Low back pain, chronic

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Chronic low back pain& psychological comorbidity

Chronic low back pain& psychological comorbidity

Aim:Low back pain is a common disease, and it is observed at least once in 70-85% of the population during their lifetime.Chronic low back pain (CLBP)interferes with the physical ability and mobility of high number of people. This study will determine if there is a relationship between mental disorders including depression, hypochondriasis and anxiety, and the functional status of patients suffering from chronic low back pain.Subjects and methods: The study was performed on a sample of 200 agreed to participate in this cross-sectional study. The patients were divided equally into two separate groups: first group consisted patients with chronic low back pain with clear organic lesion and validated radiologically.The second group consisted of patients with chronic low back pain in which no clinical and radiological confirmation for an organic lesion, or called functional group. Every patient has undergone to the following procedures: A) Medical evaluation including (Neurological evaluation, systemic examination mainly gynecological examination in all female patients and radiological examination mainly Plain x-ray of lumbosacral spine and Magnetic Resonence Imaging(MRI) lumbosacral spine. B) The psychological evaluation used to measure anxiety, depression and hypochondriasis by adopting the MMPI Questionnaire Results: This study sample has included 53% males and 47% females in organic group while 30% males and 70% females in functional group. In Organic group, age and LBPwere found to be significantly associated. Radiation was absent in 9% of patients in organic group and in 60% of patients in functional group. Parathesia present in 85% of organic group, while functional group 20%. 70% of those in organic group and 25% of those in functional group reported severe pain.Depressionwas observed in 15% oforganic group
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TO STUDY THE EFFECT OF PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION ON BACK MUSCLE STRENGTH, PAIN AND QUALITY OF LIFE IN SUBJECTS WITH CHRONIC LOW BACK PAIN AN EXPERIMENTAL STUDY

TO STUDY THE EFFECT OF PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION ON BACK MUSCLE STRENGTH, PAIN AND QUALITY OF LIFE IN SUBJECTS WITH CHRONIC LOW BACK PAIN AN EXPERIMENTAL STUDY

Methods: Ethical approval was taken before study. Forty patients with chronic low back pain (28 male, 12 female) were included in the study and divided into two groups each containing 20 subjects. All the participants were signed written consent after being informed in detail about the study. Group A has been given the proprioceptive neuromuscular facilitation exercises including Rhythmic Stabilization (RST) and Combination of Isotonics (COI) and Conventional back exercises. Group B was given conventional back exercises only. Outcome measures were taken at the end of one month i.e. after the treatment protocol. VAS, SF-36Questionnaire and Core stability gradation were taken in both groups. Results: There is significant improvement in VAS score in both groups but Group A was having more significant improvement than Group B. Also there is significant improvement in core stability grading and SF 36 score in Group A.
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Effect of cognitive behavioral therapy on chronic low back pain with sensitization

Effect of cognitive behavioral therapy on chronic low back pain with sensitization

Background: Chronic low back pain (CLBP) is a debilitating condition that persists despite the lack of tissue damage and an effective management is still lacking. CLBP is a multifactorial disorder comprising psychosocial factors like pain catastrophization, fear avoidance and central sensitization. Objectives: to investigate the effect of Cognitive Behavioural Therapy on CLBP patients with Central sensitization. Methods: This randomized clinical study was conducted on thirty patients of both genders having chronic low back pain with central sensitization, their age ranged from 20 - 37 years old. The 30 patients were divided into two groups. The first group received Cognitive Behavioural Therapy comprising of one session neurophysiology education, one biofeedback relaxation session and three sessions comprising functional training exercises. The second group received conventional physiotherapy treatment comprising 12 sessions of TENS and core strengthening exercises over the course of 4 weeks. Results: The results of this study showed a significant improvement in pain intensity according to the NPRS of 30.02% in the CBT group while only 5.82% in the conventional physiotherapy group. Conclusion: Cognitive Behavioural Therapy has a significant effect on chronic low back pain, disability and fear avoidance behavior related to its central sensitivity aspects which are neglected by conventional treatment physiotherapy. Larger studies are required to establish the best feasible treatment protocol.
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Prediction of clinical outcomes in individuals with chronic low back pain: a protocol for a systematic review with meta-analysis

Prediction of clinical outcomes in individuals with chronic low back pain: a protocol for a systematic review with meta-analysis

Low back pain (LBP) is one of the most prevalent types of chronic pain in clinical practice [1]. Researchers esti- mate that low back pain affects 4–33% of the population at any given point, and will affect 60–80% of the popula- tion at some point during life, and this prevalence in- creases with age [2–4]. After an acute low back pain episode, the majority (about 90%) recovers in a few months [5, 6], although recurrences are common (vary- ing between 25 to 50% in a year) [7]. Furthermore, LBP recurrences are the main occurrence responsible for seeking health care, sick leave and other work-related problems and activity limitations, which lead to a major impact on financial and human resources [7]. Definitions of onset or conclusion of an acute or subacute low back pain episode and what is considered recovery are still unclear [8].
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Chronic low back pain patient groups in primary care – A cross sectional cluster analysis

Chronic low back pain patient groups in primary care – A cross sectional cluster analysis

During a 5-month period, fifty-eight general practitioners (evenly distributed in the northern region of Hessen in Germany) consecutively enrolled all eligible patients consulting for CLBP as a primary or secondary consulting reason (inclusion criteria). The symptom “chronic low back pain” was defined as back pain below the costal margin and above the inferior gluteal folds (with or without pain radiation), which had started at least three months prior and continued during most days (i.e., more than 50%) in the last three months. Patients under 18 years, pregnant women, and persons with an insufficient understanding of the German language or severe cognitive impairments (e.g., dementia) were excluded from the study.
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Supervised and non supervised Nordic walking in the treatment of chronic low back pain: a single blind randomized clinical trial

Supervised and non supervised Nordic walking in the treatment of chronic low back pain: a single blind randomized clinical trial

Background: Active approaches including both specific and unspecific exercise are probably the most widely recommended treatment for patients with chronic low back pain but it is not known exactly which types of exercise provide the most benefit. Nordic Walking - power walking using ski poles - is a popular and fast growing type of exercise in Northern Europe that has been shown to improve cardiovascular metabolism. Until now, no studies have been performed to investigate whether Nordic Walking has beneficial effects in relation to back pain. Methods: A total of 151 patients with low back and/or leg pain of greater than eight weeks duration were recruited from a hospital based outpatient back pain clinic. Patients continuing to have pain greater than three on the 11-point numeric rating scale after a multidisciplinary intervention were included. Fifteen patients were unable to complete the baseline evaluation and 136 patients were randomized to receive A) Nordic walking supervised by a specially trained instructor twice a week for eight weeks B) One-hour instruction in Nordic walking by a specially trained instructor followed by advice to perform Nordic walking at home as much as they liked for eight weeks or C) Individual oral information consisting of advice to remain active and about maintaining the daily function level that they had achieved during their stay at the backcenter. Primary outcome measures were pain and disability using the Low Back Pain Rating Scale, and functional limitation further assessed using the Patient Specific Function Scale. Furthermore, information on time off work, use of medication, and concurrent treatment for their low back pain was collected. Objective measurements of physical activity levels for the supervised and unsupervised Nordic walking groups were performed using accelerometers. Data were analyzed on an intention-to-treat basis.
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Effects of obesity and chronic low back pain on gait

Effects of obesity and chronic low back pain on gait

Background: Obesity is often associated with low back pain (LBP). Despite empirical evidence that LBP induces gait abnormalities, there is a lack of quantitative analysis of the combined effect of obesity and LBP on gait. The aim of our study was to quantify the gait pattern of obese subjects with and without LBP and normal-mass controls by using Gait Analysis (GA), in order to investigate the cumulative effects of obesity and LBP on gait. Methods: Eight obese females with chronic LBP (OLG; age: 40.5 ± 10.1 years; BMI: 42.39 ± 5.47 Kg/m 2 ), 10 obese females (OG; age: 33.6 ± 5.2 years; BMI: 39.26 ± 2.39 Kg/m 2 ) and 10 healthy female subjects (CG; age: 33.4 ± 9.6 years; BMI: 22.8 ± 3.2 Kg/m 2 ), were enrolled in this study and assessed with video recording and GA.
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Psychological risk and protective factors for disability in chronic low back pain – a longitudinal analysis in primary care

Psychological risk and protective factors for disability in chronic low back pain – a longitudinal analysis in primary care

In population based samples the prevalence for CLBP is higher in older patients [1, 71 – 73] and younger patients seem to recover slightly better under multidis- ciplinary therapy [74]. In samples composed only of chronic low back pain patients however, there is usually no cross-sectional relationship between age and disability [75]. In our study, higher age also did not correlate with disability at baseline but it predicted higher disability after one year. There are several possible explanations for this finding. First, older patients might have less favourable courses of pain. For example they might develop pain in more regions and therefore also experience more dis- ability. However, when we examined the transition into CWP in another analysis of the same sample, pain generalization was not predicted by age [28]. We can therefore rule out that the age-disability relationship is confounded by pain generalization. Second, multimor- bidity increases with age which leads to additional dis- ability [76, 77]. Even though patients were asked to rate the disability caused by the pain, it might not have been possible for them to distinguish disability caused by pain or by other comorbidities, especially when their condition has been chronic for years. We can neither Table 4 Associations of predictors with follow-up disability, using multiple regression analysis
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Transdermal Fentanyl for Chronic Low Back Pain

Transdermal Fentanyl for Chronic Low Back Pain

Purpose: Chronic low back pain is a common clinical problem. As medication, non-steroidal anti-inflammatory drugs are generally used; however, they are some- times non-effective. Recently, opioids have been used for the treatment of chronic low back pain, and since 2010, transdermal fentanyl has been used to treat chronic non-cancer pain in Japan. The purpose of the current study was to examine the effi- cacy of transdermal fentanyl in the treatment of chronic low back pain. Materials and Methods: This study included patients (n=62) that suffered from chronic low back pain and were non-responsive to non-steroidal anti-inflammatory drugs. Their conditions consisted of non-specific low back pain, multiple back operations, and specific low back pain awaiting surgery. Patients were given transdermal fentanyl for chronic low back pain. Scores of the visual analogue scale and the Oswestry Disability Index, as well as adverse events were evaluated before and after therapy. Results: Overall, visual analogue scale scores and Oswestry Disability Index scores improved significantly after treatment. Transdermal fentanyl (12.5 to 50 μg/h) was effective in reducing low back pain in 45 of 62 patients; however, it was not effec- tive in 17 patients. Patients who experienced the most improvement were those with specific low back pain awaiting surgery. Adverse events were seen in 40% of patients (constipation, 29%; nausea, 24%; itching, 24%). Conclusion: Transdermal fentanyl significantly improved visual analog scale scores and Oswestry Disability Index scores in 73% of patients, especially those with specific low back pain await- ing surgery; however, it did not decrease pain in 27% of patients, including patients with non-specific low back pain or multiple back operations.
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Behavioural treatment for chronic low-back pain

Behavioural treatment for chronic low-back pain

Low-back pain is a major health and economical problem which affects large populations around the world. In particular, chronic low-back pain (CLBP) is a major cause of medical expenses, work absenteeism, and disability (Koes 2006). Current management of CLBP includes a range of different intervention strategies such as medication, exercise, and behavioural therapy. The main assump- tion underlying a behavioural therapy approach is that pain and its resulting disability are not only influenced by somatic pathology, but by psychological and social factors as well. In this way, CLBP is not only a physical problem, but may also be influenced by the patient’s attitudes and beliefs, psychologic distress, and illness behaviour (Waddell 2004). Consequently, the goal of behavioural treatment is to alter maladaptive thoughts, feelings and behaviours as well as dysfunctional sensory phenomena, and thereby the expe- rience of pain. In general, three behavioural treatment approaches can be distinguished: operant, cognitive, and respondent (Turk 1984; Vlaeyen 1995). Each of these focuses on modifying one of the three response systems which characterize emotional experi- ences: behaviour, cognition, and physiological reactivity. Operant treatments are based on the operant conditioning princi- ples of Skinner (Skinner 1953) which have been applied to CLBP by Fordyce (Fordyce 1976). This model proposes that acute pain behaviours may be reinforced by external factors (such as attention of the spouse and the medical personnel, rest, or reduction of pain level by analgesic medication) and thus develop into a chronic pain problem. Therefore, operant treatment involves the removal of positive reinforcement of pain behaviours and the promotion of healthy behaviours (e.g. exercise, work). It often incorporates involvement of the spouse to help maintain these changes. In- creased activity levels are promoted by establishing exercise quota and reinforcing exercise with positive feedback and verbal encour- agement. The exercise quota are systematically increased for each treatment session, towards a pre-defined goal. Each successfully performed increment is positively reinforced by all treatment staff (Fordyce 1976).
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Study protocol: Transition from localized low back pain to chronic widespread pain in general practice: Identification of risk factors, preventive factors and key elements for treatment – A cohort study

Study protocol: Transition from localized low back pain to chronic widespread pain in general practice: Identification of risk factors, preventive factors and key elements for treatment – A cohort study

Methods/Design: Fifty-nine general practitioners recruit consecutively, during a 5 month period, all patients who are consulting their family doctor because of chronic low back pain (where the pain is lasted for 3 months). Patients are asked to fill out a questionnaire on pain anamnesis, pain-perception, co-morbidities, therapy course, medication, socio demographic data and psychosomatic symptoms. We assess resilience, coping resources, stress management and self-efficacy as potential protective factors for pain generalization. Furthermore, we raise risk factors for pain generalization like anxiety, depression, trauma and critical life events. During a twelve months follow up period a cohort of CLBP patients without CWP will be screened on a regular basis (3 monthly) for pain
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Pregabalin, celecoxib, and their combination for treatment of chronic low-back pain

Pregabalin, celecoxib, and their combination for treatment of chronic low-back pain

Michael Bennett in 2001 [27] introduced the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale. The LANSS has subsequently been tested and validated in several settings, with sensitivity and specificity ranging from 82% to 91% and 80% to 94%, respectively, compared with clinical diagnosis [34]. After Baron and Binder [8] first introduced in 2004 the concept of mixed pain for sciatica, studies were published that confirmed the participation of nociceptive as well as neuropathic mech- anisms of low-back pain. Kaki et al. [11] applied the LANSS pain scale in a total of 1,169 patients from 117 centers; 639 patients (54.7%) had scores of 12 points or more, which suggested a neuropathic type of pain, and 530 patients (45.3%) had scores of less than 12, which sug- gested a nociceptive type of pain. These authors concluded that neuropathic pain is a major contributor to chronic low- back pain and that the LANSS pain scale is a useful tool to distinguish patients with neuropathic pain from those with nociceptive pain.
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Chronic Pain and Depression in Low Back (Spinal) Injured Patients

Chronic Pain and Depression in Low Back (Spinal) Injured Patients

The chronic pain-depression relationship demands characteristics of living with chronic pain that produces patient’s negative cognitive, and personality changes, which often leads to depression. Chronic low back pain is itself stressor which can lead to sufficient changes causing symptoms of major depression or, if depressive symptoms persist more than two years, to the dysthymic disorder. We predict that measuring depressive symptoms would prove more information about the pain and disability than would relay on measures of single pain presentation. The depressed patients’ negative outlook is often a source of their frustration to friends, family, and clinician when they try to be of help. Chronical depression makes patients’ view for the future as black and hopeless, and believe that none of their problems can be solved. In severe cases, suicidal wishes tend to be intense; they feel hopeless and helpless, and “there is only one way out – to kill myself”.
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Evaluation and implementation of graded in vivo exposure for chronic low back pain in a German outpatient setting: a study protocol of a randomized controlled trial

Evaluation and implementation of graded in vivo exposure for chronic low back pain in a German outpatient setting: a study protocol of a randomized controlled trial

CBT-P: Cognitive behavioral treatment for chronic pain; CEQ: Credibility and expectancy questionnaire; CLBP: Chronic low back pain; EQ-5D: EuroQol questionnaire; EXP: Exposure; FESS: Pain self efficacy questionnaire; HADS: Hospital anxiety and depression scale; ICER: Incremental cost- effectiveness ratio; IMMPACT: Initiative on methods measurements, and pain assessment in clinical trials; IPAQ: International physical activity questionnaire; ITT: Intention-to-treat analyses; MATD: Method of assessing treatment delivery in clinical trials; NRS: Numeric rating scale; PASOL: Pain solutions questionnaire; PASS: Pain anxiety symptom scale; PCS: Pre-stratified by degree of pain catastrophizing; PDI: Pain disability index; PHODA: Photo series of daily activities; PIPS: Psychological inflexibility in pain scale; PVAQ: Pain vigilance and attention questionnaire; QALY: Quality adjusted life years; QBPDS: Quebec back pain disability scale; RCT: Randomized controlled trial; SPSS: Statistical program for social science; TIC-P: The trimbos/iMTA questionnaire for costs associated with psychiatric illness; TSK: Tampa scale of kinesiophobia.
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The effectiveness of a simplified core stabilization program (TRICCS—Trivandrum Community-based Core Stabilisation) for community-based intervention in chronic non-specific low back pain

The effectiveness of a simplified core stabilization program (TRICCS—Trivandrum Community-based Core Stabilisation) for community-based intervention in chronic non-specific low back pain

Chronic low back pain is a major public health problem. Whether it is due to structural changes in the motion segment or due to non-specific cause, initial manage- ment is largely conservative. This involves pharmaco- therapy, spinal manipulation, back education, and exercise therapy. Four types of exercise are prescribed: (a) postural exercises, (b) aerobic exercises, (c) stretching exercises, and (d) core stabilization exercises. However, most clinicians will prescribe a combination of these ex- ercises. Exercises prescribed for the western population are not suitable to most people in suburban India. It is generally observed that patients after starting the exer- cise may have an exacerbation of symptoms and they drop out of the exercise therapy. Hence, it is important
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Imperforate Hymen Presenting as Chronic Low Back Pain

Imperforate Hymen Presenting as Chronic Low Back Pain

The patient was admitted to the pedi- atric department for investigation. She was afebrile and experienced severe back pain with only minimal response to 8 mg of oxycodone hydrochloride. Laboratory tests showed mild leuko- cytosis of 14 000/mm 3 with 81% neu- trophils. Blood chemistry, C-reactive protein, and erythrocyte sedimentation rate tests revealed no abnormalities. No tenderness or palpable mass was noted during the abdominal examina- tion. Back examination showed mild scoliosis without vertebral tenderness. Lateral bending of the back was pre- served on both sides, and there was full range of motion of fl exion and ex- tension. Marked tenderness of the quadratus lumborum and gluteus medius muscles was noted bilaterally with multiple trigger points, one of which elicited the “ that ’ s it ” sign (ie, a verbal indication that the patient recognizes the point as a possible lo- cation of the pain). There was also mild sensitivity overlying the sacroiliac joint bilaterally; Lasegue test was negative. Faber test (ie, pain during fl exion, ab- duction, and external rotation of the thigh) was positive, with mild bilateral weakness on hip fl exion. Both these fi ndings suggested iliopsoas involve- ment.
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Chronic low back pain: Osteopaths’ attitudes and management

Chronic low back pain: Osteopaths’ attitudes and management

1/3 - 2/3 of practitioners deemed entry level pain education as less than adequate, compared to over half of the osteopaths in this study indicating their pain management education was adequate. Despite this however, over half of respondents described chronic pain management teaching as having been only briefly covered and indicated that they considered graduate level education as the least useful source of pain management information. It is possible that osteopaths believed they have gained adequate pain management education via its inclusion in a variety of subjects throughout all years of osteopathic education. Conversely some respondents may have considered their pain education as having been briefly covered due to the fact there is not a sole subject at university dedicated to pain management. However perhaps
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Influence of comorbidity with depression on interdisciplinary therapy: outcomes in patients with chronic low back pain

Influence of comorbidity with depression on interdisciplinary therapy: outcomes in patients with chronic low back pain

Methods: A total of 58 patients with cLBP alone or with both cLBP and depression were age- and sex-matched with 29 healthy controls. Serum concentrations of TNF- a were assayed at the beginning of the study (T0) and 10 days (T1), 21 days (T2), and 180 days (T3) later. The clinical outcomes such as pain intensity, as well as back function, sleep, exercise, alcohol and nicotine consumption were documented. In the first three weeks, all patients underwent multidisciplinary therapy based upon biological, psychological, physical and psychosocial components. Results: Over the whole course there were no differences in TNF- a level between cLBP patients with and without depression. At T0, both cLBP patients with (cLBP+DE) and without (cLBP) depression showed significantly higher TNF- a serum levels (P = 0.002 for cLBP+DE, P = 0.004 for cLBP) than healthy controls (HC) that normalized after 10 days of therapy and remained similar to healthy controls. During the follow-up, the depression scales were
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Health utilities for chronic low back pain

Health utilities for chronic low back pain

The assessed associations between HU and potential influencing factors (e.g. age or sex) were stronger than the assessed associations between VAS and these factors. While none of these associations were statistically sig- nificant, this may have been due to the small sample size, since previous studies did find significant associa- tions: Dolan & Roberts [20] used the time-trade-off method to assess health preferences for different health states (but not LBP) and found that age, sex and marital status influenced the derived values. HU increased up to the age of 45 and then started to fall until the age of 70. Men, and married or cohabiting individuals showed higher HU compared to women and individuals living alone. Additionally, mental health states such as depres- sion have previously been shown to influence HU for cancer patients [26]. It is likely, that mental health states also influence HU for chronic LBP, since depression changes people’s outlooks on life and death (which the extreme case of suicidality illustrates).
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The efficacy of neuromuscular taping on various pain parameters among  chronic low back pain population

The efficacy of neuromuscular taping on various pain parameters among chronic low back pain population

After the administration of specific intervention to respective Group, the results obtained are illustrated above which implies, In group A (experimental), the mean pain variable pretest value is 8.2±1.54 and posttest pain value is 1.4±1.09, which show that the treatment modality used in group A has been found to be very effective in the reduction of pain variable, so it can be concluded as the conventional physiotherapy and neuromuscular taping is effective in reducing pain. Moreover, when compared to the group B (Controlled) pretest VAS value is 7.9±0.91 and posttest value 0.9±0.64 which also indicative of effective treatment modalities was used in pain reduction. But when statically checked with the P Value it showed no significance in group A & B respectively. Furthermore, for a comparison between the groups to find the effective treatment modality, the Visual analogue scale pain values compared between the two groups it was found to insignificant.
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