Aerobic capacity among chronic low-back-pain patients

The role of aerobic capacity (maximal oxygen uptake, VO2max) in connection with chronic low-back pain was assessed in a study mainly designed to evaluate the outcome of inpatient and outpatient treatment of low-back pain. A total of 245 subjects (ages 35-54 years, 71% men)--81 inpatients, 88 outpatients, and 76 controls--who had chronic low-back pain but who were still working, performed maximal graded bicycle ergometer tests four times during the follow-up of 30 months. In every group the estimated VO2max was on the level of the reference values of healthy persons. There were no significant changes in the VO2max in any of the intervention groups during the follow-up period. The correlation analyses showed no connection between aerobic capacity and pain or disability caused by chronic low-back pain. Among several components of physical fitness, aerobic capacity had no predictive value in the course of low-back pain.

Spinal cord stimulation in 60 cases of intractable pain

Sixty patients with spinal cord stimulators implanted for intractable pain lasting up to 50 years were followed for up to nine years. Forty seven per cent derived significant benefit, 23% modest benefit, 20% experienced no effect and 6.7% were made worse. Two were made worse after initial benefit. Complications, indications and factors relevant to the mode of action are discussed.

Low back pain

The main causes of low back pain are intervertebral disc and facet joint dysfunction and spondylosis. It is important to differentiate between the pain of inflammation (worse at rest, relieved by activity) and that of mechanical dysfunction (worse on activity, relieved by rest). The key to diagnosis is understanding the daily patterns of back pain.

Clinical indications for developing a physical education and aerobic research center in a multidisciplinary pain management center

The following discussion demonstrates a clinical need for a physical education service in a multidisciplinary pain center. Weight loss, and physical and aerobic conditioning are essential aspects of managing pain. By improving patient care and increasing one's pain center attraction, physical education and aerobic research centers can also increase departmental revenues.

Effects of different treatment modalities on gait symmetry and clinical measures for sacroiliac joint patients

The purpose of this study was to assess the effects of two different treatment modalities on the rehabilitation process of chronic sacroiliac joint patients. The treatment modalities included spinal manipulative therapy given by a chiropractor and a program of back school therapy given by a physiotherapist. The rehabilitation process was assessed using clinical and biomechanical measures. It was found that back school therapy was a better treatment modality than the spinal manipulative therapy, according to the clinical measures of rehabilitation. Precisely the opposite result was found for the biomechanical measures.

Back pain during pregnancy and labor

A retrospective study of 400 pregnancies and deliveries was undertaken by interview of 170 consecutive female patients presenting to five chiropractic offices in the Niagara Peninsula. Back pain was reported during 42.5% (170) of the pregnancies and 44.7% (179) of the deliveries. There was a statistically significant association between back pain during the two events (p less than .001). Of the 170 pregnancies with reported back pain, 72% (122) also reported back labor. A subsample of 170 painful pregnancies was divided into those that had received manual manipulation and those that had not. The treated group experienced less pain during labor (p less than .001).

The quadratus lumborum and low back pain

Two cases of low back pain from quadratus lumborum myofascial trigger points are presented. One of the patients suffered from an acute episode while the other had a chronic condition. This condition may be more common than previously believed. The quadratus lumborum should be examined in patients presenting with flank pain as well as low back, buttock and lateral hip pain. Thoracolumbar joint dysfunction may often coexist with quadratus lumborum myofascitis and must be treated for optimal results. Myofascial therapy directed at restoring muscle length and function, coupled with joint manipulation to related dysfunctional areas, was implemented. Diagnosis and treatment are outlined.

Low back pain

Low back pain is a very common and significant problem in our society, and there are both mechanical and psychosocial aspects to its etiology. This paper presents a systematic approach to the treatment of common types of low back pain. Treatment, beginning with conservative care, is outlined in this paper in the form of an algorithm. Current research directed at both the diagnostic and treatment aspects of low back pain is addressed.

Cerebrospinal fluid concentrations of beta-endorphin in chronic low back pain patients. Influence of depression and treatment

Cerebrospinal fluid (CSF) beta-endorphin concentrations were determined before and after treatment in 28 patients suffering chronic neuralgic low back pain/sciatica. Nine patients carried the additional diagnosis of major depressive disorder. Pain treatment was multimodal and resulted in variable pain reduction. CSF beta-endorphin concentrations spanned a wide range with no association to age, gender, pain ratings, depressive symptomatology, and drug intake. CSF beta-endorphin concentrations were not influenced by the presence of major depressive disorder and did not change with successful treatment of pain and resolution of depression.

Effectiveness of behavioral therapy for chronic low back pain: a component analysis

The effects of outpatient group behavioral therapy including aerobic exercise (BE), behavioral therapy only (B), and aerobic exercise only (E) on pain and physical and psychosocial disability were evaluated and compared in a group of mildly disabled chronic low-back-pain patients. Ninety-six Ss were randomly assigned to the 3 treatments and a waiting-list control (WL) condition and assessed on a variety of patient self-report, spouse-rated, and direct observational measures at pretreatment, posttreatment, and 6- and 12-month follow-ups. Patients in the BE condition, but not the B or E conditions, improved significantly more pretreatment to posttreatment than did WL patients on the patient self-report and observer-rated measures. At both follow-ups, all 3 treatment groups remained significantly improved from pretreatment, with no significant differences among treatments.

Iatrogenic psoas abscess. Case report

A case of iatrogenic pneumococcus psoas abscess is reported. The etiology was probably repeated local anaesthetic blockades in the lumbogluteal structures because of lumbago.

Traditional acupuncture increases the content of beta-endorphin in immune cells and influences mitogen induced proliferation

We measured beta-endorphin concentrations in peripheral blood mononuclear cells and mitogen-induced T-lymphocyte proliferation in patient who underwent treatment with traditional acupuncture. Traditional acupuncture increased both the concentrations of the opioid in the immune cells and lymphocyte proliferation. Our data are consistent with the hypothesis that traditional acupuncture modulates immune responses in man.

A controlled study of couple therapy in chronic low back pain patients. No improvement of disability

Family-oriented approaches and consequent conjoint marital sessions have been widely accepted as ingredients of comprehensive treatment and rehabilitation of chronic pain patients. However, no controlled trials have been conducted to confirm the effectiveness of couple therapy in these patients. We examined 63 chronic low back pain (CLBP) patients identified in primary health care centres. They were randomly allocated to a couple therapy group (n = 33) and to a control group without couple therapy (n = 30). The therapy consisted of five monthly sessions and was attended by two family therapists. All patients attended an initial examination and a 12-month follow-up examination. Effects on self-reported pain, disability, and some clinical measures, as well as on the use of medical services were evaluated. The study groups did not differ significantly in any of the outcome measures. Hence, we conclude that couple therapy has no significant effect on disability in CLBP patients.

A useful technique for measurement of back strength in osteoporotic and elderly patients

Improvement of back extensor strength (BES) can be used as a therapeutic method for patients with chronic back pain and osteoporosis. The method of evaluation must be reliable and accurate without compromising the condition of the patient. We report the development of a back isometric dynamometer (BID-2000) designed specifically by two of us to address these concerns in elderly patients with osteopenia or osteoporosis. As the demographics of the general population change, increasing numbers of patients will need the type of monitoring that the BID-2000 provides. Aging has been shown to cause a reduction in the number of functional muscle motor units. To examine this effect on BES, we tested 50 normal, healthy women who were 30 to 79 years old. Proper testing of BES in patients with fragile vertebrae should include isometric measurement in the prone position, maneuverability of the device to allow comfortable positioning of the patient, and simplicity of technique to minimize repetitious performance of maximal contraction. The BID-2000 incorporates each of these features and also provides meaningful results inexpensively. The device offers a safe, reliable (coefficient of variation = 2.33%), and valid (P = 0.001) method of evaluation. The results of our study demonstrated moderate, steady reduction of BES with increasing age and with each successive decade.

Dorsal column stimulation (DCS): cost to benefit analysis

In order to analyse the ratio of costs to clinical benefit of the implantation of a neurostimulator (type Medtronic SE-4) we examined a group of 14 patients who required treatment for chronic lumboischialgia after repeated surgery for herniated discs. Over a period of two years we evaluated the pre- and postimplantation costs. The implantation of a DC-Stimulator resulted in a striking decrease in drug requirements, in the total time of clinical treatment, and in the degree of disability. The DCS provides a satisfying method of treatment for chronic lumboischialgia after repeated surgery for herniated discs. Despite relatively high primary costs, treatment with a DCS results in a significant decrease in the accumulated expenses in comparison to other methods of medical treatment in similar cases.

The treatment act: an analysis of the clinical art in chiropractic

This paper discusses the nature of healing as it applies to the clinical art of chiropractic. General concepts of the phenomenology of illness and healing are developed and then applied specifically toward chiropractic care. The role of metaphor in medicine and chiropractic is discussed; chiropractic may make better use of root metaphor than does the practice of medicine. Finally, the paper discusses certain implications of the clinical art of chiropractic as they relate to teaching and research within the chiropractic profession.