographic and cartographic domains, to provide novel and powerful ways of visualising and managing back-pain data. A comparative evaluation of the proposed solutions shows that, although adding complexity and cost, the GIS-based solution is the one most appropriate for visualisation and analysis of back-pain datasets

Spinal cord stimulation for predominant low back pain in failed back surgery syndrome: study protocol for an international multicenter randomized controlled trial (PROMISE study)

Background: Although results of case series support the use of spinal cord stimulation in failed back surgery syndrome patients with predominant low back pain, no confirmatory randomized controlled trial has been undertaken in this patient group to date. PROMISE is a multicenter, prospective, randomized, open-label, parallel-group study designed to compare the clinical effectiveness of spinal cord stimulation plus optimal medical management with optimal medical management alone in patients with failed back surgery syndrome and predominant low back pain. Method/Design: Patients will be recruited in approximately 30 centers across Canada, Europe, and the United States. Eligible patients with low back pain exceeding leg pain and an average Numeric Pain Rating Scale score >= 5 for low back pain will be randomized 1:1 to spinal cord stimulation plus optimal medical management or to optimal medical management alone. The investigators will tailor individual optimal medical management treatment plans to their patients. Excluded from study treatments are intrathecal drug delivery, peripheral nerve stimulation, back surgery related to the original back pain complaint, and experimental therapies. Patients randomized to the spinal cord stimulation group will undergo trial stimulation, and if they achieve adequate low back pain relief a neurostimulation system using the Specify (R) 5-6-5 multi-column lead (Medtronic Inc., Minneapolis, MN, USA) will be implanted to capture low back pain preferentially in these patients. Outcome assessment will occur at baseline (pre-randomization) and at 1, 3, 6, 9, 12, 18, and 24 months post randomization. After the 6-month visit, patients can change treatment to that received by the other randomized group. The primary outcome is the proportion of patients with >= 50% reduction in low back pain at the 6-month visit. Additional outcomes include changes in low back and leg pain, functional disability, health-related quality of life, return to work, healthcare utilization including medication usage, and patient satisfaction. Data on adverse events will be collected. The primary analysis will follow the intention-to-treat principle. Healthcare use data will be used to assess costs and long-term cost-effectiveness. Discussion: Recruitment began in January 2013 and will continue until 2016

Chronic non-specific low back pain - sub-groups or a single mechanism?

Copyright 2008 Wand and O'Connell; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Low back pain is a substantial health problem and has subsequently attracted a considerable amount of research. Clinical trials evaluating the efficacy of a variety of interventions for chronic non-specific low back pain indicate limited effectiveness for most commonly applied interventions and approaches. Discussion: Many clinicians challenge the results of clinical trials as they feel that this lack of effectiveness is at odds with their clinical experience of managing patients with back pain. A common explanation for this discrepancy is the perceived heterogeneity of patients with chronic non-specific low back pain. It is felt that the effects of treatment may be diluted by the application of a single intervention to a complex, heterogeneous group with diverse treatment needs. This argument presupposes that current treatment is effective when applied to the correct patient. An alternative perspective is that the clinical trials are correct and current treatments have limited efficacy. Preoccupation with sub-grouping may stifle engagement with this view and it is important that the sub-grouping paradigm is closely examined. This paper argues that there are numerous problems with the sub-grouping approach and that it may not be an important reason for the disappointing results of clinical trials. We propose instead that current treatment may be ineffective because it has been misdirected. Recent evidence that demonstrates changes within the brain in chronic low back pain sufferers raises the possibility that persistent back pain may be a problem of cortical reorganisation and degeneration. This perspective offers interesting insights into the chronic low back pain experience and suggests alternative models of intervention. Summary: The disappointing results of clinical research are commonly explained by the failure of researchers to adequately attend to sub-grouping of the chronic non-specific low back pain population. Alternatively, current approaches may be ineffective and clinicians and researchers may need to radically rethink the nature of the problem and how it should best be managed

Outcome of low back pain patients referred to orthopeadic outpatient clinic

Background: Musculoskeletal complaints are the commonest encounters in primary care. Low back pain management is commonly initiated by the family practitioner. Guidelines are limited as to when patients should be referred for specialist treatment by the orthopaedic department. Objectives: Evaluate the justification of low back pain referrals to Orthopedic outpatients (OOP), Mater Dei Hospital, Malta and assess whether these merited specialist consultation. Method: Anonymous data was collected over a 3- month period, where 100 low back pain new case referrals were evaluated during OOP. Data collection was based on routine questions normally brought forward during a consultation and a management plan which was documented in a spreadsheet. Data was analyzed using the same software. Results: Out of the total number of patients reviewed, 57 had been referred for the first time to OOP. Out of these, only 10 required an MRI with a scheduled follow up appointment. The remainder were referred for physiotherapy or pain clinic and discharged to follow-up in the community by the primary care physician. Out of 43 patients who had had previous OOP appointments complaining of lower back pain, 5 patients required an MRI and follow up appointment, remainder were discharged with physiotherapy or pain clinic appointments. Conclusion: The majority of patients seen at OOP could have been managed in primary care. It reflects the importance of developing local management guidelines for low back pain, which would assist general practitioners. It is indicative that referral to OOP should only be triggered when all treatment options available in the primary care are exhausted. This would lead to patients achieving targeted treatment timely within the community, resulting in shorter waiting time for outpatient visits.peer-reviewe

Randomised controlled trial of exercise for low back pain : clinical outcomes, costs and preferences

Objective: To evaluate effectiveness of an exercise programme in a community setting for patients with low back pain to encourage a return to normal activities. Design: Randomised controlled trial of progressive exercise programme compared with usual primary care management. Patients' preferences for type of management were elicited independently of randomisation. Participants: 187 patients aged 18-60 years with mechanical low back pain of 4 weeks to 6 months' duration. Interventions: Exercise classes led by a physiotherapist that included strengthening exercises for all main muscle groups, stretching exercises, relaxation session, and brief education on back care. A cognitive-behavioural approach was used. Main outcome measures: Assessments of debilitating effects of back pain before and after intervention and at 6 months and 1 year later. Measures included Roland disability questionnaire, Aberdeen back pain scale, pain diaries, and use of healthcare services. Results: At 6 weeks after randomisation, the intervention group improved marginally more than the control group on the disability questionnaire and reported less distressing pain. At 6 months and 1 year, the intervention group showed significantly greater improvement in the disability questionnaire score (mean difference in changes 1.35, 95% confidence interval 0.13 to 2.57). At 1 year, the intervention group also showed significantly greater improvement in the Aberdeen back pain scale (4.44, 1.01 to 7.87) and reported only 378 days off work compared with 607 in the control group. The intervention group used fewer healthcare resources. Outcome was not influenced by patients' preferences. Conclusions: The exercise class was more clinically effective than traditional general practitioner management, regardless of patient preference, and was cost effective

Recovery: What does this mean to patients with low back pain?

Copyright © 2009, American College of Rheumatology. This article is freely available through the publisher’s link below.Objective - To explore patients' perceptions of recovery from low back pain, about which little is known. Methods - A qualitative study was conducted in which 36 participants, either recovered or unrecovered from low back pain, participated in focus groups. Interviews were audiorecorded and transcribed verbatim. Framework analysis was used to identify emergent themes and domains of recovery. Results - Patients' views of recovery encompassed a range of factors that can be broadly classified into the domains of symptom attenuation, improved capacity to perform a broad scope of self-defined functional activities, and achievement of an acceptable quality of life. An interactive model is proposed to describe the relationships between these domains, cognitive appraisal of the pain experience, and self-rated recovery. Pain attenuation alone was not a reliable indicator of recovery. Conclusion - The construct of recovery for typical back pain patients seeking primary care is more complex than previously recognized and is a highly individual construct, determined by appraisal of the impact of symptoms on daily functional activities as well as quality of life factors. These findings will be valuable for reassessing how to optimize measures of recovery from low back pain by addressing the spectrum of factors patients consider meaningful