Nonspecific low back pain in general practice: a delicate point (A descriptive study on the clinical relevance)

LBP is usually a self-limiting symptom. It generally has no impact on the average life expectancy and major medical interventions are not necessary. The major problem of LBP is that such a benign physical condition not only incurs high costs due to sickness leave and incapacity for work, but also demands much of health care resources (Van Tulder 1995). The expenditure on LBP includes the costs of the GP, radiodiagnostics, prescriptions, the (physio)therapist, and the medical specialist in an out-patient clinic (Liu 1995). In the Netherlands, musculoskeletal disorders, with LBP as the main cause, are the most frequent reason for sickness leave (Moens 1993). Annually, 2.5 per 1,000 employees become incapacitated for work due to LBP: a total of approximately 18,000 persons per year. In most cases, a specific cause for LBP cannot be found (Verbeek 1993). Of all reasons for visiting a GP approximately 15% are for musculoskeletal disorders, of which LBP is the most frequently occurring reason (Lamberts 1991a)

The occurrence and inter-rater reliability of myofascial trigger points in the quadratus lumborum and gluteus medius: A prospective study in non-specific low back pain patients and controls in general practice

The presence of a trigger point is essential to the myofascial pain syndrome. This study centres on identifying clearer criteria for the presence of trigger points in the quadratus lumborum and gluteus medius muscle by investigating the occurrence and inter-rater reliability of trigger point symptoms. Using the symptoms and signs as described by Simons' 1990 definition and two other former sets of criteria, 61 non-specific low back pain patients and 63 controls were examined in general practice by 5 observers, working in pairs. From the two major criteria of Simons' 1990 definition only ‘localized tenderness’ has good discriminative ability and inter-rater reliability (kappa > 0.5). This study does not find proof for the clinical usefulness of ‘referred pain’, which has neither of these two abilities. The criteria ‘jump sign’ and ‘recognition’, on the condition that localized tenderness is present, also have good discriminative ability and inter-rater reliability. Trigger points defined by the criteria found eligible in this study allow significant distinction between non-specific low back pain patients and controls. This is not the case with trigger points defined by Simons' 1990 criteria. Concerning reliability there is also a significant difference between the two different criteria sets. This study suggests that the clinical usefulness of trigger points is increased when localized tenderness and the presence of either jump sign or patient's recognition of his pain complaint are used as criteria for the presence of trigger points in the M. quadratus lumborum and the M. gluteus medius