Hirokawa, Robert G.

English

eVols at University of Hawaii at Manoa

Introduction/Statement of theProblemLow hack pain is an almost universal humancondition. It has affected man throughout mostol recorded histor . It is a motor contributor tohuman suHer inst and disability and has enormoos associated social costs. Chronic disability associated with low hack pain has reachedepidemic proportions despite advances inknowkedge and greater resources.T Persons suffering from ba hack painrepresent two distinct populations. In approximately NU’ ot persons afflicted with loss back pain, the pmblem seems to resolve nimatter what type ot care is pros ided while the remaining 20% ofpersons with low hack pain seem destined to a life of chronic painand disability regardless of the t\ pe of care providend It is this lattercroup of mdi iduaic that is associated a ith the enormous financialand societal costs of ow hack pain in aestern societies.’I-iistoricall . low back pain has been operatiunalized into twohroad categories—acute low hack pain and chronic loss hack paindisahility. Various studies have identifi.ed several factors th.at .mayhe associated with the occurrence of acute low haek pain includingsmoking obesity.’ socioeconomic status ioperationai ized by iohclassification i: and certain ps chological traits deprcssion. type -\h-ehsis or, and hr pochondria i \iost. if not all ot these studies ofacute low hack pain have heen conducted on adult populations.However, recent investigation has suggested that incident (acute)bow back pain may he occurring in early adolescence rather thanadulthood as prevouslv assumed. Thms fmnding mar resjui re futurestudies investigating risk factors for acute low back pain to include-adolescents as a eli as adults in their samples.On the other hand. Waddell describes chronic pain, chronicdi.sahil.i.ty, and ch.roni.c i.I[iess behavior assoc.iated •with low hackpain ,is a dissociation from the physical hack problem. There isusually liule es ide-nec of remaining tissue dauiacc in patients ‘ithchronic low hack pain disabi tv, Enoiional distress, depression.and disease conviction become incrcasnigiy asociated a ith thepai.n. Chroni.cpain usually hecomes sel.f’sustai.ning and. does notrespond well to traditi.onal .medical m.anager.aent. Vari.ou.s psychological states and traits are thought as the main prouioters of ehroniboxy hack pain disability. Psvehuboical condttions that have beensuggetecl as p scibic detcrmnants ot cbs OiC low hock pat disabi Ii.ty inciudt. depression. l...ypochondriasis and hysteria, inappro-pri it coping str tegis s md being mit mntcrcd moosforms of abuse may also play a role as a determinant of chronic lowhack pain disability. Females with a history of being hattered h)their partner were found to heat greater risk for development of PostTraumatic Stress Disorder. depresssion. chronic pain, and substanceabuse, Chronic pain and depression may be consequences of pastchidhood sexual abue as well Alcohol abuse has also beerssuggested as a possible determinant o[ chronic low hack pamdisability. - Nommedicab factors such as being on workers’ compensation henefits and pending litigation have been found to hepredictors of chronic Ion hack pai disahil itv,2° Finally, ineffectiveor inappropriate medical care has also been inphcated as a possibledeterminant of chronic low hack pain disability,NuN Hypothesis1. Individuals with acute low hackpain and proxdisposing psycho—logical risk factors develop chronic bow hack pain disabihtrthe same rate and trequcncr regardless of the type of healthcarcprolcssional inedical physician sersus chiropractor providingcare for their boa back pain.2. Low hack pain sufferers who seek tim services of medicalphysicians versus chiropractors do nor differ demographically.Their sex erity of injury (pain intensity and pschobogicalprofiles are homogeneous.MethodsThis study will he carried out prospectively, focusing on outcomedata, Acute bow hack pain patients will he fobboss ed over a 3-monthperiod. Anxiety, depression. functional capacits. general healthstatus, work disabibmtv, and pain ntensim\ a ill be the main outcomessarisblcs measured as curie Into the studx mid at 3 months folioss -up. so-oodeinoeraphic information wi.i I ait.’o he collected at entry:,Patients treated hy medical phy-sicians svi.l.l he compars.d withpatients treated by chmropractors. This comparison will pm’ovideniorsnation on outcou e cffccix cuess between these Ia 0 pr;-deiA sample si/c of 4mm participants, 2U0 from chiropractic clinicsand 200 froni. various med.ic.al faci.li.tiet.: will. he utilh..,ed.. Participants:will he adults (18 years or older), residin on the island of Oahu.seekmny the sets ices of a chiropractic or medical provider n-ith api’mmiary complains oi’acnie loss back pain not mote than to 3i..i dasduration, with am least a ne ear loss’ back psi-lrc’e stOte prior To tilemost .recen.r episode) of muscuboskeietal ortgn.Patients xx ith low hack pain, secondary to organ ic• dysfunction orChronic Low Back Pain Disabilitya Modern-Day Epidemic(Doctoral Research Proposal)Robert C. Hirokawa, DC, MPHDoctoral Graduate Student, John A. Burns School of Medicine; Department of Public HealthSce ces ao Epdem o ogv LIOlve s at Ha a a Manoa284malignancy, patients with pending litigation associated xx ith the lowhack pain (MVA. slip/fall), or patients being treated for depressionwill he excluded from the study.The Beck’s Depression in’, entor\ - Oswestrv Questionnaire ( lunc—non). Short Form 12 (general health status), anxiety scale (not etchosen), and Visual Analog Scale (pain intensity) will he the indicesused to measure outcomes of the two pros ider types.Each site chiropractic and medical xx ill he gis en a predeterminednumber of packets survey instruments and consent lorms 1 to hehanded out to prospective participants that fit the selection criteriartime one). The enrollment period will continue until all of thepackets are handed out and completed. The purpose of the stud \x illhe explained to each propeetive participant verhall h\ the receptionist/nurse. -S written explanation xx ill also be provided. Intormedconsent will be obtained, Confidentiality will be assured. Paruci—pants will be able to complete the surveys in approximately 10-15in in ute s.hoc h prtrlicIpIult xx ill he mailed a second packet deutical surs cvinstruments contained in the first packet, time iwo) 3 months afterenterin the study. Participants who fill out and return the surveyswill he compensated for their efforts.Statistical analvs is will include calculations of descriptive statistics of sample demographics. correlation coefficients of coxariates,logistical regression, and multiple linear regression. The mainindependent variable will he provider type. The main dependantvariables will in lade depressix esv mptoins, anxiety, general healthstV(tlis. pain intensit\. functional capacity and work disabilityConclusionIt is hoped that this outcome study will shed at least a “glimmer oflieht” into this complex public health crisis—the chronic low backpain disability eptdemic. Ohvioulv. tlii stud is attemptine tounderstand only a very small part of this serious societal burden, Itis by’ no means an attempt at a major “breakthrough”. Nevertheless,information garnered froru this studs will add to our knoss ledgebaseReferences‘6 Ac ncc”J 9i5’M P ter’tnT rani C HaS Pr v fit” a t a”dn k ip yOrl 11 flora oa , a w,ttr ch oni Hw b ck p oq,rot d eoy P in 1° i 4 11 I 11, H n ‘a F B’ “ en hrcl M id a , a M&oh Pt on lit6 I” Has pots n09 With a n4ha”t aWbac’ p in Sp 19 O 7 6 22cr47 trW’S t,,, — fi .‘ o”o,,’or ‘ “‘fl ‘a “a’ ‘a’ ‘t” -0,, at 5’c ‘02”,,,1,1,’ ‘ aC K “a “ ‘ S,xac” -, k’’”' —. ‘, ,“‘o a,A po ncc-’ I 0, 1 p holag - “ ‘ ‘0 1 0) h ‘lDc 0 7 0’ ‘— “ ‘fl‘‘‘7 —‘0 5 ‘P Pa’ (ci v’ 7 T ,d0np at r7 t a p t” a ‘ ‘‘ r ‘ .‘ H a a S0 ,S”’c ‘I”’ -‘‘c—I ‘—,, ‘c’, -ca ,, it’ S ‘ a an 0) 1 r 1 5 r t I S be I, ‘so Sn 5 b 151 ‘ it wShfiS” p i, n ‘ “ Mc’d 64’ 14” 4AL’UN1\L. FLKU1-GOC)RA,. CR1,, Notary PublicSlarcus & Associates, inc.$flXi 691-3847 Dl’595’ I 539-71-sO Ext 307aiain.aff3 marcusreal.ty,co.n.ad’n.ta.l ptotcZ’SSIO.rlSx’leoebar .--. (.o’i. o,Hi of i’sident ii Seen alis.tsI c ‘ I”“Serving you it. the .Spi.rit of Al.oha”285

Chronic low back pain disability a modern-day epidemic (doctoral research proposal).

http://evols.library.manoa.hawaii.edu/bitstream/10524/53741/1/2001-11p284-285.pdf

Chronic low back pain disability a modern-day epidemic (doctoral research proposal).

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