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Nakarai H, Kato S, Hirao Y, Maayan O, Kawamura N, Higashikawa A, Takeshita Y, Ono T, Fukushima M, Hara N, Azuma S, Iwai H, Taniguchi Y, Matsubayashi Y, Takeshita K, Tanaka S, Oshima Y. Coexisting Lower Back Pain in Patients With Cervical Myelopathy. Clin Spine Surg 2024; 37:E257-E263. [PMID: 38245809 DOI: 10.1097/bsd.0000000000001572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/29/2023] [Indexed: 01/22/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of the present study is to investigate the coexisting lower back pain (LBP) in patients with cervical myelopathy and to evaluate changes in LBP after cervical spine surgery. SUMMARY OF BACKGROUND DATA Only a few studies with a small number of participants have evaluated the association between cervical myelopathy surgery and postoperative improvement in LBP. METHODS Patients who underwent primary cervical decompression surgery with or without fusion for myelopathy and completed preoperative and 1-year postoperative questionnaires were reviewed using a prospectively collected database involving 9 tertiary referral hospitals. The questionnaires included the patient-reported Japanese Orthopaedic Association (PRO-JOA) score and Numerical Rating Scales (NRS). The minimum clinically important difference (MCID) for NRS-LBP was defined as >30% improvement from baseline. Patient demographics, characteristics, and PRO-JOA score were compared between patients with and without concurrent LBP, and the contributor to achieving the MCID for LBP was analyzed using logistic regression analysis. RESULTS A total of 786 consecutive patients with cervical myelopathy were included, of which 525 (67%) presented with concurrent LBP. LBP was associated with a higher body mass index ( P <0.001) and worse preoperative PRO-JOA score ( P <0.001). Among the 525 patients with concurrent LBP, the mean postoperative NRS-LBP significantly improved from 4.5±2.4 to 3.4±2.7 ( P <0.01) postoperatively, with 248 (47%) patients reaching the MCID cutoff. Patients with a PRO-JOA recovery rate >50% were more likely to achieve MCID compared with those with a recovery rate <0% (adjusted odd ratio 4.02, P <0.001). CONCLUSIONS More than 50% of patients with myelopathy reported improvement in LBP after cervical spine surgery, and 47% achieved the MCID for LBP, which was positively correlated with a better PRO-JOA recovery rate. Treating cervical myelopathy in patients with concomitant LBP may be sufficient to mitigate concomitant LBP. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hiroyuki Nakarai
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
- University of Tokyo Spine Group (UTSG)
| | - So Kato
- University of Tokyo Spine Group (UTSG)
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo
| | - Yujiro Hirao
- Department of Orthopaedic Surgery, Takashimadaira Chuo General Hospital, Takashimadaira, Itabashi
| | - Omri Maayan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Naohiro Kawamura
- University of Tokyo Spine Group (UTSG)
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Shibuya-Ku, Tokyo
| | - Akiro Higashikawa
- University of Tokyo Spine Group (UTSG)
- Department of Orthopedic Surgery, Kanto Rosai Hospital, Nakahara-Ku, Kawasaki
| | - Yujiro Takeshita
- University of Tokyo Spine Group (UTSG)
- Department of Orthopedic Surgery, Yokohama Rosai Hospital, Yokohama City, Kanagawa
| | - Takashi Ono
- University of Tokyo Spine Group (UTSG)
- Department of Spinal Surgery, Japan Community Health-care Organization Tokyo Shinjuku Medical Center, Shinjuku-Ku, Tokyo
| | | | - Nobuhiro Hara
- University of Tokyo Spine Group (UTSG)
- Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, Musashino City, Tokyo
| | - Seiichi Azuma
- University of Tokyo Spine Group (UTSG)
- Department of Orthopedic Surgery, Saitama Red Cross Hospital, Saitama City, Saitama
| | - Hiroki Iwai
- University of Tokyo Spine Group (UTSG)
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Shinagawa-ku, Tokyo
| | - Yuki Taniguchi
- University of Tokyo Spine Group (UTSG)
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo
| | - Yoshitaka Matsubayashi
- University of Tokyo Spine Group (UTSG)
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo
| | - Katsushi Takeshita
- Department of Orthopaedic, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo
| | - Yasushi Oshima
- University of Tokyo Spine Group (UTSG)
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo
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Huang J, Wang X. Association of depressive symptoms with risk of incidence low back pain in middle-aged and older Chinese adults. J Affect Disord 2024; 354:627-633. [PMID: 38522815 DOI: 10.1016/j.jad.2024.03.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Elevated Depressive symptoms (DS) and low back pain (LBP) pose significant and growing public health challenges, and China is no exception. This study innovatively examined the relationship between specific DS and distinct patterns of DS and incident LBP. METHODS This study extracted data from 4713 participants aged 45+ years from the China and Health Retirement Longitudinal Study (CHARLS), followed-up for incidence LBP (June 2011-September 2020). DS was assessed by the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). The incident LBP was determined by self-reported. Latent class analysis (LCA) was employed to categorize patterns of DS. Cox proportional hazards regression models were used to examine the association between DS and incident LBP. RESULTS Over the 9.25-year follow-up period, 2234 incident LBP cases were identified. There was a significant independent association between positive DS and incident LBP with an HR of 1.73 (95 % CI = 1.55-1.94). Of the 10-item DS, difficulty concentrating (adjusted HR = 1.16, 95 % CI = 1.03-1.31), effortfulness (adjusted HR = 1.32, 95 % CI = 1.18-1.49), hopelessness (adjusted HR = 1.13, 95 % CI = 1.02-1.25), restless sleep (adjusted HR = 1.17, 95 % CI = 1.06-1.30), and loneliness (adjusted HR = 1.18, 95 % CI = 1.02-1.36), each independently associated with incident LBP. Regarding patterns of DS, compared to the "healthy" pattern of DS, four patterns showed significant association with incident LBP, especially the cumulative pattern of DS. LIMITATIONS DS and LBP were assessed based on self-reported. CONCLUSIONS In middle-aged and older Chinese adults, 5 specific DS (difficulty concentrating, effortfulness, hopelessness, restless sleep, and loneliness) and distinct patterns of DS indicate varied risks of developing LBP.
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Affiliation(s)
- Jinghong Huang
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Xiaohui Wang
- School of Public Health, Lanzhou University, Lanzhou, China.
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Grøndahl LK, Axén I, Stensrud S, Hoekstra T, Vigdal ØN, Killingmo RM, Storheim K, Grotle M. Identifying latent subgroups in the older population seeking primary health care for a new episode of back pain - findings from the BACE-N cohort. BMC Musculoskelet Disord 2024; 25:60. [PMID: 38216905 PMCID: PMC10787445 DOI: 10.1186/s12891-024-07163-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/01/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Back pain is the number one condition contributing to years lived with disability worldwide, and one of the most common reasons for seeking primary care. Research on this condition in the ageing population is sparse. Further, the heterogeneity of patients with back pain complicates the management in clinical care. It is possible that subgrouping people with similar characteristics would improve management. This paper aimed to identify latent classes based on demographics, pain characteristics, psychosocial behavior, and beliefs and attitudes about back pain, among older patients seeking primary care with a new episode of back pain, and to examine if there were differences regarding the classes' first point-of-contact. METHODS The study was part of the international BACE (Back complaints in elders) consortium and included 435 patients aged ≥ 55 years seeking primary care (general practitioners, physiotherapists, and chiropractors) in Norway from April 2015 to March 2020. A latent class analysis was performed to identify latent classes. The classes were described in terms of baseline characteristics and first point-of-contact in primary care. RESULTS Four latent classes were identified. The mean age was similar across groups, as were high expectations towards improvement. Class 1 (n = 169, 39%), the "positive" class, had more positive attitudes and beliefs, less pain catastrophizing and shorter duration of current pain episode. Class 2 (n = 31, 7%), the "fearful" class, exhibited the most fear avoidance behavior, and had higher mean pain intensity. Class 3 (n = 33, 8%), the "distressed" class, had the highest scores on depression, disability, and catastrophizing. Finally, class 4 (n = 202, 46%), the "hopeful" class, showed the highest expectations for recovery, although having high pain intensity. The identified four classes showed high internal homogeneity, sufficient between-group heterogeneity and were considered clinically meaningful. The distribution of first point-of-contact was similar across classes, except for the positive class where significantly more patients visited chiropractors compared to general practitioners and physiotherapists. CONCLUSIONS The identified classes may contribute to targeting clinical management of these patients. Longitudinal research on these latent classes is needed to explore whether the latent classes have prognostic value. Validation studies are needed to evaluate external validity. TRIAL REGISTRATION Clinicaltrials.gov NCT04261309.
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Affiliation(s)
- Lise Kretz Grøndahl
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway.
- Et Liv i Bevegelse, the Norwegian Chiropractors' Research Foundation, Oslo, Norway.
| | - Iben Axén
- Et Liv i Bevegelse, the Norwegian Chiropractors' Research Foundation, Oslo, Norway
- Unit of Intervention and Implementation for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Silje Stensrud
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Trynke Hoekstra
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ørjan Nesse Vigdal
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Rikke Munk Killingmo
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Kjersti Storheim
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo, Norway
| | - Margreth Grotle
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo, Norway
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Craner JR, Schumann ME, Barr A, Morrison EJ, Lake ES, Sutor B, Flegge LG, Gilliam WP. Mediators of change in depressed mood following pain rehabilitation among participants with mild, moderate, or severe depressive symptoms. J Affect Disord 2022; 307:286-293. [PMID: 35351491 DOI: 10.1016/j.jad.2022.03.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/19/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Prior research indicates that depression and chronic pain commonly co-exist and impact each other. Interdisciplinary pain rehabilitation programs (IPRPs) have been shown to lead to statistically and clinically significant improvements for patients who report both depressed mood and chronic pain, however there is a gap in the literature regarding the mechanisms by which these improvements occur. METHODS This two-site, distinct sample study (Study 1: N = 303, 10-week, individual format, ACT-based program; Study 2: N = 406, 3-week, group format, CBT-based program) evaluated mediators of treatment improvement in depressive symptoms among adult IPRP participants who reported elevated depressive symptoms at program admission and examined treatment mechanisms for depressive symptoms. RESULTS Self-reported pain self-efficacy and pain catastrophizing - particularly the helplessness domain - mediated the treatment-related change in depression among IPRP participants with elevated depressive symptoms across the two sites and samples. In one sample, full mediation was achieved while in the other sample, partial mediation was achieved. Participants in both samples showed improvement on all measures. LIMITATIONS This study relied on self-report measures of depressive severity and not clinical diagnosis. Results may not generalize to other populations of patients with chronic pain. There was no control condition in either study. CONCLUSION Increasing pain self-efficacy and decreasing a sense of helplessness are important treatment targets among IPRP participants who endorse symptoms of depression.
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Affiliation(s)
- Julia R Craner
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, United States of America; Michigan State University College of Human Medicine, Grand Rapids, MI, United States of America.
| | - Matthew E Schumann
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Aex Barr
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, United States of America; Michigan State University College of Human Medicine, Grand Rapids, MI, United States of America
| | - Eleshia J Morrison
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Eric S Lake
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, United States of America; Michigan State University College of Human Medicine, Grand Rapids, MI, United States of America
| | - Bruce Sutor
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Lindsay G Flegge
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, United States of America; Michigan State University College of Human Medicine, Grand Rapids, MI, United States of America
| | - Wesley P Gilliam
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
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de Luca K, Briggs AM, French SD, Ferreira ML, Cross M, Blyth F, March L. Disability burden due to musculoskeletal conditions and low back pain in Australia: findings from GBD 2019. Chiropr Man Therap 2022; 30:22. [PMID: 35505334 PMCID: PMC9063272 DOI: 10.1186/s12998-022-00434-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To report the national prevalence, years lived with disability (YLDs) and attributable risk factors for all musculoskeletal conditions and separately for low back pain (LBP), as well as compare the disability burden related to musculoskeletal with other health conditions in Australia in 2019. METHODS Global Burden of Disease (GBD) 2019 study meta-data on all musculoskeletal conditions and LBP specifically were accessed and aggregated. Counts and age-standardised rates, for both sexes and across all ages, for prevalence, YLDs and attributable risk factors are reported. RESULTS In 2019, musculoskeletal conditions were estimated to be the leading cause of YLDs in Australia (20.1%). There were 7,219,894.5 (95% UI: 6,847,113-7,616,567) prevalent cases of musculoskeletal conditions and 685,363 (95% UI: 487,722-921,471) YLDs due to musculoskeletal conditions. There were 2,676,192 (95% UI: 2,339,327-3,061,066) prevalent cases of LBP and 298,624 (95% UI: 209,364-402,395) YLDs due to LBP. LBP was attributed to 44% of YLDs due to musculoskeletal conditions. In 2019, 22.3% and 39.8% of YLDs due to musculoskeletal conditions and LBP, respectively, were attributed to modifiable GBD risk factors. CONCLUSIONS The ongoing high burden due to musculoskeletal conditions impacts Australians across the life course, and in particular females and older Australians. Strategies for integrative and organisational interventions in the Australian healthcare system should support high-value care and address key modifiable risk factors for disability such as smoking, occupational ergonomic factors and obesity.
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Affiliation(s)
- Katie de Luca
- Discipline of Chiropractic, School of Health, Medical and Applied Sciences, CQUniversity, Brisbane, Australia.
| | - Andrew M Briggs
- Curtin School of Allied Health and Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
- Global Alliance for Musculoskeletal Health, Sydney, Australia
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Manuela L Ferreira
- Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Marita Cross
- Global Alliance for Musculoskeletal Health, Sydney, Australia
- Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Fiona Blyth
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Lyn March
- Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
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