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

This chapter has reviewed research on psychological and social factors associated with the onset and progression of low back pain. From this review it can be concluded that psychosocial traits appear to be important contributors to the course of pain and disability though methodologically well-designed longitudinal studies are rare. For this reason it is difficult to assess the relative importance of, for example, psychological distress compared with work stress. Furthermore, the mechanisms by which specific variables effect back pain remain unknown. The answer, no doubt, lies in longitudinal studies which employ multicausal models. It has been noted the psychosocial treatments which have proven effective for chronic pain populations are rarely assessed with acute pain patients. Some problems are the inaccessibility of acute back pain sufferers to psychologists, the difficulty of isolating the effect of one component of a multidisciplinary programme and the lack of uniform practice of psychosocial techniques. None the less, programmes which include psychosocial interventions appear to have superior results to those which do not. Since these techniques are often simple and inexpensive to include they should be incorporated into all treatment programmes where the potential for chronic pain syndrome exists. Gaps and flaws in current research methodologies have been identified and suggestions for future investigations have been proposed. In addition we have attempted to provide some practical guidelines for health care professionals to help them identify salient psychosocial issues which may effect the course of their patient's treatment. Recommendations for assessment and referral are also provided.
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PMID:Psychosocial issues in the prevention of chronic low back pain--a literature review. 147 96

The study evaluated the manual treatment of dysfunction of the pelvic joints. This is one of many condition causing low back pain. In 1987-1988 a general practitioner with special knowledge of physical examination and manual treatment of lumbar and pelvic dysfunctions made a survey of patients with acute or subacute low back pain as the main cause of the patient-to-doctor contact. Patients with defined criteria of pelvic joint dysfunction (n = 46) were randomized. After dropouts and exclusions, 18 patients with defined criteria of pelvic joint dysfunction received manual treatment, while 21 patients with similar dysfunction served as controls and received placebo treatment in a form of massage. Both groups were seen only once to evaluate whether a single treatment might be sufficient. After a period of three weeks, evaluation was made by an independent observer. Subjective pain measurement and a mobility test showed no significant difference. Sick-leave and consumption of analgesics (both decided by patient) were significantly less in the treatment group.
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PMID:Treatment of pelvic joint dysfunction in primary care--a controlled study. 148 Aug 73

Recent reports have attempted to compare the relative value of discography and MRI in the evaluation of lumbar degenerative disc disease. None has compared the accuracy of the two techniques in regard to the detection of disc herniation specifically, and none has offered surgical correlation. In this prospective study, both techniques were used to evaluate 264 disc levels in 90 patients with incapacitating low back pain or radicular pain. The results showed an 86% agreement level both between tests and between the orthopaedist and radiologist on each test. Surgical findings agreed with diagnostic studies at 63 of 76 levels in 57 patients who underwent operative treatment. An analysis of the relative sensitivity and specificity of each test in the diagnosis of degeneration and herniation revealed that the greater sensitivity of MRI in the detection of herniation was the only statistically significant difference (p < 0.05).
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PMID:Comparison of MRI and discography in the diagnosis of lumbar degenerative disc disease. 149 39

The study examined the work stresses of 107 women who were engaged in sewing machine operation in small garment manufacturing units. Of the three types of sewing machines (motor-operated, full and half shuttle foot-operated), 74% of the machines were foot-operated, where throttle action of the lower limb is required to move the shuttle of the machine. The motor-operated machines were faster than the foot-operated machines. The short cycle sewing work involves repetitive action of hand and feet. The women had to maintain a constant seated position on a stool without backrest and the body inclined forward. Long-term sewing work had a cumulative load on the musculo-skeletal structures, including the vertebral column and reflected in the form of high prevalence of discomfort and pain in different body parts. About 68% of the women complained of back pain, among whom 35% reported a persistent low back pain. Common sewing work accident is piercing of the needle through the fingers, particularly the right forefingers. Unsatisfactory man-machine incompatibility, work posture and fatigue, improper coordination of eye, leg and hand are the major problems of the operators. The design mis-match of the work place may be significantly improved by taking women's anthropometric dimensions in modifying the workplace, i.e. the seat surface, seat height, work height, backrest, etc.
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PMID:Work stress of women in sewing machine operation. 149 Nov 71

Based on a general family model Saile and Schmitz (1991) developed the Pain related inventory of family adaptability and cohesion (SIFAK), which assesses three aspects of family life related to chronic pain: adaptability in dealing with chronic pain, pain related enmeshment and pain related disengagement and alienation. 40 patients with chronic low back pain and their spouses completed a revised version of the SIFAK and measures of pain intensity, pain related disability and marital satisfaction. Patients and spouses agreed more on marital satisfaction than on pain related variables. In multiple regression analyses marital satisfaction and pain related disability--each in the view of patients and spouses--were predicted by pain and family related variables. Implications for future research (other data sources, other measurement methods) and for psychological treatment of chronic pain are discussed.
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PMID:[Familial and pain-related markers from the viewpoint of chronic pain patients and their partners]. 149 39

Segmental pedicle screw instrumentation in adult lumbar scoliosis allows better curve correction and restoration of lumbar lordosis. In a retrospective study, to assess the value of this fixation, 9 patients treated with the AO Internal Fixator and 18 with Cotrel-Dubousset instrumentation were reviewed. Mean age at surgery was 60 years (range, 40-88), and curves were measured between 22 degrees and 82 degrees. At follow-up (mean of 56 months for the AO Internal Fixator and 42 months for Cotrel-Dubousset instrumentation), the average curve correction was better than 50% Overall satisfactory clinical results with pain relief and improved walking distance were noted in 86% of the patients. Using this technique no postoperative deaths or neurologic deficits occurred. Only a few complications and a 4% pseudarthrosis rate could be observed. Our study shows that the age of the patients with degenerative scoliosis is not a contraindication for major surgery. Meticulous posterior spine release before instrumentation is essential for curve correction and bone fusion. Lumbar lordosis is more easily restored with Cotrel-Dubousset instrumentation, which seems to correspond to the incidence of low back pain. Cases with evident neurologic deficits are best treated by additional nerve decompression.
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PMID:Pedicle fixation devices in the treatment of adult lumbar scoliosis. 152 17

This paper describes a prospective, double blind, randomised and dummy-controlled trial in 28 patients with chronic mechanical low back pain presenting to the York Pain Clinic. The therapeutic effects of epidural methyl prednisolone (80 mg) were compared with intrathecal midazolam (2 mg). All the patients had pain for a considerable length of time (range: 1-35 years) and all had received previous treatments which had failed. The two groups of patients were comparable in terms of pain duration, demography, extent of disability, anxiety and depression and pain locus of control. The pain was assessed before and for 2 months after treatment using the short form McGill Pain Questionnaire as well as visual analogue and verbal rating scales for sensory and affective components of their pain experience; patients also completed a pain diary. Both treatments caused a similar improvement in one-half to three-quarters of the patients for 2 months in patterns of activity and sleep as well as in the sensory and affective components of the pain. However, although the improvement in the two groups was similar, all the patients treated with steroid were either taking more or the same amount of self-administered analgesic medication after their treatment, whereas between one-third and one-half of the midazolam-treated patients took less medication during the 2 month follow-up period. We conclude that intrathecal midazolam is an effective treatment for chronic mechanical low back pain. The mechanism responsible for this effect is discussed.
Pain 1992 Jan
PMID:Intrathecal midazolam for the treatment of chronic mechanical low back pain: a controlled comparison with epidural steroid in a pilot study. 153 83

People who experience chronic low back pain face significant changes in their lives, and it is unclear why some people adapt to the pain situation better than others. Using a cognitive appraisal model, outcomes of the pain situation were examined in 40 chronic low back pain patients using situational control and appraisal of illness as predicted mediating factors. This article presents background of the problem and the results of the study.
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PMID:Perception of control and appraisal of illness in chronic low back pain. 153 18

Observation of overt pain behaviours was carried out by physicians during routine clinical examination of 120 patients with chronic low back pain. Reliable ratings were achieved but only after very careful standardization in an additional 60 pilot patients. Overt pain behaviour was found to be related to other clinical measures of illness behaviour--pain drawing, behavioural symptoms, behavioural signs, use of walking aides and downtime--but did tap an additional dimension. It is concluded that clinical observation of overt pain behaviour can provide useful additional information about illness behaviour in low back pain. Reliable observations can be achieved in a carefully standardized research situation but in routine clinical practice are vulnerable to considerable observer error and bias.
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PMID:Observation of overt pain behaviour by physicians during routine clinical examination of patients with low back pain. 153 80

After headache, low back pain is the most common cause of intractable pain. It is a condition experienced by 50-80% of the world's population, ranking first among all health problems in frequency of occurrence. This chapter focuses on the treatment of chronic low back pain and describes the pain program at the University of Miami Comprehensive Pain and Rehabilitation Center.
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PMID:Back school programs. The pain patient. 153 98


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