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Search Results for : Chronic Low Back Pain
Merck Online Lab
Diagnosis Therapy Rehabilitation Imaging Clinical Laboratory
The development and validation of a Low Back Pain Knowledge Questionnaire - LKQ.
Author(s): Maciel, SC; Jennings, F; Jones, A; Natour, J
Journal: Clinics (Sao Paulo) 2010 Jul 24; Vol. 64, Issue 12; Page(s) 1167-75
[Medline ID - 20037704]

OBJECTIVE: The objective of this study was to develop and validate a questionnaire on specific knowledge about low back pain entitled "The Low Back Pain Knowledge Questionnaire". INTRODUCTION: There is a need for instruments to assess patient knowledge regarding chronic illness. Such methods can contribute to the education of patients. METHODS: The Low Back Pain Knowledge Questionnaire was developed through five focus groups. The questionnaire was distributed to 50 patients to assess their comprehension of the terms. To assess the reproducibility, 20 patients were surveyed by two different interviewers on the same day and twice by a single interviewer with a one-to-two week interval. For the construct validation, the Low Back Pain Knowledge Questionnaire was given to 20 healthcare professionals with knowledge on low back pain and 20 patients to determine whether the questionnaire would discriminate between the two different populations. To assess the sensitivity of the questionnaire to changes in the knowledge level of the patients, it was given to 60 patients who were randomly assigned to the Intervention Group and the Control Group. The Intervention Group answered the questionnaire both before and after attending a chronic back pain educational program (back school), whereas the Control Group answered the questionnaire twice with an interval of one month and no educational intervention. RESULTS: The focus groups generated a questionnaire with 16 items. The Spearman's correlation coefficient and the intra-class correlation coefficients ranged from 0.61 to 0.95 in the assessments of the intra-observer and inter-observer reproducibility (p < 0.01). In the construct validation, the healthcare professionals and patients showed statistically different scores (p < 0.001). In the phase regarding the sensitivity to change, the Intervention Group exhibited a significant increase in their specific knowledge over the Control Group (p < 0.001). CONCLUSION: The Low Back Pain Knowledge Questionnaire was validated and proved to be reproducible, valid and sensitive to changes in patient knowledge.

Idiopathic spinal epidural lipomatosis - two cases report and review of literature.
Author(s): Chan, JY; Chang, CJ; Jeng, CM; Huang, SH; Liu, YK; Huang, JS
Journal: Chang Gung Med J 2010 Mar 11; Vol. 32, Issue 6; Page(s) 662-7
[Medline ID - 20035646]

Spinal epidural lipomatosis (SEL), an abnormal localized or tumor-like accumulation of fat in the epidural space, is an infrequent complication of chronic steroid usage and an uncommon cause of spinal cord compression. During the period of 1990 to 2006, we have two cases of medically heath SEL patients without history of steroid administration. Their initial clinical manifestations were low back pain, progressive lower extremities weakness, numbness, followed by rapid deterioration of neurogenic intermittent claudication. They were misdiagnosed and treated as degenerative spinal disease for a long time. Due to prominent neurological deficit, lumbar magnetic resonance image (MRI) was obtained and showed SEL. These 2 patients all underwent laminectomy and removal of epidural fat. Postoperatively, they both showed improvement. We reviewed the literature and discussed the current concept in the management of SEL.

Prognostic factors for perceived recovery or functional improvement in non-specific low back pain: secondary analyses of three randomized clinical trials.
Author(s): Helmhout, PH; Staal, JB; Heymans, MW; Harts, CC; Hendriks, EJ; de Bie, RA
Journal: Eur Spine J 2010 Jun 15; Vol. 19, Issue 4; Page(s) 650-9
[Medline ID - 20035358]

The objective of this study was to report on secondary analyses of a merged trial dataset aimed at exploring the potential importance of patient factors associated with clinically relevant improvements in non-acute, non-specific low back pain (LBP). From 273 predominantly male army workers (mean age 39 +/- 10.5 years, range 20-56 years, 4 women) with LBP who were recruited in three randomized clinical trials, baseline individual patient factors, pain-related factors, work-related psychosocial factors, and psychological factors were evaluated as potential prognostic variables in a short-term (post-treatment) and a long-term logistic regression model (6 months after treatment). We found one dominant prognostic factor for improvement directly after treatment as well as 6 months later: baseline functional disability, expressed in Roland-Morris Disability Questionnaire scores. Baseline fear of movement, expressed in Tampa Scale for Kinesiophobia scores, had also significant prognostic value for long-term improvement. Less strongly associated with the outcome, but also included in our final models, were supervisor social support and duration of complaints (short-term model), and co-worker social support and pain radiation (long-term model). Information about initial levels of functional disability and fear-avoidance behaviour can be of value in the treatment of patient populations with characteristics comparable to the current army study population (e.g., predominantly male, physically active, working, moderate but chronic back problems). Individuals at risk for poor long-term LBP recovery, i.e., individuals with high initial level of disability and prominent fear-avoidance behaviour, can be distinguished that may need additional cognitive-behavioural treatment.

[Peculiarities of cognitive functions in patients with chronic back pain]
Author(s): Melkumova, KA; Podchufarova, EV; Iakhno, NN
Journal: Zh Nevrol Psikhiatr Im S S Korsakova 2010 Mar 12; Vol. 109, Issue 11; Page(s) 20-4
[Medline ID - 20032949]

The authors have studied cognitive functions and influencing factors in 64 patients with chronic low back pain. All patients have been examined using neurologic, neuroorthopedic, pathopsychological and neuropsychological methods. Patients have been divided into 2 groups according to their age: group 1 (aged 30-50 years) and group 2 (aged 51-60 years). Healthy controls were matched to patients for age, sex and education. Significant differences in neuropsychological testing, i.e. mental flexibility, delayed memory, psychomotor speed, which referred to the subtle cognitive impairment with executive function disturbances, were found in both groups of patients with chronic low back pain as compared to pain-free adults. Sensory-discriminative (pain intensity) and affective-emotional (negative emotions, in particular, anxiety) characteristics had the effect on cognitive functions in younger patients without depressive symptoms. Affective-emotional (anxiety, psychological distress) and cognitive characteristics (i.e. catastrophising) contributed to the cognitive disturbances in older patients.

Validation and reliability of the Turkish version of the fear avoidance beliefs questionnaire in patients with low back pain.
Author(s): Korkmaz, N; Akinci, A; Y; örükan, S; S; ürücü, HS; Sara; çbaşi, O; Oz; çakar, L
Journal: Eur J Phys Rehabil Med 2010 Apr 7; Vol. 45, Issue 4; Page(s) 527-35
[Medline ID - 20032912]

AIM: The aim of this study was to translate the questionnaire into Turkish and to investigate the test-retest reliability, construct validity and its sensitivity to change following physical therapy. METHODS:The questionnaire was translated into Turkish using the forward and backward translation technique. Test-retest reliability was assessed with the correlation coefficients. Scale analysis for internal validity, the Cronbach's alpha score was calculated. Construct validity was tested with principal components analysis and was also tested with divergent validity. Following three weeks of treatment, sensitivity to change and responsiveness of the questionnaire was assessed. RESULTS: The questionnaire was applied on 55 patients and high correlations were found on the repeated items 48 hours later. In the scale analysis, the Cronbach's alpha score was found as 0.911 for the total questionnaire. Two factors were found compatible with the original questionnaire with principal components analysis. These two factors explain 61.647% of the total variance in the questionnaire performed on 150 patients. In divergent validity, the fear avoidance beliefs were found in low correlation with the clinical variables. Sensitivity to change and responsiveness of the FABQ was found to be low. CONCLUSIONS: FABQ has sufficient psychometric features for its applicability in the Turkish population with subacute and chronic low back pain.

Evidences of memory dysfunction and maladaptive coping in chronic low back pain and rheumatoid arthritis patients: challenges for rehabilitation.
Author(s): Jorge, LL; Gerard, C; Revel, M
Journal: Eur J Phys Rehabil Med 2010 Apr 7; Vol. 45, Issue 4; Page(s) 469-77
[Medline ID - 20032904]

AIM: This study investigates whether chronic low back pain (LBP) and rheumatoid arthritis (RA) patients have deficits in memory functioning and whether there is correlation between memory scores and coping skills, as a disability evaluation measure. METHODS: We studied 2 samples of patients of both genders between 20 and 70 years-old, in a cross-sectional design: 21 low back pain and 23 rheumatoid arthritis. Patients were compared to historical controls. Assessment of primary outcome included memory evaluation (Wechsler Memory Scale III) and measures of coping strategies (FABQ, CPCI, CSQ). Other data included depression (HAD), pain (VAS), work status, use of medications, and perceived memory complaints. Analysis were made of between-group differences. RESULTS: Both groups were comparable regarding demographic status, had high scores of memory complaint, and low performance in memory assessment when compared to normative data. Only LBP patient's measures of catastrophizing and coping were significantly correlated to late memory indices. No correlations were found between memory and Visual Analogue Scale (VAS) or pain chronicity in both groups. One may suggest that both chronic localized and widespread pain can imply in cognitive changes and be correlated to coping dysfunction. However, bias of existence of depression/ anxiety and psychotropic medication cannot be excluded. CONCLUSIONS: Both groups of chronic pain patients are likely to have impaired memory. Maladaptive coping correlates to LBP, but not to RA. A further controlled protocol must include greater sample of patients. By analyzing memory deficits of chronic pain patients, clinicians could establish targeted rehabilitation programs and outcomes. Some techniques are discussed.

Effectiveness of a semi-intensive multidisciplinary outpatient rehabilitation program in chronic low back pain.
Author(s): Demoulin, C; Grosdent, S; Capron, L; Tomasella, M; Somville, PR; Crielaard, JM; Vanderthommen, M
Journal: Joint Bone Spine 2010 May 5; Vol. 77, Issue 1; Page(s) 58-63
[Medline ID - 20031468]

OBJECTIVES: To evaluate the efficacy of a semi-intensive multidisciplinary outpatient program complying with the requirements of the Belgian National Institute for Health and Disability Insurance and intended for patients with chronic low back pain. METHODS: We included 262 patients with nonspecific chronic low back pain, among whom 136 (73 women and 63 men) with a mean pain duration of 11.3 years completed the outpatient program (36 sessions each lasting 2h). The program consisted of education about back-sparing techniques, interventions by an occupational therapist and psychologist, and physical reconditioning. Three sessions (sessions 1, 18, and 36) were used to evaluate pain intensity, functional impairment, kinesiophobia, cognitive knowledge, knowledge of appropriate spinal movement technique, and physical performance (trunk muscle strength and endurance, mobility of the pelvis and lumbar spine, and aerobic capacity). RESULTS: All study variables were significantly improved at study completion compared to baseline: pain intensity was decreased by 44%, functional impairment by 40%, and kinesiophobia by 11% whereas knowledge was improved by 59%, back-sparing technique by 95%, trunk muscle strength by 40% on average, trunk extensor muscle endurance by 90%, mobility by 8%, and aerobic capacity by 18%. CONCLUSIONS: A semi-intensive multidisciplinary outpatient program was beneficial in patients with chronic low back pain. Careful patient selection and increased patient involvement in the program may help to improve adherence.

Cooled radiofrequency (RF) of L5 dorsal ramus for RF denervation of the sacroiliac joint: technical report.
Author(s): Kapural, L; Stojanovic, M; Bensitel, T; Zovkic, P
Journal: Pain Med 2010 Aug 13; Vol. 11, Issue 1; Page(s) 53-7
[Medline ID - 20030745]

BACKGROUND AND OBJECTIVES: The sacroiliac joint is a common source of chronic low back pain. We recently described the use of cooled radiofrequency (RF) electrodes for performing lateral branch neurotomy to treat sacroiliac joint pain. The procedure involves lesioning the lateral branches of the posterior primary rami at S1-S3, and the L5 dorsal ramus (L5DR). While the cooled RF electrode has been adopted as a means for lesioning the lateral branches, conventional RF electrodes are used to lesion the L5DR. The objective of this technical report is to evaluate the acute safety of denervating the L5DR using cooled RF electrode. METHODS: Electronic chart review was conducted on 100 consecutive RF procedures. Data collected included age, sex, years of pain, body mass index, post-procedural pain, numbness, weakness, and other complications. RESULTS: Of 100 procedures 82 were completed using cooled electrode for sacral lateral branches and L5DR. Of the 82 procedures completed using cooled RF to L5DR, 24 were reported to be of high difficulty and 19 with poor visualization (bowel gas). There were no major complications related to the procedure. Four patients reported increased pain: two from the conventional RF of L5DR group and two from the cooled RF group. All of the pains were transient and returned to the baseline within 6 weeks. There were two patients experiencing localized numbness over the upper medial quadrant of the buttock, both in cooled RF group. There was no reported weakness of the lower extremity. Two patients complained of increased lower back pain and two of prolonged itching. CONCLUSIONS: This review demonstrates the acute safety of using cooled RF for L5DR denervation with no report of significant or unusual patient complications. To establish frequency of complication associated with the treatment, a larger registry is required.

Back muscle activation patterns in chronic low back pain during walking: a "guarding" hypothesis.
Author(s): van der Hulst, M; Vollenbroek-Hutten, MM; Rietman, JS; Schaake, L; Groothuis-Oudshoorn, KG; Hermens, HJ
Journal: Clin J Pain 2010 Mar 2; Vol. 26, Issue 1; Page(s) 30-7
[Medline ID - 20026950]

OBJECTIVES: To investigate whether patients with chronic low back pain (CLBP) show "guarded" movements during walking. It is hypothesized that guarding will be reflected by increased lumbar muscle activity during all periods of stride and secondary, relatively lesser relaxation during periods of swing compared with double support. Furthermore, it is hypothesized that higher levels of perceived fear and disability are related to increased muscle activity and less relative relaxation. MATERIALS AND METHODS: In a cross-sectional study 63 patients with CLBP and 33 healthy controls walked on a treadmill at 3.8 km/h. Surface electromyography (sEMG) data of the erector spinae were obtained and smoothed rectified sEMG (SRE) values were calculated per period of swing and double support. The ratio of SRE values in swing to double support was used as a measure of relative relaxation (SRE ratio). In addition, the relationshi p between SRE values, the Roland Morris Disability Questionnaire, and the Tampa Scale for Kinesiophobia was analyzed in patients with CLBP. RESULTS: Mean SRE values were significantly higher in patients with CLBP than in controls both during periods of double support and swing. SRE ratios were not significantly different between groups. Results showed no influence of disability or fear of movement on either SRE values or ratios. DISCUSSION: In patients with CLBP, increased lumbar muscle activity during all periods of stride, with comparable alteration between swing and double support, suggests difficulties with total muscle relaxation. On the basis of this evaluation, it is concluded that patients with CLBP show a guarding mechanism during walking. No relationship is found between perceived fear, disability, and muscle activity.

Gabapentin monotherapy in patients with chronic radiculopathy: the efficacy and impact on life quality.
Author(s): Yildirim, K; Deniz, O; Gureser, G; Karatay, S; Ugur, M; Erdal, A; Senel, K
Journal: J Back Musculoskelet Rehabil 2010 Mar 24; Vol. 22, Issue 1; Page(s) 17-20
[Medline ID - 20023359]

OBJECTIVE: The purpose of this, open-label, non-comparative study, was to evaluate the efficacy on quality of life and the efficacy of gabapentin monotherapy in patients with chronic radiculopathy. METHODS: Thirty-five patients with radicular pain and diagnosed as L4, L5 or S1 radiculopathy were treated with oral gabapentin from a total of 300 mg per day once up to a total of 1800 mg per day divided in 3 doses for eight-week trial period. Quality of life, functional disability and psychological mood of the patients were assessed using the Nottingham Healthy Profile (NHP), Oswestry Low Back Pain Disability Questionnaire (ODQ) and Beck Depression Inventory (BDI). RESULTS: Of the patients (n = 35), 25 were females and 10 were males (mean age: 41.8 +/- 10.4, range: 24-60 years); mean radiculopathy duration was 16.4 +/- 14.2 months (range: 3-48 months). The pain intensity at rest, quality of life, functional disability and depression scores were determined significantly improved after treatment and 4 months compared to baseline scores (p < 0.001). 1.5 points compared to baseline for at pain rest and 15 points improvement on the ODQ were obtained. CONCLUSION: Gabapentin may provide benefits in terms of alleviation of pain and overall quality of life in patients with chronic radiculopathy.
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