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Kovačević I, Pavić J, Filipović B, Ozimec Vulinec Š, Ilić B, Petek D. Integrated Approach to Chronic Pain-The Role of Psychosocial Factors and Multidisciplinary Treatment: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1135. [PMID: 39338018 PMCID: PMC11431289 DOI: 10.3390/ijerph21091135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/20/2024] [Accepted: 08/25/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND Chronic non-malignant pain represents a growing global public health priority. Chronic pain is multifactorial, with numerous biological, psychological, and social factors contributing to this pain syndrome. It affects not only the patients, impairing their quality of life, but also their family and social environment. Chronic pain is a diagnosis and requires effective and sustainable treatment strategies. OBJECTIVE Our aim was to critically review the available evidence on the importance of different approaches in treating patients with chronic non-malignant pain, emphasizing the effectiveness of integrating psychological and social factors within a multidisciplinary framework. METHODS This was a non-systematic narrative review of the basic and recent literature analyzing approaches to the treatment of chronic non-malignant pain. The inclusion criteria for the papers were chronic non-malignant pain, treatment approach, review, and original research papers published in English in the last five years (PubMed search), and the basic literature was selected from the references of new papers according to the knowledge and experience of the authors. RESULTS This literature review included 120 papers, of which 83 were basic, and 37 were new, published in the last 5 years (2018-2023). The results show that both the basic and newly published literature advocate for a biopsychosocial approach to treating chronic pain. CONCLUSIONS New findings, compared to the earlier literature, indicate a new classification of chronic pain into primary and secondary. Chronic pain should be approached with a biopsychosocial model within a multidisciplinary treatment framework. This model addresses the complex interplay of biological, psychological, and social factors, offering a holistic strategy for effective pain management.
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Affiliation(s)
- Irena Kovačević
- Department of Nursing, University of Applied Health Sciences, 10000 Zagreb, Croatia; (J.P.); (B.F.); (Š.O.V.); (B.I.)
- Department of Nursing, Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia
| | - Jadranka Pavić
- Department of Nursing, University of Applied Health Sciences, 10000 Zagreb, Croatia; (J.P.); (B.F.); (Š.O.V.); (B.I.)
- Department of Nursing, Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia
| | - Biljana Filipović
- Department of Nursing, University of Applied Health Sciences, 10000 Zagreb, Croatia; (J.P.); (B.F.); (Š.O.V.); (B.I.)
- Department of Nursing, Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia
| | - Štefanija Ozimec Vulinec
- Department of Nursing, University of Applied Health Sciences, 10000 Zagreb, Croatia; (J.P.); (B.F.); (Š.O.V.); (B.I.)
| | - Boris Ilić
- Department of Nursing, University of Applied Health Sciences, 10000 Zagreb, Croatia; (J.P.); (B.F.); (Š.O.V.); (B.I.)
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski Nasip 58, 1000 Ljubljana, Slovenia;
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Salazar-Méndez J, Cuyul-Vásquez I, Ponce-Fuentes F, Núñez-Cortés R, Mendez-Rebolledo G, Fuentes J. Effectiveness of in-group versus individually administered pain neuroscience education on clinical and psychosocial outcomes in patients with chronic low back pain: randomized controlled study protocol. PeerJ 2024; 12:e17507. [PMID: 38832030 PMCID: PMC11146333 DOI: 10.7717/peerj.17507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/13/2024] [Indexed: 06/05/2024] Open
Abstract
Objective (1) This trial will compare the clinical and psychosocial effectiveness of in-group and individually pain neuroscience education (PNE) in patients with chronic low back pain (CLBP). In addition, (2) the influence of social determinants of health on post-treatment results will be analyzed. Methods A three-arm randomized controlled trial will be conducted. Sixty-nine participants with CLBP will be recruited in a 1:1:1 ratio. Participants, assessor, and statistician will be blinded to group assignment. The PNE intervention will be adapted to the context of the participants. An experimental group (n = 33) will receive PNE in an in-group modality, the other experimental group (n = 33) will receive PNE in an individually modality and the control group (n = 33) will continue with usual care. Additionally, participants will be encouraged to stay active by walking for 20-30 min 3-5 times per week and will be taught an exercise to improve transversus abdominis activation (bracing or abdominal following). The outcome measures will be fear avoidance and beliefs, pressure pain threshold, pain self-efficacy, catastrophizing, pain intensity, and treatment expectation. Outcome measures will be collected at one-week before intervention, immediately post-intervention, and four-weeks post-intervention. Conclusion The innovative approach of PNE oriented to fear beliefs proposed in this study could broaden the application strategies of this educational therapeutic modality. Impact. Contextualized PNE delivered by physical therapist could be essential to achieve a good cost-effectiveness ratio of this intervention to improve the clinical condition of people with CLBP.
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Affiliation(s)
- Joaquín Salazar-Méndez
- Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
| | - Iván Cuyul-Vásquez
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile
| | | | - Rodrigo Núñez-Cortés
- Departament of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Guillermo Mendez-Rebolledo
- Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
| | - Jorge Fuentes
- Clinical Research Lab, Department of Physical Therapy, Catholic University of Maule, Talca, Chile
- Faculty of Rehab Medicine, University of Alberta, Edmonton, Canada
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Sun L, Yan H, Zhang Y. Magnetic resonance spectroscopy (MRS) of multifidus muscle metabolites in chronic low back pain (CLBP). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4397-4404. [PMID: 37721604 DOI: 10.1007/s00586-023-07933-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 06/14/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE The purpose of the study was to investigate several potential imaging biomarkers of CLBP that may be useful for diagnosis and treatment efficacy evaluation. Proton magnetic resonance spectroscopy (1H-MRS) was used to detect the content and ratio of creatine (Cr), choline (Cho), and lipid (Lip) in the multifidus muscle (Mm) in patients with CLBP and to test for relationships between these metabolites and pain severity and duration. METHODS Sixty patients with CLBP (experimental group) and sixty-nine asymptomatic volunteers (control group) underwent routine diagnostic magnetic resonance imaging of the lumbar spine. 1H-MRS was acquired with single-voxel MR spectroscopy. The MRS region of interest for measuring Cho, Cr, and Lip concentrations was determined at the L4/5 multifidus muscle (Mm), bilaterally. The contents and ratios of Cr, Cho, and Lip in bilateral and ipsilateral-to-pain (or matched control side) Mm were obtained, and the integral ratios of different metabolites obtained by using Cr as an internal reference were statistically analyzed. RESULTS There were no significant within-group differences in the contents and ratios of Lip, Cr, Cho, Lip/Cr, and Cho/Cr between the left and right Mm of the healthy control group (p > 0.05) or the CLBP group (p > 0.05). The CLBP group showed a much higher Lip and Lip/Cr ratio in the bilateral Mm compared to the healthy control group (p < 0.05) but there were no between-group differences in Cr, Cho, or the Cho/Cr ratio (p > 0.05). The severity of CLBP was correlated with Lip (p < 0.05). CONCLUSION Using 1H-MRS, we demonstrated higher Lip and Lip/Cr ratios in the Mm of patients with CLBP, compared to asymptomatic controls. Mm Lip was correlated with CLBP intensity. An increase in Lip in the Mm may be a characteristic finding in CLBP and may offer a useful prognostic marker for guiding rehabilitation strategies.
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Affiliation(s)
- Limeng Sun
- Department of Radiology, The Traditional Chinese Medicine Hospital of Taian, No. 58 Dongyue Street, Taian District, Taian, 271000, Shandong Province, China
| | - Hu Yan
- Department of Spine Surgery, The Traditional Chinese Medicine Hospital of Taian, No. 58 Dongyue Street, Taian District, Taian, 271000, Shandong Province, China.
| | - Ye Zhang
- Department of Radiology, Taian Maternal and Child Health Hospital, No. 386 Longtan Road, Gaoxin District, Taian, 27100, Shandong Province, China
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Pravdyuk NG, Novikova AV, Shostak NA, Buianova AA, Tairova RT, Patsap OI, Raksha AP, Timofeyev VT, Feniksov VM, Nikolayev DA, Senko IV. Immunomorphogenesis in Degenerative Disc Disease: The Role of Proinflammatory Cytokines and Angiogenesis Factors. Biomedicines 2023; 11:2184. [PMID: 37626681 PMCID: PMC10452407 DOI: 10.3390/biomedicines11082184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
Back pain (BP) due to degenerative disc disease (DDD) is a severe, often disabling condition. The aim of this study was to determine the association between the expression level of proinflammatory cytokines (IL-1β, IL-6, and IL-17), angiogenesis markers (VEGF-A and CD31) in intervertebral disc (IVD) tissue and IVD degeneration in young people with discogenic BP. In patients who underwent discectomy for a disc herniation, a clinical examination, magnetic resonance imaging of the lumbar spine, histological and immunohistochemical analyses of these factors in IVD were performed in comparison with the parameters of healthy group samples (controls). Histology image analysis of IVD fragments of the DDD group detected zones of inflammatory infiltration, combined with vascularization, the presence of granulation tissue and clusters of chondrocytes in the tissue of nucleus pulposus (NP). Statistically significant increased expression of IL-1β, IL-6, IL-17, VEGF-A and CD31 was evident in the samples of the DDD group compared with the controls, that showed a strong correlation with the histological disc degeneration stage. Our results denote an immunoinflammatory potential of chondrocytes and demonstrates their altered morphogenetic properties, also NP cells may trigger the angiogenesis.
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Affiliation(s)
- Natalya G. Pravdyuk
- Acad. A. I. Nesterov Department of Faculty Therapy, Pirogov Russian National Research Medical University, Ostrovityanova Str., 1, 117997 Moscow, Russia; (A.V.N.)
| | - Anna V. Novikova
- Acad. A. I. Nesterov Department of Faculty Therapy, Pirogov Russian National Research Medical University, Ostrovityanova Str., 1, 117997 Moscow, Russia; (A.V.N.)
| | - Nadezhda A. Shostak
- Acad. A. I. Nesterov Department of Faculty Therapy, Pirogov Russian National Research Medical University, Ostrovityanova Str., 1, 117997 Moscow, Russia; (A.V.N.)
| | - Anastasiia A. Buianova
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Pirogov Russian National Research Medical University, Ostrovityanova Str., 1, p. 1, 117513 Moscow, Russia;
| | - Raisa T. Tairova
- Acad. A. I. Nesterov Department of Faculty Therapy, Pirogov Russian National Research Medical University, Ostrovityanova Str., 1, 117997 Moscow, Russia; (A.V.N.)
- Federal Center of Brain Research and Neurotechnologies FMBA, Ostrovityanova Str., 1, p. 10, 117513 Moscow, Russia; (O.I.P.)
| | - Olga I. Patsap
- Federal Center of Brain Research and Neurotechnologies FMBA, Ostrovityanova Str., 1, p. 10, 117513 Moscow, Russia; (O.I.P.)
| | - Aleksandr P. Raksha
- Pirogov City Clinical Hospital No. 1, Moscow Healthcare Department, Leninskiy Prospekt, 8, 117049 Moscow, Russia
| | - Vitaliy T. Timofeyev
- Acad. A. I. Nesterov Department of Faculty Therapy, Pirogov Russian National Research Medical University, Ostrovityanova Str., 1, 117997 Moscow, Russia; (A.V.N.)
| | - Victor M. Feniksov
- Pirogov City Clinical Hospital No. 1, Moscow Healthcare Department, Leninskiy Prospekt, 8, 117049 Moscow, Russia
| | - Dmitriy A. Nikolayev
- Pirogov City Clinical Hospital No. 1, Moscow Healthcare Department, Leninskiy Prospekt, 8, 117049 Moscow, Russia
| | - Ilya V. Senko
- Federal Center of Brain Research and Neurotechnologies FMBA, Ostrovityanova Str., 1, p. 10, 117513 Moscow, Russia; (O.I.P.)
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Short-term impact of COVID-19 pandemic on low back pain: data from the PAMPA Cohort, Brazil. BMC Public Health 2023; 23:44. [PMID: 36609256 PMCID: PMC9817356 DOI: 10.1186/s12889-022-14932-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To evaluate the short-term impact of COVID-19 pandemic on low back pain (LBP) outcomes in southern Brazil. METHODS Data from the PAMPA Cohort were analyzed. Adults were recruited between June and July 2020 in the Rio Grande do Sul state using online-based strategies. Participants responded a self-reported, online questionnaire on LBP with two timepoints: before (retrospectively) and during COVID-19 pandemic. We assessed LBP experience, LBP-related activity limitation (no/yes), and LBP intensity (0 to 10 [strongest pain]). RESULTS From a total sample of 2,321 respondents (mean age: 37.6 ± 13.5; 75.4% women), the prevalence of LBP did not change significantly from before (74.7% [95%CI 72.3; 76.9]) to the first months of pandemic (74.2% [95%CI 71.9; 76.3]). However, an increased pain levels (β: 0.40; 95%CI 0.22; 0.58) and a higher likelihood for activity limitation due to LBP was observed (PR 1.14; 95%CI 1.01; 1.29). Longitudinal analyzes showed that age, gender, BMI, chronic diseases, physical activity, and anxiety and depression symptoms, were associated with LBP in the first pandemic months. CONCLUSION Although the prevalence of LBP did not change at the first months of COVID-19 pandemic, LBP-induced impairment in daily activities and pain intensity was higher when compared to before the pandemic.
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Fang XX, Zhai MN, Zhu M, He C, Wang H, Wang J, Zhang ZJ. Inflammation in pathogenesis of chronic pain: Foe and friend. Mol Pain 2023; 19:17448069231178176. [PMID: 37220667 DOI: 10.1177/17448069231178176] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Chronic pain is a refractory health disease worldwide causing an enormous economic burden on individuals and society. Accumulating evidence suggests that inflammation in the peripheral nervous system (PNS) and central nervous system (CNS) is the major factor in the pathogenesis of chronic pain. The inflammation in the early- and late phase may have distinctive effects on the initiation and resolution of pain, which can be viewed as friend or foe. On the one hand, painful injuries lead to the activation of glial cells and immune cells in the PNS, releasing pro-inflammatory mediators, which contribute to the sensitization of nociceptors, leading to chronic pain; neuroinflammation in the CNS drives central sensitization and promotes the development of chronic pain. On the other hand, macrophages and glial cells of PNS and CNS promote pain resolution via anti-inflammatory mediators and specialized pro-resolving mediators (SPMs). In this review, we provide an overview of the current understanding of inflammation in the deterioration and resolution of pain. Further, we summarize a number of novel strategies that can be used to prevent and treat chronic pain by controlling inflammation. This comprehensive view of the relationship between inflammation and chronic pain and its specific mechanism will provide novel targets for the treatment of chronic pain.
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Affiliation(s)
- Xiao-Xia Fang
- Department of Human Anatomy, School of Medicine, Nantong University, Nantong, China
| | - Meng-Nan Zhai
- Department of Human Anatomy, School of Medicine, Nantong University, Nantong, China
| | - Meixuan Zhu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Cheng He
- Department of Human Anatomy, School of Medicine, Nantong University, Nantong, China
| | - Heng Wang
- Department of Human Anatomy, School of Medicine, Nantong University, Nantong, China
| | - Juan Wang
- Department of Human Anatomy, School of Medicine, Nantong University, Nantong, China
| | - Zhi-Jun Zhang
- Department of Human Anatomy, School of Medicine, Nantong University, Nantong, China
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Sant’Anna PCF, Morimoto T, Miranda FDS, Garcez ADS. Dor lombar em estudantes universitários: qual o impacto da pandemia de COVID-19? FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/22010929032022pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RESUMO O isolamento social decorrente da pandemia de COVID-19 alterou os hábitos da população e levantou questões relacionadas à saúde, por exemplo, a dor lombar. Este estudo teve por objetivo avaliar a prevalência e o risco de cronicidade de dor lombar em universitários durante o isolamento social. Para isso, foi utilizado um questionário on-line. O instrumento STarT Back Screening Tool (SBST) foi utilizado para verificar a dor lombar. Os fatores investigados foram: dados sociodemográficos, informações sobre dor e informações sobre comportamento sedentário e atividade física. Utilizou-se o teste de qui-quadrado para heterogeneidade de proporções. A análise ajustada foi realizada mediante regressão de Poisson com variância robusta. A amostra foi composta por 208 estudantes. Verificou-se que universitários com companheiro apresentaram duas vezes mais chance de dor (RP=2,07; IC95%) em comparação aos solteiros. A prevalência de dor lombar foi de 48,1%; sendo 87% maior nas mulheres (RP=1,87; IC95%: 1,09-3,21; p=0,027) quando comparadas aos homens. Universitários com comportamento sedentário apresentaram uma probabilidade 35% maior de ter dor lombar (RP=1,36; IC95%: 1,02-1,81; p=0,038); e obesos 42% (RP=1,42; IC95%: 1,04-1,94; p=0,032). O risco de cronicidade foi baixo em 82% da amostra. A dor lombar esteve presente na vida de muitas pessoas durante o isolamento social imposto pela COVID-19. Trata-se de um problema comum, limitante, e que deve ser considerado e tratado como prioridade em saúde e pesquisa.
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Sant’Anna PCF, Morimoto T, Miranda FDS, Garcez ADS. Low back pain in university students: what is the impact of COVID-19 pandemic? FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/22010929032022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
ABSTRACT The social isolation resulting from the COVID-19 pandemic has changed the population’s habits and raised health-related issues, such as low back pain. This study aimed to evaluate the prevalence and risk of chronic low back pain in university students during the social isolation of COVID-19. We used an online questionnaire, the STarT Back Screening Tool (SBST), to check for low back pain. The factors investigated: sociodemographic data, pain, sedentary behavior, and physical activity. For proportion heterogeneity, we used the chi-square test. The adjusted analysis used Poisson regression with robust variance. A total of 208 students participated in the sample. University students with a partner were twice as likely to have pain (PR=2.07; 95%CI). The prevalence of low back pain was 48.1%; 87% (PR=1.87; 95%CI: 1.09-3.21; p=0.027) higher in women. University students with obesity were 42% more likely to have low back pain (PR=1.42; 95%CI: 1.04-1.94; p=0.032); and with sedentary behavior were 35% more likely to have low back pain (PR=1.36; 95%CI: 1.02-1.81; p=0.038). In total, 82% of the sample presented low risk of chronicity. Many people presented low back pain during the social isolation imposed by COVID-19. This is a common, limiting problem that must be considered and treated as a health and research priority.
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Volinn E, Loeser JD. What are the Origins of Chronic Back Pain of "Obscure Origins"? Turning Toward Family and Workplace Social Contexts. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2022; 95:153-163. [PMID: 35370485 PMCID: PMC8961709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Chronic back pain (CBP) is a common symptom throughout the world, and those undergoing it often experience a profound degradation of life. Despite extensive research, it remains an elusive symptom. In most cases, CBP is "non-specific," since bio-mechanisms examined in the clinic do not account for it; another way of saying this is that it is "of obscure origins." This paper re-directs attention towards origins that are distal and usually out of sight from the vantage point of the clinic. CBP as considered here is non-specific, persists ≥ 3 months, and, additionally, interferes with activities of daily life, such as family interaction or work. A theory proposed in the paper draws upon Durkheim's Suicide to explain why exposures in the distal social contexts of family and workplace are fundamentally implicated in CBP. The theory is formed out of previously published studies on family and workplace social contexts of CBP and, in effect, provides a theoretical framework with which to review them. After treatment of CBP in the clinic, patients return to family and workplace contexts. Unless exposures in these contexts are addressed, they serve as continually renewing sources of CBP that remain unabated regardless of mechanism-based treatment in the clinic.
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Affiliation(s)
- Ernest Volinn
- Department of Sociology, University of Utah, Salt Lake
City, UT, USA,To whom all correspondence should be addressed:
Ernest Volinn, PhD, Department of Sociology, University of Utah, Salt Lake City,
UT;
| | - John D. Loeser
- Departments of Neurological Surgery and Anesthesia and
Pain Medicine, University of Washington, Seattle, WA, USA
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Kovačević I, Majerić Kogler V, Krikšić V, Ilić B, Friganović A, Ozimec Vulinec Š, Pavić J, Milošević M, Kovačević P, Petek D. Non-Medical Factors Associated with the Outcome of Treatment of Chronic Non-Malignant Pain: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2881. [PMID: 35270575 PMCID: PMC8910574 DOI: 10.3390/ijerph19052881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chronic pain is a global public health issue with increasing prevalence. Chronic pain causes sleep disorder, reactive anxiety, and depression, impairs the quality of life; it burdens the individual and society as a whole. The aim of this study was to examine non-medical factors related to the outcome of the treatment of chronic non-malignant pain. METHODS A cross-sectional study with two groups of patients was conducted using a questionnaire with biological, psychological, and social characteristics of patients. Since this study was cross-sectional, it was not possible to determine whether some factors were the cause or the consequence of unsuccessful treatment outcome, which is at the same time one of the disadvantages of cross-sectional studies. RESULTS The poor outcome of the treatment of chronic non-malignant pain in a multivariate binary logistic regression model was statistically significantly associated with the lower quality of life (OR = 0.95 (95% CI: 0.91-0.99; p = 0.009), and higher depression level OR = 1.08 (95% CI: 1.02-1.14; p = 0.009). The outcome of the treatment was not directly related to social support measured by the multivariate binary logistic regression model (OR = 1.04, 95% CI: 0.95-1.15, p = 0.395), but solitary life (without partner) was (OR = 2.16 (95% CI: 1.03-4.53; p = 0.043). CONCLUSION The typical patient with a poor pain management outcome is retired, presents depressive behavior; their pain disturbs general activity and sleeping. Moreover, they have a physically disturbed quality of life and require self-treatment due to the inaccessibility of doctors and therapies. The principle of treatment of patients with chronic, non-malignant pain should take into account a biopsychosocial approach with individually adjusted procedures.
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Affiliation(s)
- Irena Kovačević
- Department of Nursing, University of Applied Health Sciences, Mlinarska 38, 10000 Zagreb, Croatia; (V.K.); (B.I.); (A.F.); (Š.O.V.); (J.P.)
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, 1000 Ljubljana, Slovenia;
| | | | - Valentina Krikšić
- Department of Nursing, University of Applied Health Sciences, Mlinarska 38, 10000 Zagreb, Croatia; (V.K.); (B.I.); (A.F.); (Š.O.V.); (J.P.)
- Institution for Home Healthcare Domnius, 10000 Zagreb, Croatia
| | - Boris Ilić
- Department of Nursing, University of Applied Health Sciences, Mlinarska 38, 10000 Zagreb, Croatia; (V.K.); (B.I.); (A.F.); (Š.O.V.); (J.P.)
| | - Adriano Friganović
- Department of Nursing, University of Applied Health Sciences, Mlinarska 38, 10000 Zagreb, Croatia; (V.K.); (B.I.); (A.F.); (Š.O.V.); (J.P.)
- Department of Anaesthesiology and Intensive Medicine, University Hospital Centre Zagreb, Kišpaticeva 12, 10000 Zagreb, Croatia
| | - Štefanija Ozimec Vulinec
- Department of Nursing, University of Applied Health Sciences, Mlinarska 38, 10000 Zagreb, Croatia; (V.K.); (B.I.); (A.F.); (Š.O.V.); (J.P.)
| | - Jadranka Pavić
- Department of Nursing, University of Applied Health Sciences, Mlinarska 38, 10000 Zagreb, Croatia; (V.K.); (B.I.); (A.F.); (Š.O.V.); (J.P.)
| | - Milan Milošević
- Andrija Štampar School of Public Health, University of Zagreb School of Medicine, 10000 Zagreb, Croatia;
| | - Petra Kovačević
- Department of Rheumatology, Physical and Rehabilitation Medicine, University Hospital Centre “Sestre Milosrdnice”, 10000 Zagreb, Croatia;
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, 1000 Ljubljana, Slovenia;
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Siddiqui AS, Javed S, Abbasi S, Baig T, Afshan G. Association Between Low Back Pain and Body Mass Index in Pakistani Population: Analysis of the Software Bank Data. Cureus 2022; 14:e23645. [PMID: 35510015 PMCID: PMC9060752 DOI: 10.7759/cureus.23645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Obesity is a growing public health concern and is one of the leading causes of human suffering and disability worldwide. The number of overweight and obese people is dramatically increasing, and local data showed that low back pain (LBP) is more common in people with obesity, prolonged sitting jobs, psychological disorders, and lack of exercise. METHODS This study was conducted in a cohort of 300 adult patients of either gender who visited a pain management clinic with LBP. Patient data were retrieved from the hospital software program and recorded in a pre-designed proforma. The data included the patient's age, gender, weight, height, BMI, comorbidities, site of pain, duration of pain, distribution of pain, severity of pain, history of spinal trauma, previous spinal surgery, and working diagnosis. RESULTS Out of 300 patients with LBP, 185 (61.7 %) were female and 115 (38.3%) were male, of these, 224 (74.6%) were overweight or obese. One hundred and three (34.3%) had axial back pain and 197 (65.7%) patients had lumbar radicular pain. Linear regression analysis showed that 17% variability in pain scores in both genders can be explained by the increase in BMI. There is a statistically significant relationship, i.e. P=0.0005, exists between pain score and BMI. CONCLUSION This study showed the strong association between obesity and LBP in the Pakistani population. Approximately, 75% were overweight or obese in our LBP population-based cohort and this association was stronger among women than men.
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Affiliation(s)
| | - Sidra Javed
- Anesthesiology, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, PAK
| | - Shemila Abbasi
- Anaesthesiology, Aga Khan University Hospital, Karachi, PAK
| | - Tanveer Baig
- Anaesthesiology, Aga Khan University Hospital, Karachi, PAK
| | - Gauhar Afshan
- Anaesthesiology, The Aga Khan University, Karachi, PAK
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12
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Gulduren Aydın LG, Akesen S, Turker YG, Gurbet A, Kılıç Yılmaz V. Investigation of Effectiveness of Pulsed Radiofrequency With Multifunctional Epidural Electrode for Low Back Pain. Cureus 2021; 13:e20239. [PMID: 35004054 PMCID: PMC8734956 DOI: 10.7759/cureus.20239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
Aim: Low back pain affects many people at some point in their life. Whenever pharmacologic and other conservative treatments of chronic pain fail, ablative and interventional methods are attempted on the assumption that interrupting nerve conduction prevents central pain cognition. Pulsed radiofrequency using multifunctional epidural electrodes can be used for multiple etiologies of chronic low back and leg pain with a low complication rate and minimal side effects.
Methods: The records of the 188 patients who underwent pulsed radiofrequency with multifunctional epidural electrode between October 2014 and March 2017 in Algology clinic were examined retrospectively. Visual analogue scale (VAS) for pain, response to straight leg raising test (SLR), lumbar range of motion, analgesic use, patient satisfaction score, need for open operation or other interventional procedure were collected. Results: VAS and SLR tests were found to be significantly improved compared with the preoperative values. The VAS scores at the 10th day and first, third and sixth months were significantly decreased compared to baseline scores (p<0.001). Also, SLR tests were significantly improved compared to baseline scores at the same intervals (p<0.001). Conclusion: Pulsed radiofrequency with multifunctional epidural electrode is a safe and effective method for low back pain which is caused by several pathologies.
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13
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Fassa AG, Faria NMX, Szortyka ALSC, Meucci RD, Fiori NS, de Carvalho MP. Child Labor in Family Tobacco Farms in Southern Brazil: Occupational Exposure and Related Health Problems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12255. [PMID: 34832014 PMCID: PMC8620869 DOI: 10.3390/ijerph182212255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022]
Abstract
Tobacco farming is considered Hazardous Child Labor in Brazil. This study examined the work of children and adolescents in tobacco farming, characterizing the level of urinary cotinine and the occurrence of Green Tobacco Sickness (GTS), pesticide poisoning, respiratory symptoms, and musculoskeletal disorders. A cross-sectional descriptive study was conducted with a random sample of tobacco growers under 18 years old in Southern Brazil. Ninety-nine young people were interviewed at 79 family farms. The majority began working in agriculture before they were 14 and worked harvesting and tying hands of tobacco; 60% were 16 or 17 years old, and 51.5% were male. During their lifetime, 24.5% reported GTS, and 3% reported pesticide poisoning. In the previous year, 29.3% reported low back pain, 6.1% wheezing, and 16.2% coughing without having a cold. Half of the 12 young people evaluated had over 100 ng/mL of urinary cotinine. The study indicates that child laborers do various activities and present a high prevalence of health problems. Health workers should be trained to identify child laborers and their impacts on health. Full-time farm schools could provide knowledge about sustainable agricultural production, reducing the rates of age-grade mismatch, without taking young people away from rural areas.
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Affiliation(s)
- Anaclaudia Gastal Fassa
- Department of Social Medicine, Faculty of Medicine, Federal University of Pelotas, Pelotas 96030-000, Brazil; (N.M.X.F.); (N.S.F.); (M.P.d.C.)
| | - Neice Muller Xavier Faria
- Department of Social Medicine, Faculty of Medicine, Federal University of Pelotas, Pelotas 96030-000, Brazil; (N.M.X.F.); (N.S.F.); (M.P.d.C.)
| | | | - Rodrigo Dalke Meucci
- Faculty of Medicine, Federal University of Rio Grande, Rio Grande 96203-900, Brazil;
| | - Nadia Spada Fiori
- Department of Social Medicine, Faculty of Medicine, Federal University of Pelotas, Pelotas 96030-000, Brazil; (N.M.X.F.); (N.S.F.); (M.P.d.C.)
| | - Maitê Peres de Carvalho
- Department of Social Medicine, Faculty of Medicine, Federal University of Pelotas, Pelotas 96030-000, Brazil; (N.M.X.F.); (N.S.F.); (M.P.d.C.)
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14
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The prevalence of chronic pain in young adults: a systematic review and meta-analysis. Pain 2021; 163:e972-e984. [PMID: 34817439 DOI: 10.1097/j.pain.0000000000002541] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/15/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Prior systematic reviews have summarized the prevalence and impact of chronic pain in "average" pediatric (i.e., school-age) and adult (i.e., middle-age) age groups. To our knowledge, this is the first study to describe the prevalence of chronic pain in the subgroup of individuals that fall in between established boundaries of "childhood" and "adulthood" - known as young adulthood. The goal of this research was to meta-analyze prevalence data on pain in young adults based on available data published between 2008 and 2020. Searches were identified with MEDLINE, Embase, and PsycINFO. We included general population and university-based studies presenting prevalence estimates of chronic pain (pain lasting ≥3 months) in young adults. We identified 43 articles providing prevalence estimates across a combined population of 97,437 young adult respondents (age range: 15-34), with studies undertaken in 22 countries. Available data allowed for stratification of prevalence according to pain condition. The overall pooled random-effect prevalence rate of chronic pain in young adults was 11.6%, suggesting that 1 in every 9 young adults experience chronic pain worldwide. Prevalence rates varied considerably according to pain condition. Estimates did not vary according to sex, geographic location, and several study methodological characteristics (i.e., population type, sampling area, sampling year, investigation period, assessment method). Overall, young adult chronic pain is common and should be recognized as a major public health concern. Considering the difficulties young adults face accessing adult healthcare, greater attention is needed to develop transition programs and evidence-based treatments tailored to the unique needs of this age group.
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15
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Relationship between job rotation and work-related low back pain: a cross-sectional study using data from the fifth Korean working conditions survey. Ann Occup Environ Med 2021; 33:e3. [PMID: 34754464 PMCID: PMC7952754 DOI: 10.35371/aoem.2021.33.e3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background Job rotation was introduced in various industries as a strategic form of work for improving workers' job skills and health management. This study aims to examine the relationship between job rotation and work-related low back pain (LBP), one of the typical work-related musculoskeletal symptoms of Korean workers. Methods We conducted this study using the data of the 5th Korean Working Conditions Survey (KWCS). As the subject of this study, 27,163 wage workers were selected, and classified into three groups according to occupational type (white-collar, service and sales, and blue-collar). In this study, job rotation means to change the work-related activities with other colleagues periodically and work-related LBP was defined as whether there was work-related LBP in the last 12 months. Chi-square test and logistic regression were used to analyze the relationship between job rotation and work-related LBP. Results Out of 27,163 workers, 2,421 (8.9%) answered that they had job rotation and 2,281 (8.4%) answered that they experienced work-related LBP. According to the results from logistic regression, job rotation was significantly associated with low prevalence of work-related LBP among blue-collar workers (odds ratio [OR]: 0.71, 95% confidence interval [CI]: 0.58–0.88), whereas no significant relationship was observed among white-collar, service and sales groups. In addition, the negative association between job rotation and work-related LBP among blue-collar workers was more pronounced when exposed to ergonomic risk factors (uncomfortable posture OR: 0.79, 95% CI: 0.64–0.98; heavy work OR: 0.74, 95% CI: 0.57–0.96; repetitive work OR: 0.74, 95% CI: 0.60–0.92). Conclusions Job rotation was associated with low prevalence of work-related LBP among workers in the blue-collar occupational group in Korea. It is necessary to evaluate the effect of job rotation by occupational type and introduce an appropriate method of job rotation to reduce workers' work-related musculoskeletal symptoms.
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Pelozato de Oliveira DI, de Souza Teixeira BM, de Macedo OG, Dos Santos V, Grossi Porto LG, Rodrigues Martins W. Prevalence of chronic lower back pain in Brazilian military firefighters. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2021; 28:1699-1704. [PMID: 34006199 DOI: 10.1080/10803548.2021.1929699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives. Lower back pain (LBP) is a common health problem worldwide, affecting an increasing number of individuals. Military firefighters (MFFs) face high levels of physical and psychological demands and are commonly exposed to different occupational risk factors. This study aimed to estimate the prevalence of chronic lower back pain (CLBP) in Brazilian enlisted MFFs. Methods. This cross-sectional study was carried out at the Military Firefighters Department of the Brazilian Federal District (Corpo de Bombeiros Militar do Distrito Federal [CBMDF]). The estimated sample size was 608 MFFs. Results. Of the 623 participants, 575 valid and complete questionnaires were analyzed. A total of 183 participants reported CLBP, indicating a point prevalence of 31.8% (95% confidence interval [CI] [28.2, 35.4]). The prevalence of acute and subacute LBP was 9.2% (95% CI [7.1, 11.9]), and 59% (95% CI [54.9, 62.9]) reported no back pain. CLBP was more common among men aged 40-49 years, who were insufficiently active and overweight. Conclusion. Around one-third of the study population reported CLPB. Prevalence estimates of CLPB were greater among men and those between 40 and 49 years old. Our data support the need for programs to prevent and treat CLBP among firefighters.
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Affiliation(s)
| | | | | | | | - Luiz Guilherme Grossi Porto
- College of Physical Education, University of Brasilia, Brazil.,Graduate Program in Physical Education, University of Brasilia, Brazil
| | - Wagner Rodrigues Martins
- College of Physical Therapy, University of Brasilia, Brazil.,Graduate Program in Rehabilitation Science, University of Brasilia, Brazil
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17
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de Teresa C, Varela-López A, Rios-Álvarez S, Gálvez R, Maire C, Gracia-Villar S, Battino M, Quiles JL. Evaluation of the Analgesic Efficacy of a Bioelectronic Device in Non-Specific Chronic Low Back Pain with Neuropathic Component. A Randomized Trial. J Clin Med 2021; 10:jcm10081781. [PMID: 33923872 PMCID: PMC8072836 DOI: 10.3390/jcm10081781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open
Abstract
Low energy pulsed electromagnetic signals (PEMS) therapy, in the field of bioelectronics, has been suggested as a promising analgesic therapy with special interest in treating conditions with poor response to pharmacotherapy. This study evaluated the effectiveness of PEMS therapy on the treatment of chronic low back pain patients with a neuropathic component. A group of 64 individuals with such condition was allocated to a 2-week treatment period (10 twenty-minute sessions on consecutive days) with an active PEMS therapy device or an inactive device in random order. The pain was assessed on a visual analog scale, and the functional status was assessed using the SF-12 questionnaire. The visual analog scale scores were lower after treatment than at baseline but only in the group treated with the active device. According to the DN4 score, neuropathic pain decreased in both experimental groups with respect to baseline, but this was only significant for the group treated with the active device. Similarly, an improvement in the SF-12 and Medical Outcomes Study (MOS) sleep scale components was reported. The study demonstrated that low-energy PEMS therapy was efficient in reducing pain and improving function in chronic low back pain patients with a neuropathic component.
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Affiliation(s)
- Carlos de Teresa
- Functional and Sports Medicine Service, Quirónsalud Hospital, 29004 Malaga, Spain; (C.d.T.); (S.R.-Á.)
| | - Alfonso Varela-López
- Biomedical Research Centre, Institute of Nutrition and Food Technology “José Mataix Verdú”, Department of Physiology, University of Granada, Avenida del Conocimiento s/n., 24560 Granada, Spain;
| | - Susana Rios-Álvarez
- Functional and Sports Medicine Service, Quirónsalud Hospital, 29004 Malaga, Spain; (C.d.T.); (S.R.-Á.)
| | - Rafael Gálvez
- Pain Universitario Virgen de las Nieves University Hospital, 18012 Granada, Spain; (R.G.); (C.M.)
| | - Coralie Maire
- Pain Universitario Virgen de las Nieves University Hospital, 18012 Granada, Spain; (R.G.); (C.M.)
| | - Santos Gracia-Villar
- Research Center for Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, 39011 Santander, Spain;
- Research Center for Foods, Nutritional Biochemistry and Health, Universidad Internacional Iberoamericana, Campeche 24560, Mexico
| | - Maurizio Battino
- Department of Clinical Sicences, Università Politecnica delle Marche, 60131 Ancona, Italy;
- International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang 212013, China
| | - José L. Quiles
- Biomedical Research Centre, Institute of Nutrition and Food Technology “José Mataix Verdú”, Department of Physiology, University of Granada, Avenida del Conocimiento s/n., 24560 Granada, Spain;
- Research Group on Food, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, 39011 Santander, Spain
- Correspondence:
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Krishnan R, Kurup V, Vadivelu N, Dai F, Zhou B, Rajput K. Does Choice of Steroid Matter for Treatment of Chronic Low Back Pain with Sacroiliac Joint Injections: a Retrospective Study. Curr Pain Headache Rep 2021; 25:34. [PMID: 33760993 DOI: 10.1007/s11916-021-00942-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Prevalence of chronic low back pain (cLBP) is increasing. Sacroiliac joint (SIJ) is a common source of cLBP, but data behind its diagnosis and treatment is controversial. There is moderate quality evidence for effectiveness of therapeutic SIJ injections. However, there are no studies comparing the two most common steroid preparations, methylprednisolone (MTP) and triamcinolone (TAC) in SIJ injections. RECENT FINDINGS After institutional IRB approval, a retrospective chart review was conducted to evaluate the effectiveness of SIJ injections in terms of pain relief at 1-month follow-up and compare MTP versus TAC. All injections were performed by a single pain physician with fluoroscopic guidance. RESULTS Sixty-five percent of patients in the MTP group and 57% patients in the TAC group had >50% pain relief at 1-month follow-up, with no statistical difference between the two groups. Patients in the TAC group had significantly greater BMI and consisted of higher proportion of smokers (72% patients in TAC group versus 39% patients in the MTP group, p-value 0.004). Other sources of pain such as facet joints were unmasked post-procedurally after SIJ injections, with this unmasking being significant for the TAC group. Opiate use decreased in the MTP group from 35% pre-procedurally to 20% post-procedurally, and this difference did not reach statistical significance. Both MTP and TAC are effective in providing pain relief for SIJ pain at 1-month follow-up, with no statistical difference between the two types of steroids. Although not statistically significant, there is a modest reduction in opiate use in the MTP group.
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Affiliation(s)
- Ramya Krishnan
- Department of Anesthesia, Yale University School of Medicine, New Haven, CT, USA
| | - Viji Kurup
- Department of Anesthesia, Yale University School of Medicine, New Haven, CT, USA
| | - Nalini Vadivelu
- Department of Anesthesia, Yale University School of Medicine, New Haven, CT, USA
| | - Feng Dai
- Department of Anesthesia, Yale University School of Medicine, New Haven, CT, USA
| | - Bin Zhou
- Department of Anesthesia, Yale University School of Medicine, New Haven, CT, USA
| | - Kanishka Rajput
- Department of Anesthesia, Yale University School of Medicine, New Haven, CT, USA.
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Sant’Anna PCF, Olinto MTA, Bairros FSD, Garcez A, Costa JSDD. Dor lombar crônica em uma população de mulheres do Sul do Brasil: prevalência e fatores associados. FISIOTERAPIA E PESQUISA 2021. [DOI: 10.1590/1809-2950/19011628012021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo deste estudo foi identificar a prevalência de dor lombar crônica e seus fatores associados em uma população de mulheres. Para isso, realizou-se um estudo transversal, de base populacional, com 1.128 mulheres com idade entre 20 e 69 anos e residentes na zona urbana de São Leopoldo, Rio Grande do Sul. A dor lombar crônica foi avaliada a partir da presença de dor com duração mínima de três meses, e os fatores investigados incluíram aspectos sociodemográficos, comportamentais e antropométricos. Os resultados indicaram uma prevalência de dor lombar crônica de 46,5% (IC95%: 43,6-49,4). Após ajuste, os fatores associados à dor lombar crônica foram: idade, atividade física e estado nutricional. Observou-se uma associação com tendência linear positiva entre idade e dor lombar, assim como uma probabilidade 31% (RP=1,31; IC95%: 1,05-1,64; p=0,02) e 25% (RP=1,25; IC95%: 1,09-1,42; p<0,001) maior de mulheres fisicamente inativas e obesas terem dor lombar, quando comparadas às mulheres fisicamente ativas e com peso corporal normal, respectivamente. Assim, este estudo evidenciou uma elevada prevalência de dor lombar crônica em mulheres, identificando como principais fatores associados a sua ocorrência a idade avançada, a inatividade física e a obesidade.
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Mullerpatan R, Nahar S, Singh Y, Cote P, Nordin M. Burden of spine pain among rural and tribal populations in Raigad District of Maharashtra State of India. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:1004-1010. [PMID: 32914232 DOI: 10.1007/s00586-020-06585-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/18/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Among non-communicable disorders, low back and neck pain are the most common causes of severe, long-term pain and disability affecting more than a billion people globally. Yet, the burden and impact of these conditions are not well understood, especially among rural and tribal people living in low- and middle-income countries. OBJECTIVE The aims of this study were to measure point prevalence of low back and neck pain among rural and tribal people in Raigad District of Maharashtra, India, and explore attitudes and beliefs of rural people towards spine pain and disability. DESIGN In a cross-sectional survey of six villages in the Raigad District of Maharashtra State of India from August to October 2016, low back and neck pain were measured using the Spine Pain Questionnaire. RESULTS We surveyed 2323 participants, which did not include children and adolescents. Among rural people (n = 2073), the point prevalence of low back and neck pain was 4.9% (95% CI 3.94-5.79) and 2.9% (95% CI 2.21-8.87), respectively. Among tribal people (n = 250), prevalence was 10.0% (95% CI 6.28-13.71) for low back pain and 3.6% (95% CI 1.29-5.90) for neck pain. Lifting heavy weights and bending trunk were the most limiting activities. During informal discussions, most villagers attributed spine pain to traditional lifestyle and age. Participants continued occupational work in the presence of pain. Lack of transport facilities and cost of treatment emerged as the two most common reasons for delay in seeking treatment at nearby healthcare centres. This information will inform the development of customized spine care programmes through community-engaged partnerships and self-empowerment of the local community.
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Affiliation(s)
- Rajani Mullerpatan
- MGM School of Physiotherapy, MGM Institute of Health Sciences, MGM Educational Campus, Sector 1, Kamothe, Navi Mumbai, Maharashtra, 410 209, India.
| | - Shweta Nahar
- MGM School of Physiotherapy, MGM Institute of Health Sciences, MGM Educational Campus, Sector 1, Kamothe, Navi Mumbai, Maharashtra, 410 209, India
| | - Yuvraj Singh
- MGM School of Physiotherapy, MGM Institute of Health Sciences, MGM Educational Campus, Sector 1, Kamothe, Navi Mumbai, Maharashtra, 410 209, India
| | - Pierre Cote
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Oshawa, ON, Canada
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY, USA.,World Spine Care Europe, Holmfirth, UK
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The short-term effects of balneotherapy on pain, disability and fatigue in patients with chronic low back pain treated with physical therapy: A randomized controlled trial. Complement Ther Med 2020; 54:102550. [PMID: 33183668 DOI: 10.1016/j.ctim.2020.102550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/09/2020] [Accepted: 08/24/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE This study aimed to compare whether there are positive effects of balneotherapy(BT) on pain, quality of life and disability of individuals receiving physical therapy(PT) for chronic low back pain and to examine the effect of body mass index(BMI) on treatment. MATERIALS AND METHOD This prospective, controlled, single blind study was conducted. Patients were randomized into two groups through a simple randomization in a 1:1 ratio. The clinician and biostatistics expert were blinded. PT group was applied PT, BT + PT group was applied PT + BT. All patients were included in the study for 3 weeks (total of 15 sessions, 5 days per week). All patients applied hot pack, transcutaneous electrical nerve stimulation and ultrasound. Patients in the BT + PT group applied BT in thermo mineralized water pool (20 min at 38-40 °C). Assessments were made using Pain-Visual Analog Scale(VAS), EQ-5D-3 L Scale(EQ5), EQ-VAS, Functional Assessment of Chronic Illness Therapy-Fatigue(FACIT-F), Roland-Morris Disability Questionnaire(RMDQ) and Quebec Back Pain Disability Scale(QBPDS) at the beginning (W0) and end (W3) of treatment. While performing statistical analysis, patients were divided into 3 categories of BMI1(18.5-24.9 kg/m2), BMI2 (25.0-29.9 kg/m2) and BMI3(≥30.0 kg/m2). RESULTS 270 patients were randomized. 129 patients in PT group and 133 patients in PT + BT group completed the study. In the BT + PT group, there were increases in the EQ5 and EQ-VAS variables and decreases in all other variables compared to the PT group which were found to be statistically significant (for QBPDS p < 0.05, the others p < 0.01). The differences in all variables W0 and W3 were at least half reductions and increases which were found to be statistically significant (p < 0.01). In terms of BMI, there were significant differences for all groups, especially BMI3 had higher means for all variables apart from EQ5 and EQ-VAS than the other two categories. BMI1 was the BMI category with highest means for EQ5 and EQ-VAS. The Group × Time interaction was found to be statistically significant for Pain-VAS, EQ5, EQ-VAS, FACIT-F, QBPDS and RMDQ(p < 0.01). For Pain-VAS, the effect of the Group × Time × BMI interaction was found to be statistically significant(p < 0.05). CONCLUSION BT plus PT was more effective than PT. BT may have positive contributions to reducing pain, functionality of patients, quality of life, fatigue and disability status.
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Physical Performance, Anthropometrics and Functional Characteristics Influence the Intensity of Nonspecific Chronic Low Back Pain in Military Police Officers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176434. [PMID: 32899413 PMCID: PMC7504182 DOI: 10.3390/ijerph17176434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/07/2020] [Accepted: 08/14/2020] [Indexed: 01/14/2023]
Abstract
Background: Chronic low back pain (CLBP) is a serious problem in Military Police Officers (MPO), which accounts for up to 45% of the sick leave rates. It has been assumed that the strength and the endurance of trunk flexor and extensor muscles are CLPB key factors, but it is not known whether these attributes are related to pain intensity. It was aimed to determine whether the strength and endurance of trunk flexor and extensor muscles differ in MPO with no pain (CON; n = 24), moderate (MOD; n = 42), and severe (SEV; n = 37) nonspecific chronic low back pain (CLBP). Methods: The peak torque and endurance test of trunk flexor (PTF.BM−1) and extensor (PTE.BM−1) muscles were compared. A multiple regression analysis was used to identify pain intensity predictors in all groups (PAIN) and according to pain intensity (MOD and SEV). Results: The PTF.BM−1 was negatively related to pain and was a significant predictor, irrespective of pain intensity (PAIN). Conclusion: When pain intensity was considered the PTF.BM−1 and PTE.BM−1 explained the pain in the MOD, while the PTE.BM−1 and service time explained pain intensity in the SEV. Endurance of the flexor and extensor muscles was not related to pain intensity. These results indicated that training protocols must emphasize specific strengthening routines.
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Feitosa AA, Amaro Junior E, Sanches LG, Borba EF, Jorge LL, Halpern ASR. Chronic low back pain and sick-leave: a functional magnetic resonance study. Adv Rheumatol 2020; 60:46. [PMID: 32873331 DOI: 10.1186/s42358-020-00146-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 08/14/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Chronic low back pain (CLBP) represents a problem in the occupational environment, often associated with disability, sick-leave demands, loss of productivity, anxiety, depression and high socioeconomic cost. The emergence of functional neuroimaging allowed new insights into brain structure and physiology in normality and chronic pain. While occupational related aspects are recognized as important risk factors for chronicity there have not been thus far evaluated by fMRI experiments. The overall objective of this study is to compare the neuronal correlates between groups of individuals CLBP with or without sick-leave demands. METHODS A total of 74 individuals were divided into three groups: chronic low back pain with sick-leave demands [CLBP_L]; chronic low back pain without sick-leave demands [CLBP_NL]; individuals without pain or sick-leave demands [Control]. Functional magnetic resonance imaging was used to assess brain function during moderate acute pain stimulation task (thumb controlled pressure). RESULTS After acute painful stimulation, a higher brain response was found in the anterior cingulate and superior and medium frontal gyrus was observed in CLBP_NL vs. CLBP_L (p < 0,001) and increased brain response in the frontal pole and paracingulate region in control vs. CLBP_L (p < 0.001) during acute pain stimulation. CONCLUSION The modulation of acute pain participates in the mechanism propagating chronic pain perception. The lower activation in the superior frontal gyrus observed in the CLBP_L group compared to CLBP_NL, reinforces the idea of an already existing activation in this area.
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Affiliation(s)
- Aloma A Feitosa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, n° 455, Sao Paulo, SP, Brazil
| | - Edson Amaro Junior
- Instituto do Cérebro - Hospital Israelita Albert Einstein, Av Albert Einstein 627/701 BA, 2SS, Sao Paulo, SP, Brazil
| | - Liana Guerra Sanches
- Instituto do Cérebro - Hospital Israelita Albert Einstein, Av Albert Einstein 627/701 BA, 2SS, Sao Paulo, SP, Brazil
| | - Eduardo Ferreira Borba
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, n° 455, Sao Paulo, SP, Brazil
| | - Liliana Lourenço Jorge
- Instituto do Cérebro - Hospital Israelita Albert Einstein, Av Albert Einstein 627/701 BA, 2SS, Sao Paulo, SP, Brazil
| | - Ari Stiel Radu Halpern
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, n° 455, Sao Paulo, SP, Brazil. .,Instituto do Cérebro - Hospital Israelita Albert Einstein, Av Albert Einstein 627/701 BA, 2SS, Sao Paulo, SP, Brazil.
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Fassa AG, Spada Fiori N, Dalke Meucci R, Müller Xavier Faria N, Peres de Carvalho M. [Neck pain among tobacco farm workers in Southern Brazil]. Salud Colect 2020; 16:e2307. [PMID: 33147389 DOI: 10.18294/sc.2020.2307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/12/2020] [Indexed: 11/24/2022] Open
Abstract
This study aims to assess neck pain prevalence and associated factors among tobacco farm workers. This is a cross-sectional study of 2,469 tobacco farm workers in southern Brazil. An adapted version of the Nordic Questionnaire of Musculoskeletal Symptoms was used to characterize neck pain. Multivariate analysis was performed using Poisson regression, following a hierarchical theoretical model. Neck pain prevalence in the last year among the population studied was 7.4%. Worker age, tobacco smoking, tobacco bundling, use of heavy chainsaws, working at an intense or accelerated pace and green tobacco sickness were variables associated with neck pain in females. Among males, age, use of heavy chainsaws, working in a sitting position on the ground, pesticide poisoning, and green tobacco sickness were associated with the outcome. The study reinforces the importance of ergonomic and physiological workloads in the determination of neck pain. Future studies are needed to understand the role of pesticides and nicotine exposures on musculoskeletal problems. The mechanization of tobacco harvesting could reduce ergonomic and chemical exposure, thereby improving farmers' health.
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Affiliation(s)
- Anaclaudia Gastal Fassa
- Doctora en Epidemiología. Profesora Titular, Universidade Federal de Pelotas, Pelotas, Brasil.
| | - Nadia Spada Fiori
- Doctora en Epidemiología. Profesora Adjunta, Universidade Federal de Pelotas, Pelotas, Brasil.
| | - Rodrigo Dalke Meucci
- Doctor en Epidemiología. Profesor Adjunto, Universidade Federal do Rio Grande, Rio Grande, Brasil.
| | - Neice Müller Xavier Faria
- Doctora en Epidemiología. Médica Ocupacional, Departamento de Saúde, Municipio de Bento Gonçalves, Brasil.
| | - Maitê Peres de Carvalho
- Doctora en Ciencias de la Salud. Investigadora, Universidade Federal de Pelotas, Pelotas, Brasil.
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Beyera GK, O’Brien J, Campbell S. The development and validation of a measurement instrument to investigate determinants of health care utilisation for low back pain in Ethiopia. PLoS One 2020; 15:e0227801. [PMID: 31945105 PMCID: PMC6964895 DOI: 10.1371/journal.pone.0227801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/31/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Low back pain (LBP) is a highly prevalent and disabling public health problem globally. However, little is known about factors affecting health care utilisation for optimal management of the pain, and there is no validated instrument to derive epidemiological data for a better understanding of these factors. The aim of this study was to develop and validate an instrument used to measure determinants of health care utilisation for LBP in Ethiopia. METHODS The relevant domains of potential determinants of health care utilisation for LBP were identified following a comprehensive review of the literature. Items relating to each domain were then generated by considering the context of Ethiopia, and where necessary, existing items were adapted. The instrument was then translated, and an expert panel reviewed the instrument for content validity, clarity and any other suggestions. Using the data collected from 1303 adults with LBP, factorial validity was assessed by conducting principal component and parallel analyses. Internal consistency reliability was also assessed using Cronbach's alpha. Intraclass correlation coefficient (ICC) and Cohen Kappa statistic were calculated to evaluate temporal stability of the instrument. RESULTS Parallel analysis showed that there were six components with Eigenvalues (obtained from principal component analysis) exceeding the corresponding criterion values for a randomly generated data matrix of the same size. Cronbach's alpha for the internal consistency reliability ranged from 0.65 to 0.82. In assessing temporal stability, ICC ranged from 0.60, 95% CI: 0.23-0.98 to 0.95, 95% CI: 0.81-1.00 while Cohen Kappa ranged from 0.72, 95% CI: 0.49-0.94 to 0.93, 95% CI: 0.85-1.00. CONCLUSIONS This study demonstrated that the newly developed instrument has an overall good level of content and factorial validity, internal consistency reliability, and temporal stability. In this way, this instrument is appropriate for measuring determinants of health care utilisation among people with LBP in Ethiopia.
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Affiliation(s)
- Getahun Kebede Beyera
- School of Nursing, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Jane O’Brien
- School of Nursing, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Steven Campbell
- School of Nursing, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
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Carvalho MPD, Fiori NS, Meucci RD, Faria NMX, Fassa AG. Dor na coluna torácica e fatores associados em fumicultores. REVISTA BRASILEIRA DE SAÚDE OCUPACIONAL 2020. [DOI: 10.1590/2317-6369000002019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Introdução: dor na coluna torácica diz respeito a traumas cumulativos envolvendo má postura, movimentos repetitivos e longos períodos na mesma posição. Objetivo: avaliar a prevalência de dor na coluna torácica e fatores associados em fumicultores no sul do Brasil. Métodos: estudo transversal cuja associação entre o desfecho e os fatores sociodemográficos e comportamentais, atividades laborais, cargas de trabalho e comorbidades foram examinadas pelo teste de Wald para heterogeneidade e tendência linear. A análise multivariável foi realizada utilizando modelo hierárquico e regressão de Poisson com variância robusta. Resultados: o estudo envolveu 2.469 indivíduos de ambos os sexos. A prevalência de dor na coluna torácica foi de 21,2%. Limpar equipamento para aplicação de agrotóxico, número de episódios de Doença da Folha Verde, sintomas respiratórios e transtornos psiquiátricos menores foram positivamente associados ao desfecho em ambos os sexos. Tabagismo e intoxicação por agrotóxicos foram associados ao desfecho entre as mulheres, enquanto escolaridade e passar varas com folhas de tabaco foram associados aos homens. Conclusões: reestruturação ergonômica, redução das cargas de trabalho, trocas de posição durante o turno de trabalho e mecanização do processo de trabalho são estratégias importantes para reduzir a exposição à nicotina, agrotóxicos e carga de trabalho ergonômica.
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Arifoğlu Karaman Ç, Küçükakkaş O. Cross-cultural adaptation and validation of the Back Beliefs Questionnaire to the Turkish language. Disabil Rehabil 2019; 43:1917-1923. [PMID: 31607168 DOI: 10.1080/09638288.2019.1677788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To perform the translation and cross-cultural adaptation of Back Beliefs Questionnaire to Turkish language and evaluate its reliability and validity. MATERIALS AND METHODS Back Beliefs Questionnaire was translated and culturally adapted into Turkish regarding to the published guidelines. This observational cross-sectional study was performed with 110 chronic low back pain patients. All participants were asked to complete Back Beliefs Questionnaire and also fill the socio-demographic data form and evaluation tools (Numeric rating scale-pain, Oswestry Disability Index, Fear Avoidance Beliefs Questionnaire, Hospital Anxiety and Depression Scale). Internal consistency was evaluated with Cronbach's alfa coefficient. Intraclass correlation coefficient was used to assess test-retest reliability. Structural validity was assessed by correlations with other tools. RESULTS Back Beliefs Questionnaire had a good internal consistency (Cronbach alfa = 0.79) and an excellent test-retest reliability (Intraclass correlation coefficient = 0.84). A moderate correlation was determined between Back Beliefs Questionnaire and Fear Avoidance Beliefs Questionnaire. Correlations with Numeric rating scale-pain, Oswestry Disability Index, Hospital Anxiety and Depression Scale were fair. CONCLUSIONS Turkish version of Back Beliefs Questionnaire is a valid and reliable questionnaire that can be used to evaluate beliefs about pain in patients with chronic low back pain.IMPLICATIONS FOR REHABILITATIONNegative attitudes and beliefs about low back pain cause patients to avoid engaging in physical activities and consequently lead to disability.The Back Belief Questionnaire can be used to evaluate these negative attitudes and beliefs to determine whether the patient will suffer from a disability in the future.Informations obtained with the Back Belief Questionnaire can be used to train the susceptible patients to prevent the development of disability and to promote patient participation in daily life.The Turkish version of Back Belief Questionnaire is a valid and reliable tool that can be used to assess back pain beliefs in Turkish-speaking individuals to prevent potential disability and burden to the economy.
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Affiliation(s)
- Çiğdem Arifoğlu Karaman
- Department of Physical Medicine and Rehabilitation, Metin Sabancı Baltalimani Bone Diseases Training and Research Hospital, İstanbul, Turkey
| | - Okan Küçükakkaş
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
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Santos MAD, Lunkes LC, Ribeiro ADO, Souza ADC. Low back pain and risk factors during the third infancy. FISIOTERAPIA EM MOVIMENTO 2019. [DOI: 10.1590/1980-5918.032.ao10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Low back pain is characterized as a pain in the area between the 12th rib and the low gluteal fold. This pain can affect different ages. During the growth peak, the postural control system is rearranged; therefore, the maintenance and fixation of these structures is crucial for the performance of daily activities. Thus, the prevalence of low back pain and their risk factors must be investigated, so that effective preventive measures against low back pain may be taken. Objective: To investigate the prevalence of low back pain and the risks associated to it during the third infancy, that is, children aged between 6 and 12 years old. Method: A transversal and observational study with 150 children of both genders, students from private institutions of Lavras, Minas Gerais, in 2016. Questionnaires were applied in order to understand the characteristics of the sample (age, gender, school year, ethnic group, parents’ educational level, means of transportation to go to school and situations that caused or aggravated low back pain) and their low back pain (in the last 12 months). Results: The rate of occurrence of low back pain in the senior year of school was 20%. According to the chi-squared, “school year” and “ethnic group” (pardos) were the variables associated to low back pain. Sitting, mainly in front of the computer, was reported to be the main cause of the symptoms. Conclusion: Low back pain presented a prevalence of 20% with no significant difference between genders, but there was an association of low back pain and variables related to the school year and the ethnic group.
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Duarte VM, Meucci RD, Cesar JA. Dor lombar intensa em gestantes do extremo Sul do Brasil. CIENCIA & SAUDE COLETIVA 2018; 23:2487-2494. [DOI: 10.1590/1413-81232018238.22562016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/23/2016] [Indexed: 08/30/2023] Open
Abstract
Resumo O objetivo deste artigo é medir a prevalência e identificar fatores associados à dor lombar intensa (DL intensa) entre parturientes do município de Rio Grande, RS, Brasil, em 2013. Questionário padronizado aplicado por entrevistadoras previamente treinadas em até 48 horas após o parto. Realizou-se análise multivariável utilizando regressão de Poisson tendo a razão de prevalência como medida de efeito. Dentre as 2685 parturientes incluídas no estudo, 51,2% referiram dor lombar gestacional e 27,3% tinham DL intensa, com maior probabilidade de ocorrência entre adolescentes, mulheres com sobrepeso/obesidade, ex-fumantes e naquelas que praticaram atividade física na gestação. Entre as parturientes que tiveram DL intensa, 29,2%, 37,3% e 33,3% tiveram que deixar de fazer as lidas da casa, faltar ao trabalho e procurar um médico devido à DL, respectivamente. É elevada a prevalência de dor lombar intensa no período gestacional e preocupante seu impacto sobre as atividades da vida diária e utilização de serviços de saúde. Recomenda-se investigação clínica e manejo da dor lombar durante a gestação nas consultas de rotina do pré-natal.
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Wei G, Li H, Wang B, Wu J, Wu F, Lin Z. A retrospective cross-sectional survey of non-specific lower back pain among a cohort of Chinese army soldiers. Int J Surg 2018; 56:288-293. [DOI: 10.1016/j.ijsu.2018.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/30/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
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Meucci RD, Linhares AO, Olmedo DWV, Cousin Sobrinho ELP, Duarte VM, Cesar JA. Dor lombar em adolescentes do semiárido: resultados de um censo populacional no município de Caracol (PI), Brasil. CIENCIA & SAUDE COLETIVA 2018. [DOI: 10.1590/1413-81232018233.04312016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo O objetivo deste artigo é avaliar a prevalência e os fatores associados à dor lombar nos últimos 12 meses entre adolescentes de um município do sul do estado do Piauí, Brasil. Estudo transversal com 1112 adolescentes de 13-19 anos do município de Caracol. Investigaram-se características demográficas, socioeconômicas, nutricionais, comportamentais e comorbidades. O desfecho foi a ocorrência de dor lombar (DL) nos últimos 12 meses. Foi calculada a prevalência do desfecho de acordo com as variáveis independentes. Entre os adolescentes com DL no último ano, foi calculada a proporção de indivíduos com dor lombar crônica. Para análise dos fatores associados, foi utilizada a regressão de Poisson bruta e ajustada para cálculo das razões de prevalência. A prevalência de dor lombar nos últimos 12 meses foi de 32,9%. De acordo com a análise ajustada, sexo feminino (RP = 1,75; IC95%:1,45-2,10), idade entre 18-19 anos (RP = 1,27; IC95%:1,01-1,62), maior renda (RP = 1,33; IC95%:1,06-1,67), estar trabalhando (RP 1,25 IC95%:1,02-1,53) e apresentar distúrbios psiquiátricos menores (RP 1,51 IC95%: 1,25-1,82) permaneceram associados à DL nos últimos 12 meses. Este estudo encontrou elevada prevalência de DL entre adolescentes de um município pequeno do semiárido nordestino.
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Olafsson G, Jonsson E, Fritzell P, Hägg O, Borgström F. A health economic lifetime treatment pathway model for low back pain in Sweden. J Med Econ 2017; 20:1281-1289. [PMID: 28840772 DOI: 10.1080/13696998.2017.1372252] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS To develop a health economic model to evaluate the long-term costs and outcomes over the healthcare treatment pathway for patients with low back pain (LBP). MATERIALS AND METHODS A health economic model, consisting of a decision tree structure with a Markov microsimulation model at the end of each branch, was created. Patients were followed from first observed clinical presentation with LBP until the age of 100 years or death. The underlying data to populate the model were based on Swedish national and regional registry data on healthcare resource use and sickness insurance in patients presenting with LBP in the Swedish region Västra Götaland during 2008-2012. Costs (outpatient healthcare visits, inpatient bed days, pharmaceuticals, productivity loss), EUR 2016, and quality-of-life based on EQ-5D data from the registries and published estimates were summarized over the lifetime of the patients with 3% annual discount. A lost quality-adjusted life year (QALY) was valued at €70,000. RESULTS Mean lifetime total cost was estimated at €47,452/patient, of which indirect costs were 57%. Total lifetime economic burden for all patients coming to clinical presentation in Sweden per year was €8.8bn. The average LBP patient was estimated to face a loss of 2.7 QALYs over their lifetime compared with the general population. For all patients in Sweden coming to clinical presentation in 1 year this gives 505,407 QALYs lost, valued at €35.3bn. Adding the economic burden, the total societal burden amounts to €44.1bn. CONCLUSION This pathway model shows that most patients with LBP receive conservative care, and a minority consume high-cost healthcare interventions like surgery. The model could be used to see broad economic effects of different patterns of healthcare provision in sub-groups with LBP and to estimate where it is possible to influence these pathways to increase utility for patients and for society.
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Affiliation(s)
- Gylfi Olafsson
- a Quantify Research , Stockholm , Sweden
- b LIME/MMC , Karolinska Institutet , Stockholm , Sweden
| | | | - Peter Fritzell
- c Capio St Göran , Stockholm , Sweden
- d Futurum Academy , Jönköping , Sweden
| | - Olle Hägg
- e Spine Center Göteborg , Gothenburg , Sweden
| | - Fredrik Borgström
- a Quantify Research , Stockholm , Sweden
- b LIME/MMC , Karolinska Institutet , Stockholm , Sweden
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Müller-Schwefe G, Morlion B, Ahlbeck K, Alon E, Coaccioli S, Coluzzi F, Huygen F, Jaksch W, Kalso E, Kocot-Kępska M, Kress HG, Mangas AC, Margarit Ferri C, Mavrocordatos P, Nicolaou A, Hernández CP, Pergolizzi J, Schäfer M, Sichère P. Treatment for chronic low back pain: the focus should change to multimodal management that reflects the underlying pain mechanisms. Curr Med Res Opin 2017; 33:1199-1210. [PMID: 28277866 DOI: 10.1080/03007995.2017.1298521] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
UNLABELLED Chronic low back pain: Chronic pain is the most common cause for people to utilize healthcare resources and has a considerable impact upon patients' lives. The most prevalent chronic pain condition is chronic low back pain (CLBP). CLBP may be nociceptive or neuropathic, or may incorporate both components. The presence of a neuropathic component is associated with more intense pain of longer duration, and a higher prevalence of co-morbidities. However, many physicians' knowledge of chronic pain mechanisms is currently limited and there are no universally accepted treatment guidelines, so the condition is not particularly well managed. DIAGNOSIS Diagnosis should begin with a focused medical history and physical examination, to exclude serious spinal pathology that may require evaluation by an appropriate specialist. Most patients have non-specific CLBP, which cannot be attributed to a particular cause. It is important to try and establish whether a neuropathic component is present, by combining the findings of physical and neurological examinations with the patient's history. This may prove difficult, however, even when using screening instruments. Multimodal management: The multifactorial nature of CLBP indicates that the most logical treatment approach is multimodal: i.e. integrated multidisciplinary therapy with co-ordinated somatic and psychotherapeutic elements. As both nociceptive and neuropathic components may be present, combining analgesic agents with different mechanisms of action is a rational treatment modality. Individually tailored combination therapy can improve analgesia whilst reducing the doses of constituent agents, thereby lessening the incidence of side effects. CONCLUSIONS This paper outlines the development of CLBP and the underlying mechanisms involved, as well as providing information on diagnosis and the use of a wide range of pharmaceutical agents in managing the condition (including NSAIDs, COX-2 inhibitors, tricyclic antidepressants, opioids and anticonvulsants), supplemented by appropriate non-pharmacological measures such as exercise programs, manual therapies, behavioral therapies, interventional pain management and traction. Surgery may be appropriate in carefully selected patients.
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Affiliation(s)
| | | | | | - Eli Alon
- d Universitätsspital Zurich , Zurich , Switzerland
| | | | - Flaminia Coluzzi
- f Department of Medical and Surgical Sciences and Biotechnologies , Sapienza University of Rome , Italy
| | - Frank Huygen
- g University Hospital , Rotterdam , The Netherlands
| | | | - Eija Kalso
- i Pain Clinic, Department of Anaesthesiology, Intensive Care and Pain Medicine , University of Helsinki, and Helsinki University Hospital , Finland
| | - Magdalena Kocot-Kępska
- j Department of Pain Research and Treatment , Collegium Medicum Jagiellonian University , Kraków , Poland
| | - Hans-Georg Kress
- k Department of Special Anaesthesia and Pain Therapy , Medizinische Universität/AKH Wien , Vienna , Austria
| | | | | | | | | | | | | | - Michael Schäfer
- r Department of Anaesthesiology and Intensive Care Medicine , Charité University Berlin, Campus Virchow Klinikum , Berlin , Germany
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Dagostino C, De Gregori M, Gieger C, Manz J, Gudelj I, Lauc G, Divizia L, Wang W, Sim M, Pemberton IK, MacDougall J, Williams F, Van Zundert J, Primorac D, Aulchenko Y, Kapural L, Allegri M. Validation of standard operating procedures in a multicenter retrospective study to identify -omics biomarkers for chronic low back pain. PLoS One 2017; 12:e0176372. [PMID: 28459826 PMCID: PMC5411039 DOI: 10.1371/journal.pone.0176372] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 04/10/2017] [Indexed: 12/03/2022] Open
Abstract
Chronic low back pain (CLBP) is one of the most common medical conditions, ranking as the greatest contributor to global disability and accounting for huge societal costs based on the Global Burden of Disease 2010 study. Large genetic and -omics studies provide a promising avenue for the screening, development and validation of biomarkers useful for personalized diagnosis and treatment (precision medicine). Multicentre studies are needed for such an effort, and a standardized and homogeneous approach is vital for recruitment of large numbers of participants among different centres (clinical and laboratories) to obtain robust and reproducible results. To date, no validated standard operating procedures (SOPs) for genetic/-omics studies in chronic pain have been developed. In this study, we validated an SOP model that will be used in the multicentre (5 centres) retrospective “PainOmics” study, funded by the European Community in the 7th Framework Programme, which aims to develop new biomarkers for CLBP through three different -omics approaches: genomics, glycomics and activomics. The SOPs describe the specific procedures for (1) blood collection, (2) sample processing and storage, (3) shipping details and (4) cross-check testing and validation before assays that all the centres involved in the study have to follow. Multivariate analysis revealed the absolute specificity and homogeneity of the samples collected by the five centres for all genetics, glycomics and activomics analyses. The SOPs used in our multicenter study have been validated. Hence, they could represent an innovative tool for the correct management and collection of reliable samples in other large-omics-based multicenter studies.
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Affiliation(s)
- Concetta Dagostino
- Anesthesia, Critical Care and Pain Medicine Unit, Division of Surgical Sciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
- * E-mail:
| | - Manuela De Gregori
- PainTherapy Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Christian Gieger
- Institute of Epidemiology II, Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Judith Manz
- Institute of Epidemiology II, Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Ivan Gudelj
- Genos, Glycoscience Research Laboratory, Zagreb, Croatia
| | - Gordan Lauc
- Genos, Glycoscience Research Laboratory, Zagreb, Croatia
| | - Laura Divizia
- Laboratory of Biochemistry and Genetics, Division of Pneumology, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Wei Wang
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Moira Sim
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Iain K. Pemberton
- IP Research Consulting SASU (PHOTEOMIX) - Rex de Chaussée, Noisy le Grand, France
| | - Jane MacDougall
- IP Research Consulting SASU (PHOTEOMIX) - Rex de Chaussée, Noisy le Grand, France
| | - Frances Williams
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | - Jan Van Zundert
- Department of Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Dragan Primorac
- St. Catherine Specialty Hospital, Zabok, Croatia
- Eberly College of Science, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- University of Split School of Medicine, Split, Croatia
- University of Osijek School of Medicine, Osijek, Croatia
- Children's Hospital Srebrnjak, Zagreb, Croatia
| | | | - Leonardo Kapural
- Carolinas Pain Institute, Winston-Salem, North Carolina, United States of America
| | - Massimo Allegri
- Anesthesia, Critical Care and Pain Medicine Unit, Division of Surgical Sciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Vygonskaya MS. Nonspecific low-back pain: approaches to diagnosis and treatment. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:142-146. [DOI: 10.17116/jnevro201711791142-146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Batista AADS, Henschke N, Oliveira VC. Prevalence of low back pain in different educational levels: a systematic review. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.s01.ar04] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Non-specific low back pain (LBP) can be understood through the interaction of biopsychosocial factors such as education. Unfortunately, it remains unclear whether education can be considered an important risk and prognostic factor for the occurrence of LBP. Objective: To investigate the association between education and LBP. Methods: The following databases were searched: MEDLINE, EMBASE, Cochrane, AMED and PsyINFO. Results: Thirteen studies were included in the review. The Prevalence Critical Appraisal Instrument (PCAI) was used to assess risk of bias. Methodological quality scores ranged from 7 to 10 on a scale of 0-10. There was a 23% (95% CI, 13-37) prevalence of LBP (10,582 out of a total of 99,457 cases) in the general sample at the time of assessment. The meta-analysis of studies on the prevalence of LBP in people with low, medium or high educational level found the following results, respectively: 24% (95% CI, 12-43), 27% (95% CI, 9-56), and 18% (95% CI, 5-50). The meta-regression identified heterogeneity among the studies included in the review. This can be explained by educational differences (p < 0.05). Conclusion: Occurrence of LBP varies according to educational level. Individuals with higher educational levels are less often affected by LBP than individuals with medium or low educational levels.
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Malta DC, Bernal RTI, de Souza MDFM, Szwarcwald CL, Lima MG, Barros MBDA. Social inequalities in the prevalence of self-reported chronic non-communicable diseases in Brazil: national health survey 2013. Int J Equity Health 2016; 15:153. [PMID: 27852264 PMCID: PMC5112650 DOI: 10.1186/s12939-016-0427-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 09/01/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Considering the high socioeconomic inequalities in Brazil related to occurrence of morbidity and premature mortality, the objective of this study was to analyze inequalities in self-reported prevalence of Non-Communicable Diseases (NCD) and in the physical limitations caused by these diseases, among the Brazilian adult population, according to sociodemographic variables. METHODS This was a population-based cross-sectional study that analyzed information on 60,202 individuals who formed a representative sample of Brazilian adults interviewed for the National Health Survey 2013. Disparities by schooling levels and possession of private health insurance were assessed by calculating the prevalence (P) and prevalence ratio (PR) of each of the 13 NCDs and any associated limitations, while controlling for other socioeconomic and demographic variables. RESULTS 45 % of the Brazilian adult population reported having at least one NCD. The prevalence ratio was greater among women (1.24 CI 1.21-1.28), individuals over 55 years of age, individuals with low schooling levels (illiterate and incomplete elementary education) (1.08 CI 1.02-1.14) and people living in the Southeast (1.10 CI 1.04-1.16), South (1.26 CI 1.19-1.34) and Central-West (1.11 CI 1.05-1.18) regions of the country. Diseases such as diabetes (1.42 CI 1.13-1.47), hypertension (1.17 CI 1.06-1.28), stroke (2.52 CI 1.74-3.66), arthritis (1.4 CI 1.11-1.77), spinal problems (1.39 CI .1.25-1.56), and chronic renal failure (1.65 CI 1.10.2.46), were more prevalent among adults with low education. For most NCDs, greater reports of limitations were associated with lower schooling levels and lack of private health insurance. CONCLUSION Populations with lower schooling levels and lack of private health insurance present higher prevalence of various NCD and greater degrees of limitation due to these diseases. Results reveal the extent of social inequalities that persist with regard to occurrence and the impact of NCDs in Brazil.
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Affiliation(s)
- Deborah Carvalho Malta
- Nursing School, Universidade Federal de Minas Gerais (UFMG), Avenida Alfredo Balena, 190 Santa Efigenia, CEP – 30.130.100 Belo Horizonte, Minas Gerais Brazil
| | - Regina Tomie Ivata Bernal
- Center for Epidemiological Research on Nutrition and Health School of Public Health, University of São Paulo, São Paulo, SP Brazil
| | | | - Celia Landman Szwarcwald
- Center for Scientific and Technological Information, Department of Health Information, Oswaldo Cruz Foundation, Manguinhos, Brazil
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Allegri M, De Gregori M, Minella CE, Klersy C, Wang W, Sim M, Gieger C, Manz J, Pemberton IK, MacDougall J, Williams FMK, Van Zundert J, Buyse K, Lauc G, Gudelj I, Primorac D, Skelin A, Aulchenko YS, Karssen LC, Kapural L, Rauck R, Fanelli G. 'Omics' biomarkers associated with chronic low back pain: protocol of a retrospective longitudinal study. BMJ Open 2016; 6:e012070. [PMID: 27798002 PMCID: PMC5073566 DOI: 10.1136/bmjopen-2016-012070] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Chronic low back pain (CLBP) produces considerable direct costs as well as indirect burdens for society, industry and health systems. CLBP is characterised by heterogeneity, inclusion of several pain syndromes, different underlying molecular pathologies and interaction with psychosocial factors that leads to a range of clinical manifestations. There is still much to understand in the underlying pathological processes and the non-psychosocial factors which account for differences in outcomes. Biomarkers that may be objectively used for diagnosis and personalised, targeted and cost-effective treatment are still lacking. Therefore, any data that may be obtained at the '-omics' level (glycomics, Activomics and genome-wide association studies-GWAS) may be helpful to use as dynamic biomarkers for elucidating CLBP pathogenesis and may ultimately provide prognostic information too. By means of a retrospective, observational, case-cohort, multicentre study, we aim to investigate new promising biomarkers potentially able to solve some of the issues related to CLBP. METHODS AND ANALYSIS The study follows a two-phase, 1:2 case-control model. A total of 12 000 individuals (4000 cases and 8000 controls) will be enrolled; clinical data will be registered, with particular attention to pain characteristics and outcomes of pain treatments. Blood samples will be collected to perform -omics studies. The primary objective is to recognise genetic variants associated with CLBP; secondary objectives are to study glycomics and Activomics profiles associated with CLBP. ETHICS AND DISSEMINATION The study is part of the PainOMICS project funded by European Community in the Seventh Framework Programme. The study has been approved from competent ethical bodies and copies of approvals were provided to the European Commission before starting the study. Results of the study will be reviewed by the Scientific Board and Ethical Committee of the PainOMICS Consortium. The scientific results will be disseminated through peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02037789; Pre-results.
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Affiliation(s)
- Massimo Allegri
- Department of surgical science, University of Parma, Parma, Italy
- Anesthesia Intensive Care and Pain Therapy service, Azienda Ospedaliera Universitaria Parma, Parma, Italy
| | - Manuela De Gregori
- Anesthesia, Intensive Care and Pain Therapy, Emergency Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cristina E Minella
- Anesthesia, Intensive Care and Pain Therapy, Emergency Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Research Department, Service of Biometry & Statistics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Wei Wang
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Moira Sim
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Christian Gieger
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, Neuherberg, Germany
| | - Judith Manz
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, Neuherberg, Germany
| | | | - Jane MacDougall
- Photeomix, IP Research Consulting SAS, Noisy le Grand, France
| | - Frances MK Williams
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Jan Van Zundert
- Department of Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Klaas Buyse
- Department of Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Gordan Lauc
- Genos Glycoscience Research Laboratory, Zagreb, Croatia
| | - Ivan Gudelj
- Genos Glycoscience Research Laboratory, Zagreb, Croatia
| | - Dragan Primorac
- St. Catherine Specialty Hospital, Zabok, Croatia
- Eberly College of Science, State College, Penn State University,Pennsylvania, USA
- Faculty of Medicine, University of Osijek, Osijek, Croatia
- University of Split School of Medicine, Split, Croatia
- Children's Hospital Srebrnjak, Zagreb, Croatia
| | - Andrea Skelin
- Genos Glycoscience Research Laboratory, Zagreb, Croatia
- St. Catherine Specialty Hospital, Zabok, Croatia
| | | | | | | | - Richard Rauck
- Carolinas Pain Institute, Winston-Salem, North Carolina, USA
| | - Guido Fanelli
- Department of surgical science, University of Parma, Parma, Italy
- Anesthesia Intensive Care and Pain Therapy service, Azienda Ospedaliera Universitaria Parma, Parma, Italy
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Depintor JDP, Bracher ESB, Cabral DMC, Eluf-Neto J. Prevalence of chronic spinal pain and identification of associated factors in a sample of the population of São Paulo, Brazil: cross-sectional study. SAO PAULO MED J 2016; 134:375-384. [PMID: 27901240 PMCID: PMC10871843 DOI: 10.1590/1516-3180.2016.0091310516] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 05/31/2016] [Indexed: 01/21/2023] Open
Abstract
CONTEXT AND OBJECTIVE: Chronic spinal pain, especially low-back pain and neck pain, is a leading cause of years of life with disability. The aim of the present study was to estimate the prevalence of chronic spinal pain among individuals aged 15 years or older and to identify the factors associated with it. DESIGN AND SETTING: Cross-sectional epidemiological study on a sample of the population of the city of São Paulo. METHOD: Participants were selected using random probabilistic sampling and data were collected via face-to-face interviews. The Hospital Anxiety and Depression Scale (HADS), EuroQol-5D, Alcohol Use Disorders Identification Test (AUDIT), Fagerström test for nicotine dependence and Brazilian economic classification criteria were used. RESULTS: A total of 826 participants were interviewed. The estimated prevalence of chronic spinal pain was 22% (95% confidence interval, CI: 19.3-25.0%). The factors independently associated with chronic spinal pain were: female sex, age 30 years or older, schooling level of four years or less, symptoms compatible with anxiety and high physical exertion during the main occupation. Quality of life and self-rated health scores were significantly worse among individuals with chronic spinal pain. CONCLUSION: The prevalence of chronic spinal pain in this segment of the population of São Paulo was 22.0%. The factors independently associated with chronic pain were: female sex, age 30 years or older, low education, symptoms compatible with anxiety and physical exertion during the main occupation.
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Affiliation(s)
| | | | | | - José Eluf-Neto
- MD, PhD. Professor, Department of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
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Abstract
Epidemiological data suggests that the prevalence of musculoskeletal and neuropathic pain increases with age until at least late mid-life, though the pattern is somewhat unclear beyond this point. And though the prevalence of some types of pain may peak in late midlife, pain is still a substantial and common complaint even in the oldest age groups. This article provides an overview of later-life pain and includes a brief review of its epidemiology, describes commonly encountered barriers to its management, and discusses guidelines and recommended approaches to its assessment and management.
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Affiliation(s)
- Steven M Savvas
- Clinical Division, National Ageing Research Institute, 34-48 Poplar Road, Parkville, Victoria 3052, Australia.
| | - Stephen J Gibson
- Clinical Division, National Ageing Research Institute, 34-48 Poplar Road, Parkville, Victoria 3052, Australia
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Rodrigues-de-Souza DP, Palacios-Ceña D, Moro-Gutiérrez L, Camargo PR, Salvini TF, Alburquerque-Sendín F. Socio-Cultural Factors and Experience of Chronic Low Back Pain: a Spanish and Brazilian Patients' Perspective. A Qualitative Study. PLoS One 2016; 11:e0159554. [PMID: 27434594 PMCID: PMC4951039 DOI: 10.1371/journal.pone.0159554] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 07/04/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Low back pain (LBP) could be influenced by socio-cultural factors. Pain narratives are important to understand the influence of environment on patients with chronic LBP. There are few studies that have explored the experience of patients with chronic LBP in different socio-cultural environments. The aim of this study was to describe the experience of patients with chronic LBP in Spain and Brazil. METHODS A qualitative phenomenology approach was implemented. Chronic LBP patients from the University Hospital of Salamanca (Spain), and/or Federal University of São Carlos (Brazil) were included, using purposeful sampling. Data were collected from 22 Spanish and 26 Brazilian patients during in-depth interviews and using researchers' field notes and patients' personal diaries and letters. A thematic analysis was performed and the guidelines for reporting qualitative research were applied. RESULTS Forty-eight patients with a mean age of 50.7 years (SD: ± 13.1 years) were included in the study. The themes identified included: a) ways of perceiving and expressing pain-the participants focused constantly on their pain and anything outside it was considered secondary; b) the socio-familial environment as a modulator of pain-most participants stated that no one was able to understand the pain they were experiencing; c) religion as a modulator of pain-all Brazilian patients stated that religious belief affected the experience of pain; and d) socio-economic and educational status as a modulator of pain-the study reported that economic factors influenced the experience of pain. CONCLUSIONS The influences of LBP can be determined based on the how a patient defines pain. Religion can be considered as a possible mechanism for patients to manage pain and as a form of solace.
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Affiliation(s)
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Lourdes Moro-Gutiérrez
- Department of Social Psychology and Anthropology, University of Salamanca, Salamanca, Spain
| | | | - Tania Fátima Salvini
- Department of Physical Therapy, Federal University of Sao Carlos, São Paulo, Brazil
| | - Francisco Alburquerque-Sendín
- Biomedical Research Institute of Salamanca (IBSAL), Department of Nursing and Physical Therapy, University of Salamanca, Salamanca, Spain
- * E-mail:
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Rodrigues-De-Souza DP, Fernández-De-Las-Peñas C, Martín-Vallejo FJ, Blanco-Blanco JF, Moro-Gutiérrez L, Alburquerque-Sendín F. Differences in pain perception, health-related quality of life, disability, mood, and sleep between Brazilian and Spanish people with chronic non-specific low back pain. Braz J Phys Ther 2016; 20:412-421. [PMID: 27333485 PMCID: PMC5123262 DOI: 10.1590/bjpt-rbf.2014.0175] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 03/03/2016] [Indexed: 12/29/2022] Open
Abstract
Background Cultural and social factors play an important role in the development and persistence of Low Back Pain (LBP). Nevertheless, there are few studies investigating differences in LBP features between countries. Objective To determine differences in pain perception between individuals with LBP living in Brazil and Spain. Method Thirty Spanish individuals and 30 age- and sex-comparable Brazilian individuals with LBP were recruited from the Public Health Services of both countries. The Numerical Pain Rating Scale and the pain rating index (PRI), the number of words chosen (NWC), and the present pain index (PPI) extracted from the McGill Pain Questionnaire were used to assess pain. The Oswestry Disability Index, the Short Form-36, Beck Depression Inventory-II, and Pittsburgh Sleep Quality Index were also applied. Differences between countries and the correlation between demographic and clinical variables in each country were assessed with parametric and the nonparametric tests. Results A significant Country by Gender interaction was found for the PRI total score (P=0.038), but not for intensity of pain, disability, PPI, or NWC, in which Spanish women exhibited greater pain ratio than Spanish men (P=0.014), and no gender differences were identified in Brazilians. The Spanish group showed a consistent pattern of correlations for clinical data. Within Brazilian patients, fewer correlations were found and all of the coefficients were lower than those in the Spanish group. Conclusion The pain perception in patients with LBP is different depending on the country. Within Spanish patients, LBP is considered a more global entity affecting multidimensional contexts.
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Affiliation(s)
| | - César Fernández-De-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.,Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Spain
| | | | - Juan F Blanco-Blanco
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.,Hospital Universitario de Salamanca Unidad Virgen Vega, Salamanca, Spain
| | - Lourdes Moro-Gutiérrez
- Department of Social Psychology and Anthropology, Universidad de Salamanca, Salamanca, Spain
| | - Francisco Alburquerque-Sendín
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.,Department of Nursing and Physical Therapy, Universidad de Salamanca, Salamanca, Spain
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Wáng YXJ, Wáng JQ, Káplár Z. Increased low back pain prevalence in females than in males after menopause age: evidences based on synthetic literature review. Quant Imaging Med Surg 2016; 6:199-206. [PMID: 27190772 DOI: 10.21037/qims.2016.04.06] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Female sex hormones play an important role in the etiology and pathophysiology of a variety of musculoskeletal degenerative diseases. Postmenopausal women show accelerated disc degeneration due to relative estrogen deficiency. This literature review aims to validate or falsify this hypothesis, i.e., while overall females have higher prevalence of low back pain (LBP) across all age groups, this male vs. female difference in LBP prevalence further increases after female menopause age. The literature search was performed on PubMed on January 2, 2016. The search word combination was (low back pain) AND prevalence AND [(males OR men) AND (females OR women)]. The following criteria were taken to include the papers for synthetic analysis: (I) only English primary literatures on nonspecific pain; (II) only prospective studies on general population, but not population with occupational LBP causes, of both males and female subjects studied using the same LBP criterion, ages-specific information available, and males and female subjects were age-matched; (III) studies without major quality flaws. In total 98 studies with 772,927 subjects were analyzed. According to the information in the literature, participant subjects were divided into four age groups: (I) school age children group: 6-19 years; (II) young and middle aged group: 20-50 years; (III) mixed age group: data from studies did not differentiate age groups; (IV) elderly group: ≥50 years old. When individual studies were not weighted by participant number and each individual study is represented as one entry regardless of their sample size, the median LBP prevalence ratio of female vs. males was 1.310, 1.140, 1.220, and 1.270 respectively for the four age groups. When individual studies were weighted by participant number, the LBP prevalence ratio of female vs. males was 1.360, 1.127, 1.185, and 1.280 respectively for the four groups. The higher LBP prevalence in school age girls than in school age boys is likely due to psychological factors, female hormone fluctuation, and menstruation. Compared with young and middle aged subjects, a further increased LBP prevalence in females than in males was noted after menopause age.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Jùn-Qīng Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Zoltán Káplár
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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Leopoldino AAO, Diz JBM, Martins VT, Henschke N, Pereira LSM, Dias RC, Oliveira VC. Prevalência de lombalgia na população idosa brasileira: revisão sistemática com metanálise. REVISTA BRASILEIRA DE REUMATOLOGIA 2016. [DOI: 10.1016/j.rbr.2016.01.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Leopoldino AAO, Diz JBM, Martins VT, Henschke N, Pereira LSM, Dias RC, Oliveira VC. Prevalence of low back pain in older Brazilians: a systematic review with meta-analysis. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 56:258-69. [PMID: 27267645 DOI: 10.1016/j.rbre.2016.03.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 01/29/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Prevalence of low back pain (LBP) is expected to increase worldwide with aging of the population but its prevalence in older people is not clear, mainly in developing countries. OBJECTIVE To estimate the prevalence of LBP in older Brazilians. METHODS Electronic searches on SciELO, LILACS, MEDLINE, EMBASE and CINAHL, as well as hand-searching identified studies investigating prevalence of LBP in older Brazilians aged 60 years or over. Two independent reviewers selected studies fulfilling the inclusion criteria, assessed risk of bias for each included study and extracted relevant data. Meta-analysis was conducted when enough homogeneity allowed and the GRADE system was used to summarize the overall quality of the evidence. RESULTS Sixteen studies were included with a total of 28,448 participants. Data from point- and period-prevalence of LBP were obtained. Meta-analysis was conducted for 13 studies reporting point-prevalence. Pooled point-prevalence of LBP was 25.0% (95% CI 18.0-32.0). Other three studies investigated period-prevalence: one-week prevalence=15.0% (95% CI 13.0-18.0); six-month prevalence=43.0% (95% CI 42.0-44.0); and 12-month prevalence=13.0% (95% CI 11.0-16.0). Sensitivity analyses were performed for point-prevalence and exclusion of studies with poorer methodological quality tended to increase the estimated prevalence of LBP. CONCLUSION Moderate-quality evidence showed that at any point in time one in four older Brazilians suffers from LBP. This was the first systematic review investigating nationwide data on the prevalence of LBP in older people and contributes important clinical and epidemiological evidence for policymakers.
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Affiliation(s)
- Amanda Aparecida Oliveira Leopoldino
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia; Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | | | - Vítor Tigre Martins
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Nicholas Henschke
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Leani Souza Máximo Pereira
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Rosângela Correa Dias
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Vinícius Cunha Oliveira
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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A Subtle Threat to Urban Populations in Developing Countries: Low Back Pain and its Related Risk Factors. Spine (Phila Pa 1976) 2016; 41:618-27. [PMID: 27018901 DOI: 10.1097/brs.0000000000001269] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional, population-based survey. OBJECTIVE The aim of this study was to estimate the prevalence, and biological and psychological correlates of low back pain (LBP) in large, populated urban areas. SUMMARY OF BACKGROUND DATA LBP is a common and costly medical problem all around the world. Currently, there are limited data available on prevalence as well as biological and psychological correlates of LBP in large urban populations in developing countries. METHODS Here, in a cross-sectional, population-based survey, we analyzed data obtained from 22,952 subjects living in Tehran. RESULTS Chronic, 1-year, and point prevalence of LBP among subjects were 12.2%, 42.1%, and 36.2%, respectively. LBP was more prevalent among older population, women, housewives, and obese people after adjustment for confounding factors using logistic regression models. In addition, persons with a general health questionnaire (GHQ-28) score ≥6 were about 2 times more likely to experience LBP in comparison with others. Both subjects with higher educational levels and those who were never married reported significantly less LBP. Furthermore, we could not find any significant correlation between smoking and physical activity level with LBP. CONCLUSION LBP is prevalent among the general population of Tehran. Our findings can help health care providers regarding logical assignment of limited resources, in order to create multidimensional prevention plans according to potentially modifiable associated factors. LEVEL OF EVIDENCE 3.
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Teles AR, Righesso O, Gullo MCR, Ghogawala Z, Falavigna A. Perspective of Value-Based Management of Spinal Disorders in Brazil. World Neurosurg 2016; 87:346-54. [DOI: 10.1016/j.wneu.2015.11.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 11/12/2015] [Accepted: 11/14/2015] [Indexed: 01/22/2023]
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Iguti AM, Bastos TF, Barros MBDA. Dor nas costas em população adulta: estudo de base populacional em Campinas, São Paulo, Brasil. CAD SAUDE PUBLICA 2015; 31:2546-58. [DOI: 10.1590/0102-311x00178114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 06/08/2015] [Indexed: 11/22/2022] Open
Abstract
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.
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Meucci RD, Fassa AG, Faria NMX. Prevalence of chronic low back pain: systematic review. Rev Saude Publica 2015; 49:S0034-89102015000100408. [PMID: 26487293 PMCID: PMC4603263 DOI: 10.1590/s0034-8910.2015049005874] [Citation(s) in RCA: 465] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/31/2015] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To estimate worldwide prevalence of chronic low back pain according to age and sex. METHODS We consulted Medline (PubMed), LILACS and EMBASE electronic databases. The search strategy used the following descriptors and combinations: back pain, prevalence, musculoskeletal diseases, chronic musculoskeletal pain, rheumatic, low back pain, musculoskeletal disorders and chronic low back pain. We selected cross-sectional population-based or cohort studies that assessed chronic low back pain as an outcome. We also assessed the quality of the selected studies as well as the chronic low back pain prevalence according to age and sex. RESULTS The review included 28 studies. Based on our qualitative evaluation, around one third of the studies had low scores, mainly due to high non-response rates. Chronic low back pain prevalence was 4.2% in individuals aged between 24 and 39 years old and 19.6% in those aged between 20 and 59. Of nine studies with individuals aged 18 and above, six reported chronic low back pain between 3.9% and 10.2% and three, prevalence between 13.1% and 20.3%. In the Brazilian older population, chronic low back pain prevalence was 25.4%. CONCLUSIONS Chronic low back pain prevalence increases linearly from the third decade of life on, until the 60 years of age, being more prevalent in women. Methodological approaches aiming to reduce high heterogeneity in case definitions of chronic low back pain are essential to consistency and comparative analysis between studies. A standard chronic low back pain definition should include the precise description of the anatomical area, pain duration and limitation level.
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Affiliation(s)
- Rodrigo Dalke Meucci
- Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brasil
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Chen C, Jia Z, Han Z, Gu T, Li W, Li H, Tang Y, Wu J, Wang D, He Q, Ruan D. Quantitative T2 relaxation time and magnetic transfer ratio predict endplate biochemical content of intervertebral disc degeneration in a canine model. BMC Musculoskelet Disord 2015; 16:157. [PMID: 26123048 PMCID: PMC4485356 DOI: 10.1186/s12891-015-0610-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/29/2015] [Indexed: 12/24/2022] Open
Abstract
Background Direct measurement of disc biochemical content is impossible in vivo. Therefore, magnetic resonance imaging (MRI) is used to evaluate disc health. Unfortunately, current clinical imaging techniques do not adequately assess degeneration, especially in the early stage of cartilage endplate, and subchondral bone zone (CEPZ). Therefore, this study aimed to investigate the sensitivity of quantitative MRI methods, namely T2 relaxation time and Magnetic Transfer Ratio (MTR), to identify early disc degeneration, especially for the CEPZ, using an experimental canine model of intervertebral disc injury and to investigate their sensitivity in depicting biochemically and histologically controlled degenerative changes in the disc. Methods Sixteen juvenile dogs underwent iatrogenic annular disruption via stab incisions. The animals underwent repeated 3.0 T MR imaging, and were sacrificed 4, 8, and 12 weeks post-operatively. A continuous rectangle drawing method was used to select regions of interest for the intervertebral disc from the cephalic to caudal CEPZ including the vertebrae, nucleus pulposus (NP) and annulus fibrosus (AF), which resembled pixel measurement for imaging analysis. Presence of degenerative changes was controlled by biochemical and histological analyses. The correlations between histological score, biochemical content, and quantitative MRI signal intensities were also analyzed. Results Both T2 relaxation time and MTR values changed for CEPZ, NP, and AF tissues within 12 weeks. T2 relaxation time values decreased significantly in the NP, AF, and CEPZ separately at pre-operation, 4, 8, and 12 weeks when compared each time (P < 0.05). MTR values showed no significant differences for the CEPZ between 8 and 4 weeks or 12 weeks, or compared to pre-operative values; there were significant differences for the AF. Biochemical and histological analysis showed changes consistent with quantitative MRI signal intensities for early stage degeneration. Conclusions Early traumatic or degenerative changes are detectable with both T2 and MTR. T2 changes were more sensitive to the differences in disc status, especially for the CEPZ. Since T2 and MTR reflect different disc properties, performing both imaging under the same conditions would be helpful in the evaluation of disc degeneration. The continuous rectangle drawing can be a sensitive method to detect the changes of CEPZ. Electronic supplementary material The online version of this article (doi:10.1186/s12891-015-0610-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chun Chen
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China. .,Department of Orthopedic Surgery, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
| | - Zhiwei Jia
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China.
| | - Zhihua Han
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China.
| | - Tao Gu
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China.
| | - Wei Li
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China.
| | - Hao Li
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China.
| | - Yong Tang
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China.
| | - Jianhong Wu
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China.
| | - Deli Wang
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China.
| | - Qin He
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China.
| | - Dike Ruan
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China.
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