[Back pain in the general population of Catalonia (Spain). Prevalence, characteristics and therapeutic behavior]

Efficacy of epidural infiltration in the management of pain and disability due to acute and subacute lumbosacral radiculopathy

BACKGROUND AND OBJECTIVE

Epidural infiltrations are used for treatment of low back pain and sciatica. Linked to lumbar radiculopathy (lumbosacral radicular syndrome). This study evaluates the efficacy of epidural infiltration by different routes to reduce pain intensity, disability and return to work.

METHODS

Is a prospective observational study in one hundred consecutive patients sent to pain unit for severe lumbo-sacral radiculopaty. We analyze the efficacy on pain relief (Visual Analogue Scale) and funcional status at two weeks, one month, and three months after epidural injection of local anesthetics and esteroids with differents approachs (interlaminar, caudal and transforaminal).

RESULTS

Ninety nine patients (46.5% men, 53.5 women) were finally enrrolled in the study. Mean age was 57.47 ± 11.1 years. The caudal approach was used in 58.6% patients, 23.2% transforaminal approach, and 18.2% interlaminar approach. A significant pain relief was found in all times studied (EAV 7.48 ± 1.5 basal; 6.2 ± 0,9 at 15 days; 6.3 ± 1.2 at one month; 6.15 ± 1.3 at 3 months, p < 0.05). Transforaminal approach was superior to caudal or interlaminal. Seventy percent in time off work patients returned to work after epidural inyections.

CONCLUSIONS

Epidural local anesthetics with esteroids injections for lumbo-sacral radiculopathy were effective for low back pain, improved functional status and promoted return to work. Transforaminal approach is superior to others.

What are the benefits of cultivating self-compassion in adults with low back pain? A systematic review

Introduction

Low back pain is one of the most prevalent public health problems in the world, generating psychosocial impacts on quality of life and a high demand for medical care. Self-compassion may be beneficial for low back pain control, however, studies in the area are scarce. Therefore, this systematic review aimed to investigate the benefits of self-compassion-related interventions on low back pain and mental health in adults.

Methods

The review protocol was registered in PROSPERO and the method was performed according to the PRISMA guidelines. Searches were conducted using the keywords "self-compassion" and "low back pain" in Portuguese, English, and Spanish in the following databases: PubMed, LILACS, SciELO, PePSIC, PsycInfo, Embase, Scopus, Web of Science, and Cochrane. Additional searches were also conducted through the references of the included studies.

Results

Thirty-three articles were identified and analyzed by two independent reviewers using Rayyan. Four of these studies were included. RoB 2 was used to assess the risk of bias of each study. The main findings suggest that self-compassion-related interventions demonstrate benefits in the treatment of low back pain, as well as reduction in pain intensity, psychological stress, and improvement of pain acceptance.

Discussion

However, these positive data must be analyzed carefully, as only two studies presented a low risk of bias. Despite growing interest in this field, more research self-compassion-related interventions for low back pain are suggested, since biopsychosocial aspects associated with low back pain can impact the outcome of treatment.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier (CRD42022376341).

Cognitive representations in low back pain in patients receiving chiropractic versus physiotherapy treatment

This study focused on cognitive representations of low back pain patients receiving chiropractic ( n = 213) versus physiotherapy treatment ( n = 125). Variables assessed included satisfaction with care, illness perceptions, beliefs about pain and medicines, attitudes towards doctors and medicine, suffering, adherence and functional incapacity. In the chiropractic treatment, functional incapacity was predicted by painful symptoms, suffering and personal control, and in the physiotherapy treatment by age, pain intensity, positive suffering, care satisfaction, illness identity and medication adherence. The groups differed on all cognitive variables assessed. Interventions should take into consideration cognitive dimensions, across treatment modalities.

Dor nas costas em população adulta: estudo de base populacional em Campinas, São Paulo, Brasil

Resumo Este estudo teve por objetivos estimar a prevalência de dor nas costas na população urbana de Campinas, São Paulo, Brasil, e identificar os subgrupos populacionais mais afetados pelo problema. Os dados foram obtidos na pesquisa populacional realizada em 2008 e 2009, que envolveu 1.118 indivíduos com idades de 18 a 59 anos. A prevalência de dor nas costas foi de 30,6%, acometendo 34,4% das mulheres e 26,5% dos homens. Após ajustes, a prevalência se mostrou mais elevada nas mulheres, nos de menor escolaridade, nos que trabalhavam mais de 40 horas por semana, nos fumantes e ex-fumantes, nos que não faziam atividade física em contexto de lazer e nos ativos nas atividades domésticas e de trabalho. A prevalência revelou-se crescente com a idade e com o número de filhos, com o número de morbidades e problemas de saúde e com a piora da autoavaliação da saúde. Os resultados confirmam a elevada prevalência do problema e das limitações que provoca, indicando os segmentos sociodemográficos que merecem maior atenção em ações de prevenção e controle dos serviços de saúde.

The association of chronic neck pain, low back pain, and migraine with absenteeism due to health problems in Spanish workers

STUDY DESIGN

Cross-sectional.

OBJECTIVE

To examine whether 3 types of chronic pain are associated with absenteeism and with the number of days absent from work in the general population of Spain.

SUMMARY OF BACKGROUND DATA

Chronic pain has been associated with absenteeism, but most of the evidence is based on unadjusted analyses and on specific professional categories.

METHODS

A cross-sectional analysis was performed on the basis of data of 8283 Spanish workers. Chronic pain was ascertained from self-reported information on frequent symptoms of pain in the low back and neck and/or migraine in the last 12 months. Absenteeism was defined as missing at least 1 day from work because of health problems. Multivariate regression models were adjusted for the main confounders.

RESULTS

Health-related absenteeism was reported by 27.8% of subjects. The prevalence of chronic pain was reported to be 12.3% in the neck, 14.1% in the low back, and 10.3% migraine. In adjusted analyses, absenteeism was associated with chronic neck pain (odds ratio: 1.20; 95% confidence interval [CI], 1.02-1.40), low back pain (odds ratio: 1.22; 95% CI, 1.06-1.42), and migraine (odds ratio: 1.22; 95% CI, 1.04-1.44). These associations were strongest in younger (18-34 yr) rather than in older workers. Furthermore, those who reported frequent pain in the neck and low back were 44% more likely to be absent for more than 30 days in the past year than those who did not report these symptoms.

CONCLUSION

Spanish workers with chronic pain were more likely to be absent from work and to stay absent from work for longer. These associations are independent of sociodemographic characteristics, occupation, lifestyle, health status, and analgesics use.

LEVEL OF EVIDENCE

N/A.

[Indications for magnetic resonance imaging for low back pain in adults]

INTRODUCTION

Low back pain is a common disorder that generates many medical consultations. Magnetic Resonance Imaging (MRI) is commonly used in the clinical management of some of these patients. However, the cost of inappropriate MRI use is high, so there is a need to develop guidelines to help physicians make correct decisions and optimize available resources.

OBJECTIVE

To determine the main clinical indications for MRI scanning in adults with low back pain.

MATERIAL AND METHODS

The RAND/UCLA appropriateness method was used: After a systematic review (May 2012), a list of the clinical indications for MRI scanning in patients with low back pain was prepared. A multidisciplinary expert panel scored each indication from 1, «totally inappropriate» to 9, «totally appropriate». A first on-line round, an in-person panel meeting, where results of the first round were discussed, and a final second on-line round were arranged. A clinical indication was considered appropriate if the median score was 6.5 or higher, and there was agreement between experts (IPRAS index was used).

RESULTS

An MRI test is considered appropriate if cancer, spinal infection or a fracture, even with a negative X-ray test is suspected.; if there is inflammatory back pain; severe/progressive neurological deficit; severe and progressive low back pain; subacute or chronic low back pain with radicular involvement unresponsive to conservative therapy.

CONCLUSIONS

Clinical indications for a MRI scanning are based on the suspicion of a secondary serious pathology. This methodology helps to set clinical indications for MRI, and may be of great value for both clinicians and health managers.

Design considerations of a randomized clinical trial on a cognitive behavioural intervention using communication and information technologies for managing chronic low back pain

Background

Psychological treatments have been successful in treating chronic low back pain (CLBP). However, the effect sizes are still modest and there is room for improvement. A way to progress is by enhancing treatment adherence and self-management using information and communication technologies (ICTs). Therefore, the objective of this study was to design a trial investigating the short- and long-term efficacy of cognitive behavioural treatment (CBT) for CLBP using or not ICTs. A secondary objective of this trial will be to evaluate the influence of relevant variables on treatment response. Possible barriers in the implementation of CBT with and without ICT will also be investigated.

Methods

A randomised controlled trial with 180 CLBP patients recruited from specialised care will be conducted. Participants will be randomly assigned to three conditions: Control group (CG), CBT, and CBT supported by ICTs (CBT + ICT). Participants belonging to the three conditions will receive a conventional rehabilitation program (back school). The CBT group program will last six sessions. The CBT + ICT group will use the internet and SMS to practice the therapeutic strategies between sessions and in the follow-ups at their homes. Primary outcome variables will be self-reported disability and pain intensity. Assessment will be carried out by blinded assessors in five moments: pre-treatment, post-treatment and 3-, 6-, and 12-month follow-ups. The influence of catastrophizing, fear-avoidance beliefs, anxiety and depression in response to treatment in the primary outcomes will also be analysed.

Discussion

This study will show data of the possible benefits of using ICTs in the improvement of CBT for treating CLBP.

Trial registration

ClinicalTrials.gov, NCT01802671

Prevalence of chronic head, neck and low back pain and associated factors in women residing in the Autonomous Region of Madrid (Spain)

OBJECTIVE

To compare the prevalence of chronic headache (CH), chronic neck pain (CNP) and chronic low back pain (CLBP) in the autonomous region of Madrid by analyzing gender differences and to determine the factors associated with each pain location in women in 2007.

METHODS

We analyzed data obtained from adults aged 16 years or older (n = 12,190) who participated in the 2007 Madrid Regional Health Survey. This survey includes data from personal interviews conducted in a representative population residing in family dwellings in Madrid. The presence CH, CNP, and CLBP was analyzed. Sociodemographic features, self-perceived health status, lifestyle habits, psychological distress, drug consumption, use of healthcare services, the search for alternative solutions, and comorbid diseases were analyzed by using logistic regression models.

RESULTS

The prevalence of CH, CNP and CLBP was significantly higher (P<0.001) in women (7.3%, 8.4%, 14.1%, respectively) than in men (2.2%, 3.2%, 7.8%, respectively). In women, CH, CNP and CBLP were significantly associated with having ≥3 chronic diseases (OR 7.1, 8.5, 5.8, respectively), and with the use of analgesics and drugs for inflammation (OR: 3.5, 1.95, 2.5, respectively). In the bivariate analysis, the factors associated with pain in distinct body locations differed between men and women.

CONCLUSIONS

This study found that CH, CNP and CLBP are a major public health problem in women in central Spain. Women have a higher overall prevalence of chronic pain than men. Chronic pain was associated with a higher use of analgesics and healthcare services.

Avoidable costs of physical treatments for chronic back, neck and shoulder pain within the Spanish National Health Service: a cross-sectional study

BACKGROUND

Back, neck and shoulder pain are the most common causes of occupational disability. They reduce health-related quality of life and have a significant economic impact. Many different forms of physical treatment are routinely used. The objective of this study was to estimate the cost of physical treatments which, despite the absence of evidence supporting their effectiveness, were used between 2004 and 2007 for chronic and non-specific neck pain (NP), back pain (BP) and shoulder pain (SP), within the Spanish National Health Service in the Canary Islands (SNHSCI).

METHODS

Chronic patients referred from the SNHSCI to private physical therapy centres for NP, BP or SP, between 2004 and 2007, were identified. The cost of providing physical therapies to these patients was estimated. Systematic reviews (SRs) and clinical practice guidelines (CPGs) for NP, BP and SP available in the same period were searched for and rated according to the Oxman and AGREE criteria, respectively. Those rated positively for ≥70% of the criteria, were used to categorise physical therapies as Effective; Ineffective; Inconclusive; and Insufficiently Assessed. The main outcome was the cost of physical therapies included in each of these categories.

RESULTS

8,308 chronic cases of NP, 4,693 of BP and 5,035 of SP, were included in this study. Among prescribed treatments, 39.88% were considered Effective (physical exercise and manual therapy with mobilization); 23.06% Ineffective; 13.38% Inconclusive, and 23.66% Insufficiently Assessed. The total cost of treatments was € 5,107,720. Effective therapies accounted for € 2,069,932.

CONCLUSIONS

Sixty percent of the resources allocated by the SNHSCI to fund physical treatment for NP, BP and SP in private practices are spent on forms of treatment proven to be ineffective, or for which there is no evidence of effectiveness.

Influência da Escola de Postura na qualidade de vida, capacidade funcional, intensidade de dor e flexibilidade de trabalhadores administrativos

O objetivo do estudo foi analisar os efeitos de um programa "Escola de Postura" em relação à qualidade de vida, capacidade funcional, intensidade de dor e flexibilidade em trabalhadores com dor lombar inespecífica. Participaram 33 trabalhadores do setor administrativo. O programa foi realizado em sete encontros com quatro grupos (com sete ou oito participantes), uma vez por semana, com duração de uma hora cada. Antes e após a intervenção, os voluntários responderam ao questionário de qualidade de vida Short-Form Health Survey (SF-36) e ao questionário de incapacidade funcional Roland-Morris, realizaram o teste sentar e alcançar com o banco de Wells e assinalaram a intensidade de dor na escala visual analógica. O teste estatístico de Shapiro-Wilk foi usado para analisar a normalidade de distribuição dos dados. Os dados foram analisados pelo teste Wilcoxon e pelo teste t de Student, com nível de significância de 5% (p<0,05). Foi observada melhora da qualidade de vida em sete domínios do SF-36 (p<0,005), da incapacidade funcional (p<0,005), da intensidade de dor (p<0,005) e da flexibilidade (p<0,005). O índice de adesão foi de 58,93%. O programa "Escola de Postura" proposto melhorou significativamente a qualidade de vida, capacidade funcional, flexibilidade e intensidade de dor de adultos trabalhadores de setores administrativos.

Study protocol of effectiveness of a biopsychosocial multidisciplinary intervention in the evolution of non-specific sub-acute low back pain in the working population: cluster randomised trial

Background

Non-specific low back pain is a common cause for consultation with the general practitioner, generating increased health and social costs. This study will analyse the effectiveness of a multidisciplinary intervention to reduce disability, severity of pain, anxiety and depression, to improve quality of life and to reduce the incidence of chronic low back pain in the working population with non-specific low back pain, compared to usual clinical care.

Methods/Design

A Cluster randomised clinical trial will be conducted in 38 Primary Health Care Centres located in Barcelona, Spain and its surrounding areas. The centres are randomly allocated to the multidisciplinary intervention or to usual clinical care. Patients between 18 and 65 years old (n = 932; 466 per arm) and with a diagnostic of a non-specific sub-acute low back pain are included. Patients in the intervention group are receiving the recommendations of clinical practice guidelines, in addition to a biopsychosocial multidisciplinary intervention consisting of group educational sessions lasting a total of 10 hours. The main outcome is change in the score in the Roland Morris disability questionnaire at three months after onset of pain. Other outcomes are severity of pain, quality of life, duration of current non-specific low back pain episode, work sick leave and duration, Fear Avoidance Beliefs and Goldberg Questionnaires. Outcomes will be assessed at baseline, 3, 6 and 12 months. Analysis will be by intention to treat. The intervention effect will be assessed through the standard error of measurement and the effect-size. Responsiveness of each scale will be evaluated by standardised response mean and receiver-operating characteristic method. Recovery according to the patient will be used as an external criterion. A multilevel regression will be performed on repeated measures. The time until the current episode of low back pain takes to subside will be analysed by Cox regression.

Discussion

We hope to provide evidence of the effectiveness of the proposed biopsychosocial multidisciplinary intervention in avoiding the chronification of low back pain, and to reduce the duration of non-specific low back pain episodes. If the intervention is effective, it could be applied to Primary Health Care Centres.

Trial Registration

ISRCTN21392091

[Repeat sick leave procedures and diagnosis]

OBJECTIVE

To find out the recurrence of absence due to sick leave from the perspective of diagnosing the disease-causing absenteeism.

DESIGN

Case-control study.

CONTROLS

workers who only had only been on sick leave once.

CASES

workers with repeated sick leave. CASES with 2, 3, 4 or more absences due to sick leave were analysed separately.

SETTING

Guipuzcoa, from 2001 to 2005.

PARTICIPANTS

There were 7,313 sick leave procedures collected from a Mutual Company with the medical reason, age and gender were duly registered and coded. Of the 6,030 workers who took some time off work, 5,016 had a single sick leave procedure, and were considered as controls and there were 1,014 cases that had two or more sick leave procedures.

MEASUREMENTS

We calculated the odds ratio (OR) and 95% confidence intervals, adjusting for age and stratified by gender, using a logistic regression model. The slope of sick leave repeats was evaluated.

RESULTS

An increase in the risk of recurrent sick leave was observed for both genders over the age of 45, with a significant slope. There was an increase in the risk of recurrent sick leave in the most common diseases, musculoskeletal, external causes, mental and gastrointestinal in males, and pregnancy, musculoskeletal, mental and external causes in females.

CONCLUSIONS

An alternative method for verifying the correct prescribing of sick leave would be to just study diseases that occur most often. This would focus on those workers who had recurrent absences due to sick leave.

Lombalgia na terceira idade: distribuição e prevalência na Clínica Escola de Fisioterapia da Universidade Estadual do Sudoeste da Bahia

Resumo A degeneração da coluna vertebral inerente ao processo de envelhecimento, juntamente com o maior tempo de exposição a sobrecargas ao longo da vida, pode tendenciar o idoso a ser acometido pela lombalgia. Neste sentido, este estudo tem como objetivo determinar a prevalência e a caracterização da lombalgia em idosos atendidos no Setor de Geriatria da Clínica Escola de Fisioterapia da Universidade Estadual do Sudoeste da Bahia. Trata-se de um estudo de caráter descritivo, com corte transversal, realizado por meio de investigação de prontuários. Foram analisados 44 prontuários de pacientes portadores de lombalgia, com idade igual ou superior a 60 anos, de ambos os sexos, a partir de um universo de 131 prontuários de idosos, encontrando-se uma prevalência de 33,6%. Os indivíduos são predominantemente mulheres, com faixa etária entre 60 e 69 anos, e aposentados. Verificou-se que dos 21 (47,73%) dos idosos apresentaram lombalgia de causa desconhecida; 19 (43,18%), dor do tipo crônica; e 26 (59,09%), irradiação para os membros inferiores. A partir deste estudo, constatou-se alta prevalência de lombalgia em idosos, sendo um dado importante para prevenção e intervenção precoce, no intuito de melhorar a qualidade de vida desta população.

[Back pain: do we follow the recommendations in the guidelines?]

OBJECTIVE

To describe how patients with back pain are usually handled at a health centre.

DESIGN

Retrospective, descriptive study.

SETTING

Urban health centre.

PARTICIPANTS

All patients seen for back pain in the centre's general medical consultations during 2003.

MAIN MEASUREMENTS

Patients' personal details, clinical characteristics of back pain (alarm signals), semiological data, request for further tests, treatments prescribed, referral to specialists.

RESULTS

Five hundred and thirty eight clinical histories were included. 53.2% of patients were women, and 33.6% were over 55. 35% of patients were not questioned on pain characteristics; and in over half the cases (54.6%), there were no questions on the presence of alarm signals, either. Only in 0.6% of cases was any analogical visual scale used to assess pain. Only 46.8% of the x-rays taken were thought to be well indicated, in terms of pre-established criteria. Total rest was not normally advised (1.9%); the drugs most commonly prescribed were NSAIDs (39.6%).

CONCLUSIONS

Clinical evaluation of patients with back pain is still inadequate in our centre, and x-rays are requested without adherence to formal or explicit criteria. We prescribe more NSAIDs than paracetamol for therapy.

Epidemiology of back pain in a representative cohort of Italian persons 65 years of age and older: the InCHIANTI study

STUDY DESIGN

Clinico-epidemiologic study in the Chianti area (Tuscany, Italy).

OBJECTIVES

To describe prevalence and correlates of back pain in a representative sample of the population.

SUMMARY OF BACKGROUND DATA

Back pain is common in old age and is related to functional limitations, but back pain characteristics and correlates in older adults, which may be targeted by specific interventions, are still underinvestigated.

METHODS

A total of 1,299 persons aged 65 or older were selected from the city registry of Greve in Chianti and Bagno a Ripoli; 1,008 (565 women; 443 men) were included in this analysis. Back pain in the past 12 months was ascertained using a questionnaire. Potential correlates of back pain were identified in age- and sex-adjusted regression analyses, and their independent association with back pain was tested in a multivariate model.

RESULTS

The prevalence of frequent back pain was 31.5%. Back pain was reported less often by men and the very old, was primarily located in the dorsolumbar and lumbar spine, was moderate in intensity and mainly elicited by carrying, lifting, and pushing heavy objects. Among participants who reported frequent back pain, 76.3% had no back pain-related impairments; 7.4% of the overall study population had back pain-related functional limitation. Back pain participants were significantly more likely to report difficulty in heavy household chores, carrying a shopping bag, cutting toenails, and using public transportation. Limited trunk extension, depression, low levels of prior-year physical activity, and hip, knee, and foot pain were independent correlates of back pain.

CONCLUSIONS

Frequent back pain is highly prevalent in the older population and is often associated with conditions that are potentially reversible.