Purpose: This retrospective original research was designed to illustrate the general outcome after radiofrequency (RF) neurotomy of lumbar medial branch (MB) and posterior ramus of the sacro- iliac joint of 160 patients with chroniclowbackpain (LBP) 1, 6, and 12 months after treatment. Methods: Visual Analog Scale (VAS) 0–10 pain scores, quality of life, body mass index (BMI), medication usage, and frequency of physical exercise/sports participation (none, 1–3×/week, more) were collected before the procedure, at 1 month post procedure (n = 160), and again at 6 (n=73) and 12 months (n=89) post procedure.
Background: Lowbackpain (LBP) is one of the most prevalent and recurrent conditions in the general population, with personal, professional, social and economic impact. However, there is a lack of consistent evidence about chroniclowbackpain (CLBP) prognosis, especially highlighting predictors that influence CLBP outcome. Existing systematic reviews are scarce, outdated and incomplete. The primary aim of this systematic review is to identify multivariable models and/or predictors associated with clinical outcomes in subjects with CLBP (namely pain intensity, disability, return to work, psychological well-being and quality of life).
Obesity is recognised as a major public health problem in industrialized countries and it is often associated with various musculoskeletal disorders including lowbackpain (LBP) [1-3]. Some studies have shown a correlation between obesity and functional impairment of the spine secondary to weakness and stiffness of the lumbar mus- cles, leading to LBP and disability [4-6]. Low flexibility of the spine and increased dorsal stiffness have also been reported in obese subjects [7-9]. Quantitative evidence exists that obesity per se affects standing up [10,11], walk- ing [12-14] and running [15,16]. The gait pattern in obese adult males appears generally similar to the one in their lean counterparts, but some of the temporal and angular components have been shown to be different . Excess of mass in fact imposes abnormal mechanics on body movements [18,19]. Body shape is influenced by the excess of mass [20-22], which can hinder the joints’
For health economic evaluations of (primarily) preventable disorders like chronicLBP a reflection of the disease expression in the general population is of particular importance. In the chronicLBP description used in this study, we did not give explicit indications of pain intensity. However, the description seems to reflect moderate pain intensity since the mean VAS as rated by all LBP patients for the standardized chronicLBP scenario was 40.91 which is comparable to the mean VAS of 39.75 that LBP patients with a moderate degree of disability attributed to their own complaints. The ad- vantage of not giving explicit indications of pain inten- sity is that it reflects how the intensity of chronicLBP varies in the population. The disadvantage of this approach is that it impedes the concrete description of an illness that is primarily pain based. This problem becomes clear when comparing the patient and the population group in our sample: On average, healthy participants rated chronicLBP as more severe than pa- tients with chronicLBP did (note that most chronicLBP patients in our sample reported only light pain inten- sities). Furthermore, patients with more severe LBP rated the standardized chronicLBP scenario as more se- vere than patients with less severe LBP (Fig. 2). Conse- quently, future studies should incorporate explicit descriptions of a range of different pain intensities in their chronicLBP scenarios and derive HU for different
participants and in 35% of patients of functional group in LBP patients. Depression scores reported in the functional group are strikingly higher than that inthe group with organic lesion.Anxiety were (14%) in organic group, 20% in functional group, hysteria scores in the second group are decidedly higher than that in the group with organic lesions. Hypochondriasis disorders reported in 9.5%of organic pain patients and in 15% of functional pain group.Hypochondriasis scorewas found to be definitely higher in the functional groupthan in the organic group.Conclusion: Depression, anxiety, and hypochondriasis are highly prevalent among people with chroniclowbackpain. So in order to manage the pain, it is useful to treat patient’s mental dysfunctions that will probably improve their functional status. This way, patients can avoid addictive management and treatment regimens prescribed by their physician to treat their functional disabilities.
most important occupational injury in nurses with a prevalence of 56-90%, which is slightly higher than in other populations (8). The prevalence of LBP has been reported as 62% (9) and 49.4% in (10) some parts of Iran. In a study conducted on the nursing staff of Namazi and Shahid Faghihi Hospitals, Shiraz, Iran, in 1999, a 78.3% prevalence of occupational LBP was reported (11). About 98% of nurses move patients in such a way that applies a great amount of pressure on the lumbar vertebrae (12). Moreover, bending on the patient’s bed during work and stretching the back increases the risk of backpain. In addition, inappropriate body postures, squatting, bending, prolonged standing, and a low nurse to patient ratio are other risk factors of backpain in nurses (12). Nurses who work in intensive care units are particularly prone to backpain due to their distinct work conditions (13, 14). Nurses are an efficient and effective part of any health system and are prone to the risk factors of backpain more than other occupational groups. They lose many work days due to backpain every year which lowers their productivity. However, backpain can be decreased using appropriate preventive measures, which requires the knowledgability of nurses on the
Neuro Muscular Taping (NMT) is a biomechanical therapy method using decompressive stimuli to obtain positive effects in the musculoskeletal, vascular, lymphatic and neurological systems. As the tapes form wrinkles, lifting the skin, they facilitate venous and lymphatic drainage, improve blood circulation, and relieve pain. Correct application may also assist to correct the alignment of joints, support muscles during movement, and improve stability and posture. In this study we evaluated the effectiveness of a low cost and relatively easy to learn taping technique for the treatment of lowbackpain which is the most prevalent musculoskeletal condition and the most common cause of disability in developed nations. The lifetime prevalence of LBP (at least one episode of LBP in a lifetime) in developed countries is reported to be up to 85%. LBP results in significant levels of disability, producing significant restrictions on usual activity and participation, such as an inability to work. Furthermore, the economic, societal and public health effects of LBP appear to be increasing. 40 subjects with lowbackpain were included in this study at the Mekelle University, Ethiopia, Ayder Comprehensive Specialized Hospital, Physiotherapy Department as a part of rehabilitation project to evaluate economic and practical solutions for non specific lowbackpain in developing countries. Standardized NMT application for lumbar pain was used in one group while the other group received standard physical therapy over a 4 to 6 week treatment period. According to Oswestry LowBackPain Disability index there was a significant reduction in pain with the NMT lumbar application in comparison to the physical therapy only treatment group. While the Visual Analogue scale showed significant reduction in pain from 8.2±1.54 pretest to 1.4±1.09 post test. The results show that NeuroMuscular taping has an important role in the treatment of non specific lowbackpain in developing countries due to its low economic cost and the easiness of specific training required to apply correctly the methodology outlined in this article.
Third, in the multivariate analyses, we were able to adjust for a large number of potential confounding factors, but the possibility of residual confounding by unrecognized fac- tors cannot be ruled out. For example, injury at neck or lowback is a major cause of NP and LBP, but unfortunately the EHSS does not collect information on these injuries. Fourth, the characteristics of DM are not collected in the EHSS, including the DM type, duration, treatment, and chronic complications.
(e.g., antidepressants and traction), which are effective in the short term . A primary effect on muscle may ex- plain why we did not find any significant effect of LLLT on knee osteoarthritis (OA) pain , in which the sources of pain are diverse. Moreover, NSCLPB is likely a heterogeneous group of diseases, which have different etiologies but share similar symptoms. Thus, some of them might react well to LLLT while others not. Only two studies provided data on ROM. For this outcome, negative results might relate to inadequate study power that could be overcome with more high-quality investi- gations with ROM. Finally, like other LBP interventions, effects on pain appear to be stronger than effects on function .
Table 3 shows the results of the evaluation of LBP after treatment in all 62 patients. VAS and ODI one month after treatment were 5.0±0.3 (mean±S.E.M.) and 32±6, respec- tively, and were significantly less than that before treatment (p<0.01). Mean VAS score and ODI score at final follow- up were 4.6±0.3 and 28±6, respectively, and were signifi- cantly lower than values obtained before treatment (p<0.01). Transdermal fentanyl was very effective, especially in all patients with specific LBP awaiting surgery, so we divided the patients into the following three groups: 1) transdermal fentanyl was effective (responders), n=32; 2) transdermal fentanyl was effective in patients awaiting surgery (respond- ers), n=12; and 3) transdermal fentanyl was not effective (non-responders), n=18 (Table 4). VAS scores and ODI scores were significantly lower after treatment than before treatment in the two responder groups (p<0.05). Also, VAS scores and ODI scores after treatment in the two responder groups were significantly lower than those of the non-re- sponder group (p<0.05). However, pain scores one month after treatment and at final follow-up were not significantly lower than those of the non-responder group before treat- ment (p>0.05) (Fig. 1). On the other hand, transdermal fen- tanyl was more effective in the responders awaiting surgery compared with the other responders (p<0.05) (Fig. 2).
A musculoskeletal pain (MSP) in children is important public health problem, which is manifested in only occasional limiting movements with pain and usually with little clinical implications . A nonspecific musculoskeletal pain (NSMSP) in childhood includes often a specific, identifiable pathoanatomical basis for symptoms cannot be found, resulting in non-specific diagnoses based on the location of symptoms . Amongst various risk factors, it has been suggested that elevated body mass index (BMI), overweight and obesity might be an independent risk factor for NSMSP . The relationship between BMI and MSP has mainly been investigated in studies on lowbackpain (LBP) [4-6]. Body height was associated with increased risk of lowbackpain in both genders . MSP in the lower extremities occurs both in children and in adolescents with ankle and foot problems being more common in children . There is emerging evidence that children, especially adolescents who report persistent musculoskeletal pain, are at increased risk of chronicpain as adults [1,2,5]. The time of adolescence is the transition period from childhood to adulthood and over only a few years, both body and soul will undergo many changes. The most apparent morphological differences are increased height and a change in body composition. It has been proposed that these may impact LBP [8-10].
Lowbackpain is a common musculoskeletal problem af- fecting the population both in developing and developed world. It is the major cause of work absenteeism and mus- culoskeletal disability . Chronicity of lowbackpain leads to significant expenses causing strain on the health care system. Eighty percent of the population is expected to suffer from lowbackpain at one time or other during their life. In developed countries like the UK, the point prevalence of lowbackpain is estimated to be close to 50% [2, 3]. In the USA, the point prevalence ranges from 8 to 56% . Various studies of lowbackpain epidemi- ology done in India give the prevalence of lowbackpain (LBP) between 6.2 and as high as 92% depending on the population studied . In the majority of people, backpain is self-limiting. However, a significant percentage of these patients develop to have chronicity of their symptoms.
Thirty undergraduates from the Department of Clinical Medicine at the School of Medicine, Shanghai Jiao Tong University were responsible for distributing and retrieving the questionnaires. The undergraduates had received training related to aspects of the survey in advance. Be- fore conducting the survey, the undergraduates gave the participants a popular science lecture; marked the specific scope of headache, abdominal pain, neck and shoulder pain (NSP), and LBP using diagrams of the human body; and explained in detail the characteristics of pain and the differences between post-exercise sore- ness, menstrual pain in women, and post-traumatic pain. Onset of pain was defined as pain lasting for more than 10 min, and we define “chronicpain” as “the pain lasting over 6 h single a time or short time with high frequency over 2–3 one day, and this bad situation happened more than 3 times in one month”. But in the questionnaire, simply we described the standard as” in the last 3 months, how often did you feel this kind of frequent or continuous pain in neck/shoulder, lowback, head and abdomen” to differentiate chronicpain from acute pain. Instead of directly using “yes” and “no” to as- sess the exposure to risk factors, the onset frequency of pain was classified into the following four levels: “almost never”, less than once per month; “occasionally”, 1–3 times per month; “often”, 1–3 times per week; and “al- ways”, more than 3 times per week. General treatment of the results: “often” and “always” were treated as “yes”, while the other two levels, “almost never” and “occasion- ally”, were treated as “No”.
Personal factors are the second important area for context-specific additions to the ICF in MEWC involv- ing CWP and LBP. Standardized reporting of psycho- logical aspects such as coping strategies or pain beliefs  as well as occupational experiences or work motiv- ation  is crucial for pain and work ability assess- ments. In MEWC, personal factor categories may be helpful in illustrating whether functional limitations are likely due to a health condition (e.g. “depressive symp- toms”) or due to individual characteristics (e.g. “reduced work motivation”). Whilst in the former case claimants may be entitled to receive a disability pension, in the latter they are more likely to be assigned to a return to work program. Most relevant personal factors in the con- text of MEWC involving chronicpain were found to be the claimant’s educational, occupational and biograph- ical background, behavior patterns as well as personal emotions and cognitions such as, for instance, expec- tations related to the job . As an alternative to the determination of context-specific additions for personal factors, already existing personal factor taxonomies Table 6 Absolute and relative frequency of the codings
All those studies supported our study as it revealed that a one of lowbackpain among adolescent Egyptian football players is high. Among the total of 94.44% (n=170) of sample size involved in this study, 33.5% (n=57) of players pain whereas 66.47% (n=113) of players reported that they were having lowbackpain. In contrast, other authors of more recent studies have found, however, that LBP is not uncommon in adolescents and that most cases are musculoskeletal in origin (Fritz et al., 2010). When comparing the literatures that exist, it is not entirely clear whether competing athletes are at a risk of a higher severity of lowbackpain compared athletic population (Hoskins, 2012). This the prevalence estimates may be due to differences among the studies in such factors as the age of the
Todayʼs therapy involves, above all, rest, sometimes complemented by the active building of the pelvic and spinal muscular corset or passive ﬁ xation using a pelvic belt. The importance of exercise activating the postural muscles prior to pregnancy in order to prevent future LBP is not clear yet. There is no evidence as to whether the biochemical and biomechanical changes occurring during pregnancy have a more excessive impact on the fe- male body than the state of her muscular apparatus itself. However, we believe that proper exercise prior to preg- nancy helps pregnant women deal with the discomfort in their lower back area. This alleviation of pain should occur thanks to better support for the growing uterus and also thanks to a higher awareness of the body helping to prevent the pain by avoiding certain kinds of movements. Despite the high incidence of LBP occurrence dur- ing pregnancy, our knowledge of pathogenesis, clini- cal demonstrations and therapy is insuﬃ cient so far. Foreign literature does contain some articles on the topic of LBP during pregnancy, Czech scientiﬁ c jour- nals present very few related articles and there are vir- tually no study materials for obstetricians at all. Mechanisms of LBP occurence during pregnancy
In our study somatization was the only psychosocial construct which predicted disability. This adds to exist- ing evidence of somatization being a risk factor for dis- ability and chronification [5, 7]. But how exactly could somatization contribute to higher levels of disability? The scale we used to measure somatization presents 12 somatic symptoms (e.g. head-, chest- and muscular pain in different areas, dizziness, heavy breathing, feelings of weakness or heaviness, nausea) relating to dysfunction in autonomic physical systems and asks patients how much they have been suffering from these symptoms. There- fore a higher score reflects suffering from more symp- toms and to a higher degree. There are several possible explanations how this can relate to stronger disability. First, people who suffer from more somatic symptoms are known to feel increased fatigue and rest more which will unintentionally contribute to further decline in func- tional ability and feelings of disability [62 – 64]. Second, people who experience more symptoms might feel more Table 2 Pairwise spearman correlations ( ρ ) of baseline variables (predictors)
Data will be collected from the current body of knowledge. However, exclusion criteria are set to ensure that the required sources are accessed. Foremost, only sources that have been published in the last five years will be considered. This necessarily means that any source, regardless of its relevance that was published before 2012 will not be considered. Secondly, sources that look at the effectiveness of exercise as a chronicpain management approach when compared to the rest of the therapeutic approaches will be taken into account. Concerning the search strategy, several credible databases will be used. However, priority will be given to nursing databases. The most preferred include Ebsco, Pubmed, Cochrane, and NCBI.
mation about GPs' perceptions of patients presenting with LBP; and Section 3 focussed on how GPs handled specific cases of LBP, and they were asked in advance to retain the case notes of recent patients to discuss their histories, con- sultations, and decisions made. This case-based approach allowed probing of actual decisions to refer for LSX or choosing other courses of action. In Section 4, GPs were asked specifically about their beliefs and attitudes towards the use of LSXs. The order of topics in the interviews var- ied depending on spontaneous discussion and the emphasis accorded to topics by respondents. The topic guide was amended throughout the study as new themes were identified using constant comparative analysis. A sub-sample of five transcripts was fully coded by two researchers (RB, SB) to develop an initial coding frame and to identify concepts and themes. Subsequent themes were debated and agreed upon by all three authors. Draw- ing on principles of constant comparison , the devel- opment of the coding frame and emergent themes were subject to deviant case analysis. NVivo qualitative analysis software  was used to index and interrogate the data. Themes that were consensual across high- and low-users of LSX were classified as 'convergent themes' and views which differentiated the two groups were classified as 'divergent themes.'