Effects of warming imagery aimed at trigger-point sites on tissue compliance, skin temperature, and pain sensitivity in biofeedback-trained patients with chronic pain: a preliminary study

13 subjects were trained in biofeedback and self-regulation strategies for reducing chronic pain. Upon demonstrating ability to hand warm, subjects were exposed to an imagery exercise designed to increase skin temperature at trigger-point sites, which are small tender irritative foci located in the soft tissue. Skin temperature, tissue compliance, and pressure-pain sensitivity were recorded before and after imagery intervention. Subjects showed significant increases in skin temperature and muscle relaxation at trigger-point sites and decreases in pressure-pain sensitivity. This suggests that localized trigger-point warming may be an effective adjunct in treating chronic pain.

[Opinion of patients with back pain about the treatment received. A questionnaire study]

6 1/2 years after hospitalization for low back pain 364 patients answered a questionnaire on their opinion of the help they had received. 53.5% were satisfied with the help and support provided by their general practitioner and 78.7% were satisfied with the hospital treatment. We discuss possible reasons for this difference. It seems difficult for many patients to accept the conservative treatment prescribed by the general practitioner.

[Therapeutic principles in chronic back pain]

Treatment of patients with chronic back pain may become a most difficult task. This article discusses the principles and indications for surgical treatment. Conservative treatment should emphasize information and exercises to increase function. Soft tissue treatment, manipulation, and poor pain treatment should be used as supplements, and not as alternatives to this treatment. Contra-indications to physiotherapy are discussed to the extent that ordination of treatment that is not well-founded may have unfortunate therapeutic consequences. The general practitioner should act as coordinator when a more extensive somatic and psycho-social rehabilitation programme is required.

[Low back pain malingering]

As in the case of other painful conditions, patients with low back pain may exhibit symptoms of malingering and of decreased function. This may occur at a conscious or a subconscious level. Certain signs in the case history and the clinical examination are typical of malingerers. Local treatment of symptoms may cause an exaggeration of the patients decreased function. Treatment should focus on possible underlying psycho-social problems. Sick leave should be avoided if possible during the treatment period.

A comparison of low back pain profiles of chiropractic teaching clinic patients with patients attending private clinicians

A study was undertaken at six chiropractic college outpatient (teaching) clinics and 60 private chiropractic clinics, to evaluate the comparability of patients' pain quality and pain intensity in each of three low back pain diagnostic groups. The McGill Pain Questionnaire (MPQ) was employed for this purpose. There was a tremendous range of measurable pain characteristics (Pain Rating Index scores) within the three diagnostic groups in both patient samples. Overall, patients of field doctors had higher mean scores on all dimensions of pain quality measured by the MPQ, and they described a higher pain intensity than patients attending the teaching clinics. In all three diagnostic groups, patients attending teaching clinics were more likely than private patients to present with a chronic low back condition. Although patients in the field more frequently used words implying greater pain intensity, the characteristics of pain quality (descriptor profiles) showed similar trends among the two patient samples. The consistent findings of less pain intensity among teaching clinic patients support previous reports that these patients have milder complaints than patients seen by field doctors. While these findings do not rule out the use of teaching clinic patients as subjects in clinical trials, it is suggested that generalizations from teaching clinic patients to private patients should be made with caution.

[Neck, shoulder and back problems in dentists]

Many dentists suffer from pains in the region of the neck, the shoulder and the back, which are due to the unphysiological body positions dentists take during their daily work. In many cases these unphysiological body positions damage the skeleton and the muscular system. This paper discusses the pathophysiological mechanisms which are responsible for these damages in detail. Additionally, suggestions for prevention, therapeutical advice and a gymnastic training program especially for dentists are given.

Experimental measurement of the force exerted during spinal manipulation using the Thompson technique

The purpose for conducting this study was to quantify the forces exerted by a chiropractor on a patient during spinal manipulative therapy. Six patients received three treatments each from two chiropractors for a sacroiliac joint fixation. The Thompson technique was used to treat the patients. The force characteristics of the spinal manipulation were analyzed with respect to the following five points: preloading force, peak force, duration of manipulation, impulse of manipulation and point of application of the peak force. The results obtained indicated that all treatments have certain common characteristics; for example, a preload force is always followed by a large thrusting force. The values for the preload force, peak force, duration and impulse were found to have large standard deviations for a given adjuster and between patients. The location of the point of application of the peak force relative to a low back reference system appeared to be very consistent. However, it was not on the posterior superior iliac spines (PSIS) as expected, but always slightly medial to this point. This is the first study to report force results which were measured directly during spinal manipulative therapy in a clinical situation. In further studies, the results of this investigation will be compared to results obtained from a large population of patients and chiropractic adjusters. Differences in the force characteristics between chiropractors will be compared to clinical and objective measures of the rehabilitation process of the patients in order to find an "optimal" way of performing spinal manipulative therapies.

Extradural abscess following local anaesthetic and steroid injection for chronic low back pain

A case is described of extradural abscess following extradural injection of local anaesthetic and steroid for the management of chronic low back pain. The common signs and symptoms are reviewed, possible causes discussed and the association with diabetes stressed.

Chiropractic adjustive manipulation on subjects with acute low back pain: visual analog pain scores and plasma beta-endorphin levels

The purpose of this study was to evaluate pain scores and plasma beta-endorphin levels following a single spinal adjustive manipulation in subjects with acute low back pain. Eighteen subjects were randomly assigned to either a control group, which received no treatment; a sham group, which received only light physical contact (touch); or an experimental group, which received an adjustive manipulation at a specific lumbar segment. Following a standard protocol, all subjects were administered visual analog pain scales and venous blood was drawn 5 min prior to, 5 min after, and 30 min after intervention. Analysis of the pain scores indicated that there was a slight, but significant, reduction of pain in the experimental group, but no similar reduction in the control or sham groups. Furthermore, this reduction of pain in the experimental group was not accompanied any significant change in the plasma beta-endorphin concentration.

Patterns of conscious failure to provide accurate self-report data in patients with low back pain

Assessment and treatment responses were compared in 17 subjects with chronic low back pain assessed as showing at least one clear consciously produced inconsistency in statements and/or behaviors during their participation in an interdisciplinary treatment program and 143 subjects assessed as showing no such inconsistency. Numerous statistically significant differences emerged: Inconsistent subjects were more likely to have pending litigation and to be assessed by staff as showing a higher degree of focus on pain and more dramatized complaints, lower levels of medical findings and attention and interest in treatment, and poor compliance with treatment and assessment procedures. In addition, these subjects reported lower levels of physical activity and generally more inconsistent or negative responses to lumbar sympathetic injections with fewer expected changes in physical sensations. Though not definitive, these results suggested a syndrome of characteristics among such subjects which are similar to those proposed as likely characterizing malingerers. The need for a particularly careful validation of self-report data in patients showing many of these characteristics was emphasized.

Spinal cord stimulation in 112 patients with epi-/intradural fibrosis following operation for lumbar disc herniation

A total of 112 patients with epi-/intradural fibrosis following operation for lumbar disc herniation were treated by spinal cord stimulation. Lumbosacral spinal fibrosis is seen particularly often after extensive and repeated operations. Radicular pain responds better to stimulation than back pain. A favourable long-term effect on radicular pain has been observed in 67% of patients treated by epidural implantation, the corresponding average follow-up period being 4 1/2 years. 40% of these patients needed less analgesics after the operation, while 25% of them showed an improved fitness for work. Among about 5,000 patients who underwent surgical treatment for lumbar disc herniation, an indication for spinal cord stimulation was found in 1.5%. By comparison, the frequency of the "last resort" procedure of microsurgical cordotomy was 0.3%. We no longer use other ablative methods like extirpation of spinal ganglia.

Lumbar sagittal mobility and low back symptoms in patients treated with manipulation

The relationship between lumbar sagittal mobility and symptoms was explored in a 1-year prospective study of 55 patients undergoing manipulative treatment. A significant increase in mean mobility was found to occur in the 1st month, together with a concomitant significant decrease in mean pain values; symptoms continued to decrease thereafter, but mobility remained unchanged. More detailed analysis of the data revealed that symptomatic improvement was as common in patients with unaltered or reduced mobility as it was in those who showed an increase; changes in mobility at 1 month had no predictive value for symptomatic status at 1 month or 1 year. It is concluded that if any benefits actually result from manipulative therapy they are not a direct function of increased overall lumbar sagittal mobility. It remains possible that manipulation may influence other mobility parameters, such as coupled motions, so future studies should be directed toward investigation of three-dimensional movement patterns.

Recidivism in the management of medical back pain

One Ohio hospital underwent three years of 100% focused review of admissions for medical back problems (DRG 243) due to excessive numbers of admissions previously noted. On cessation of the focused review, the volume of admissions rose at this hospital, and the admission denial rate increased. Reinstitution of focused review appeared to decrease the number of admissions, but did not affect the rate of admission denials.