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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It has been proposed that pain treatment evaluation is hindered by heterogeneous properties of patient samples. Therefore, to facilitate pain treatment evaluation in this psychological study, a heterogeneous group of chronic low back pain patients was classified into more homogeneous subgroups. Two designs were used to compare the outcome by the "functioning activation" and the "spa resort" type of rehabilitation. In the first design, the outcome was compared in groups, clinically homogenized by sociodemographic variables and in respect to contraindications for heavy physical training. In the second design, the pain patient subgroups, homogenized by cluster analysis technique in accordance with the psychological profiles of functioning, were compared in their response to treatments. The results indicated that the outcome evaluation was facilitated by the latter design releasing more specific information about the effects of the program quality, the patient characteristics, and their interaction on the improvement by rehabilitation. It was concluded that in treatment outcome analysis, the subgroup's homogeneity must be considered.
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PMID:Patient classification, a key to evaluate pain treatment: a psychological study in chronic low back pain patients. 138 50

The prevalence of major depression in patients with chronic low back pain (CLBP) is approximately three to four times greater than that reported in the general population. In spite of these high prevalence rates, there have been few systematic attempts to investigate the efficacy of treatment for major depression in patients with CLBP. While several studies have examined the efficacy of antidepressant medication and psychological treatment in patients with chronic pain, most of these studies have focused on treating chronic pain rather than depression. The few studies that have specifically addressed the treatment of depression in CLBP indicate that tricyclic antidepressants and cognitive-behavioral approaches may be effective means of treating depressed chronic pain patients. Clinical issues related to diagnostic confounds, rehabilitation outcome, and conceptualizations of the relation between pain and depression are discussed. It is argued that, in patients with clinical levels of depression, treatment modalities specifically targeting depressive symptomatology deserve serious consideration as an integral component of pain management programs.
Pain 1992 Jul
PMID:The treatment of depression in chronic low back pain: review and recommendations. 845 72

This preliminary study was conducted to identify a facet joint syndrome in low back pain. Ninety maneuvers and symptoms were compared between patients relieved (responders) and those unrelieved (nonresponders) after intraarticular blocks. Fifty-one patients participated in the study; 11 were excluded from evaluation because of unsuccessful injection into the joints as planned. Of the 40 patients included, 20 had four joints anesthetized, 16 had two joints anesthetized, and four had three joints anesthetized. Twenty-two were responders, 17 of whom had more than 90% relief of pain. Only a few variables were more frequent in the responder group: older age, absence of exacerbation by coughing, relief when recumbent, absence of exacerbation by forward flexion and when raising from this flexion, absence of worsening by hyperextension, and extension-rotation. When four of these seven variables were present in the same patient, sensitivity was 81.8% and specificity 77.8%, but this discriminant power must be evaluated in a new population.
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PMID:Facet joint block for low back pain: identifying predictors of a good response. 138 21

Research regarding the effect of exercise on chronic benign axial pain is reviewed. Both chronic low back pain (LBP) and chronic neck pain are associated with weakness of the trunk and neck musculature; however, it is unknown whether weakness is a cause or effect. The relationship between incoordination of the neck or trunk musculature and chronic pain is unclear. Exercise is associated with improved strength and endurance and decreased pain in subjects with LBP but the literature is very sparse with respect to chronic neck pain. Range-of-motion is also diminished in those with LBP and improves with exercise, and is associated with abatement in symptoms. No evidence could be found regarding the effect of exercise on segmental motion. Exercise is also associated with improved function, however the mechanism whereby either pain report or function improves is unclear. A greater understanding of the role of exercise will require more specific studies of strength, coordination, motion, function, and pain.
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PMID:Therapeutic exercise in chronic neck and back pain. 138 24

One hundred fifty 45-55-year-old men were divided into three groups: those with healthy backs, recurrent low back pain (LBP), and chronic LBP. These groups were studied with respect to anthropometry, spinal canal width, spinal sagittal configuration and flexibility, and the flexibility of the hamstrings musculature with straight leg raising (SLR). There were no differences between the groups with respect to anthropometry. The group with healthy backs had significantly greater lordosis and sagittal flexibility than the other groups. The width of the spinal canal was correlated to body height. The SLR test showed significantly higher values in the group with healthy backs and in the recurrent pain group than in the chronic pain group. The possible role of restoring normal range of motion to minimize the risk of LBP recurrence is discussed.
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PMID:Anthropometry, spinal canal width, and flexibility of the spine and hamstring muscles in 45-55-year-old men with and without low back pain. 138 20

Cluster headache is a disorder of unknown origin. Some studies have focused their attention on neuroendocrine derangement, others on immunity. To probe central alterations in cluster headache (CH), immune parameters were investigated in cluster headache patients in comparison to low back pain patients and healthy controls. Increases in peripheral blood monocytes found in remission cluster headache patients may be attributable to chronic central nervous system (hypothalamic?) noradrenergic dysfunction or altered beta-endorphin. Alterations in NK+, CD3+ and CD4+ levels found in cluster period cluster headache and low back pain patients are probably pain or stress-related.
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PMID:Immunological alterations in cluster headache during remission and cluster period. Comparison with low back pain patients. 138 94

We studied 135 lumbar discs from 27 spines removed post-mortem from subjects of an average age of 31.5 years. Defects of the annulus fibrosus were classified as peripheral, circumferential or radiating; the nucleus pulposus as normal, moderately or severely degenerate. Peripheral tears were more frequent in the anterior annulus, except in the L5-S1 disc. Circumferential tears were equally distributed between the anterior and the posterior annulus. Almost all the radiating tears were in the posterior annulus, and closely related to the presence of severe nuclear degeneration. Histology suggested that peripheral tears were due to trauma rather than biochemical degradation, and that they developed independently of nuclear degeneration. The association of peripheral annular lesions with low back pain is uncertain but our study suggests that they may have a role in the pathogenesis of discogenic pain.
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PMID:Annular tears and disc degeneration in the lumbar spine. A post-mortem study of 135 discs. 138 73

This study appraised the significance of psychological factors in the long-term prognosis of patients with chronic low back pain (LBP). The MMPI ratings of 80 long-term sick-listed LBP patients were set in relation to their disability pension status 6 to 12 years later. The number of elevated scales, in combination with the level of certain scales (HS and HY), proved to be a better predictor than profile patterns, advocated in some studies. Moreover, in a review of prognostic studies, the HS and HY scales appeared most frequently as significant predictors. That result also was confirmed in this study of long-term prediction of overall functional level. The results are discussed in relation to the concepts of pain-fear and sick role.
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PMID:Psychological factors in the long-term prognosis of chronic low back pain patients. 140 Nov 43

Normal adult rabbits were studied in a whole body vibration model which simulates the type of environmental exposure associated with vibration-induced low back pain. This model has previously been shown to induce changes in pain-related neuropeptides in the dorsal root ganglion. Following two weeks of daily exposure to whole body vibration, dorsal root ganglia were excised from control and vibrated rabbits and prepared for ultrastructural evaluation. Of over 1,200 cells sampled, 190 appropriately sectioned cells were analyzed: 32 from immobilized controls, 44 from normal controls, and 114 from vibrated animals. Analysis of nuclear contours revealed more prevalent and more extensive clefting of the nuclear membrane in vibrated cells. The membrane lining these clefts was traversed by numerous pores; density of these pores was 46% greater than in adjacent nonclefted segments (p less than .001). Number of clefts per nucleus was increased by 39% in vibrated animals. Cleft area represented 1.19% of nuclear area in vibrated cells compared to 0.74% in controls (p less than .001). Numerous mitochondria and free ribosomes and abundant rough endoplasmic reticulum were located within the cleft spaces of vibrated cells. Pores in the cleft membrane appeared normal, supporting the conclusion that the clefts are structural alterations rather than fixation or sectioning artifacts. Changes in dorsal root ganglion neuropeptides seen in previous studies of vibrated animals may result from increased or redirected cellular synthesis. Ultrastructural changes seen in these vibrated dorsal root ganglion neurons are consistent with such an alteration in metabolism and could reflect increased synthesis of pain-related neuropeptides.
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PMID:Nuclear clefting in dorsal root ganglion neurons: a response to whole body vibration. 140 Dec 48

Fifty-six chronic low back pain (CLBP) patients participated in a controlled, prospective 5-yr follow-up study evaluating the long-term effects of five-session couple therapy. Twenty-eight patients were included both in the treatment group and in the control group. Outcome measures were self-reported psychological distress, marital satisfaction, health locus of control, pain and disability as well as clinical examinations. The reliability of the outcome measures was statistically analysed and found acceptable. At the 5-yr follow-up assessments, psychological distress was found to be decreased in the treatment group and increased in controls. The difference between the groups was significant. No difference was found in the other self-reported or clinical outcome measures. We conclude that couple therapy has a prolonged beneficial effect on the mental well-being of CLBP patients.
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PMID:Couple therapy improves mental well-being in chronic low back pain patients. A controlled, five year follow-up study. 140 99


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