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Kunow A, Freyer Martins Pereira J, Chenot JF. Extravertebral low back pain: a scoping review. BMC Musculoskelet Disord 2024; 25:363. [PMID: 38714994 PMCID: PMC11075250 DOI: 10.1186/s12891-024-07435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is one of the most common reasons for consultation in general practice. Currently, LBP is categorised into specific and non-specific causes. However, extravertebral causes, such as abdominal aortic aneurysm or pancreatitis, are not being considered. METHODS A systematic literature search was performed across MEDLINE, Embase, and the Cochrane library, complemented by a handsearch. Studies conducted between 1 January 2001 and 31 December 2020, where LBP was the main symptom, were included. RESULTS The literature search identified 6040 studies, from which duplicates were removed, leaving 4105 studies for title and abstract screening. Subsequently, 265 publications were selected for inclusion, with an additional 197 publications identified through the handsearch. The majority of the studies were case reports and case series, predominantly originating from specialised care settings. A clear distinction between vertebral or rare causes of LBP was not always possible. A range of diseases were identified as potential extravertebral causes of LBP, encompassing gynaecological, urological, vascular, systemic, and gastrointestinal diseases. Notably, guidelines exhibited inconsistencies in addressing extravertebral causes. DISCUSSION Prior to this review, there has been no systematic investigation into extravertebral causes of LBP. Although these causes are rare, the absence of robust and reliable epidemiological data hinders a comprehensive understanding, as well as the lack of standardised protocols, which contributes to a lack of accurate description of indicative symptoms. While there are certain disease-specific characteristics, such as non-mechanical or cyclical LBP, and atypical accompanying symptoms like fever, abdominal pain, or leg swelling, that may suggest extravertebral causes, it is important to recognise that these features are not universally present in every patient. CONCLUSION The differential diagnosis of extravertebral LBP is extensive with relatively low prevalence rates dependent on the clinical setting. Clinicians should maintain a high index of suspicion for extravertebral aetiologies, especially in patients presenting with atypical accompanying symptoms.
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Affiliation(s)
- Anna Kunow
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany.
| | | | - Jean-François Chenot
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany
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Ekşi MŞ, Orhun Ö, Demir YN, Kara M, Berikol G, Özcan-Ekşi EE. Are serum thyroid hormone, parathormone, calcium, and vitamin D levels associated with lumbar spine degeneration? A cross-sectional observational clinical study. 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; 32:1561-1574. [PMID: 36976340 DOI: 10.1007/s00586-023-07673-w] [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: 10/02/2022] [Revised: 03/11/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Low back pain (LBP) impairs the quality of life and rises healthcare costs. The association of spine degeneration and LBP with metabolic disorders have been reported, previously. However, metabolic processes related with spine degeneration remained unclear. We aimed to analyze whether serum thyroid hormones, parathormone, calcium, and vitamin D levels were associated with lumbar intervertebral disc degeneration (IVDD), Modic changes, and fatty infiltration in the paraspinal muscles. METHODS We cross-sectionally analyzed a retrospective database. Patients who visited internal medicine outpatient clinics with suspect of endocrine disorders and chronic LBP were searched. Patients with biochemistry results within 1 week before lumbar spine magnetic resonance imaging (MRI) were included. Age- and gender-matched cohorts were made-up and analyzed. RESULTS Patients with higher serum free thyroxine levels were more likely to have severe IVDD. They were also more likely to have fattier multifidus and erector spinae at upper lumbar levels, less fatty psoas and less Modic changes at lower lumbar levels. Higher PTH levels were observed in patients with severe IVDD at L4-L5 level. Patients with lower serum vitamin D and calcium levels had more Modic changes and fattier paraspinal muscles at upper lumbar levels. CONCLUSION Serum hormone, vitamin D, and calcium levels were associated with not only IVDD and Modic changes but also with fatty infiltration in the paraspinal muscles, mainly at upper lumbar levels in patients with symptomatic backache presenting to a tertiary care center. Complex inflammatory, metabolic, and mechanical factors present in the backstage of spine degeneration.
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Affiliation(s)
- Murat Şakir Ekşi
- Associate Professor of Neurosurgery, FSM Training and Research Hospital, Neurosurgery Clinic, Göztepe Mah. Mesire Sok. Tütüncü Mehmet Efendi Cad. No: 3/34 Kadıkoy, Istanbul, Turkey.
| | - Ömer Orhun
- School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Yaren Nur Demir
- School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Müjdat Kara
- Endocrinology Unit, Department of Internal Medicine, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Gürkan Berikol
- Neurosurgery Clinic, Taksim Training and Research Hospital, Istanbul, Turkey
| | - Emel Ece Özcan-Ekşi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Bahçeşehir University, Istanbul, Turkey
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Jiang X, Zhou R, He Y, Zhu T, Zhang W. Causal effect of serum 25-hydroxyvitamin D levels on low back pain: A two-sample mendelian randomization study. Front Genet 2022; 13:1001265. [PMID: 36212121 PMCID: PMC9534573 DOI: 10.3389/fgene.2022.1001265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/05/2022] [Indexed: 11/14/2022] Open
Abstract
Background: Previous observational studies have suggested the involvement of 25-hydroxyvitamin D [25(OH)D] in chronic pain. However, whether the 25(OH)D is a novel target for management, the causality remains unclear. Methods: A two-sample Mendelian randomization (MR) study was conducted to identify the causal association between 25(OH)D and low back pain (LBP). The primary analysis was revealing causality from serum 25(OH)D level (n = 417,580) on LBP (21,140 cases and 227,388 controls). The replicated analysis was performing MR estimates from circulating 25(OH)D concentration (n = 79,366) on LBP experienced last month (118,471 cases and 343,386 controls). Inverse variance weighted (IVW) was used as the main analysis. In addition, we used weighted median and MR-Egger to enhance the robustness. Sensitivity analysis was conducted to evaluate the robustness of MR results. Results: IVW estimation indicated strong evidence that higher serum 25(OH)D levels exerted a protective effect on LBP (OR = 0.89, 95% CI = 0.83–0.96, p = 0.002). Similar trends were also found in replicate analysis (OR = 0.98, 95% CI = 0.96–1.00, p = 0.07). After meta-analysis combining primary and replicated analysis, the causal effect is significant (p = 0.03). Sensitivity analysis supported that the MR estimates were robust. Conclusion: In our MR study, genetically increased serum 25(OH)D levels were associated with a reduced risk of LBP in the European population. This might have an implication for clinicians that vitamin D supplements might be effective for patients with LBP in clinical practice.
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Affiliation(s)
- Xiaojuan Jiang
- Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Ruihao Zhou
- Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Yi He
- Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Zhu
- Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Weiyi Zhang
- Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Weiyi Zhang,
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Ekşi MŞ, Orhun Ö, Yaşar AH, Dursun AT, Berikol G, Börekci A, Özcan-Ekşi EE. At What Speed Does Spinal Degeneration Gear Up?: Aging Paradigm in Patients with Low Back Pain. Clin Neurol Neurosurg 2022; 215:107187. [DOI: 10.1016/j.clineuro.2022.107187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 11/25/2022]
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Al-Rawaf HA, Gabr SA, Alghadir AH. Vitamin D Deficiency and Molecular Changes in Circulating MicroRNAs in Older Adults with Lower Back Pain. Pain Res Manag 2021; 2021:6662651. [PMID: 34055120 PMCID: PMC8149253 DOI: 10.1155/2021/6662651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/16/2021] [Accepted: 05/07/2021] [Indexed: 12/24/2022]
Abstract
Background MicroRNAs play an essential role in regulating pain processing within a wide range of clinical pain disorders. Objectives The present study aimed to evaluate the role of circulating miRNAs as biomarkers of lower back pain in older adults. In addition, the correlation between miRNAs and other related cofounders such as muscle function, adiposity, malnutrition, and Ca and vitamin D intake was assessed. Methods A total of 110 older subjects with an age range of 40-60 years were included in this study. The participants were classified according to a modified Oswestry lower back pain disability questionnaire (OSW) into subjects with minimal LBP (n = 40; LBP score: 0-20%), moderate LBP (n = 35; LBP score: 20-40%), and severe LBP (n = 35; LBP score: 41-60%). RT-PCR and immunoassays were used to study the circulating miRNA profile, vitamin D status, and CRP, IL-6, TNF-α, s-Ca, s-BAP, s-OC, and s-NTX levels. In addition, malnutrition and muscle performance were estimated in all subjects as other factors related to LBP. Results In this study, normal LBP-OSW cutoff values (8.96 ± 3.6) were reported in 36.4% of the total population, whereas 63.6% of the population had higher LBP-OSW scores, classified as follows: 31.8% with moderate LBP (LBP-OSW score: 31.4 ± 9.1) and 31.8% with severe LBP (LBP-OSW score: 54.9 ± 14.6). Four circulating miRNAs, namely, miR-146a, miR-558, miR-155, and miR-124a, as biomarkers of the intensity of back pain were identified in all participants. In subjects with moderate to severe LBP, the expression levels of miR-146a and miR-558 were significantly reduced and those of miR-155 and miR-124a were significantly increased compared to subjects with minimal LBP scores. Subjects with moderate to severe LBP showed a significant increase in adiposity markers, lower PA, muscle performance, malnutrition, and lower Ca and vitamin D intake compared to normal controls. In addition, serum levels of vitamin D and circulated plasma markers of inflammation and bone metabolism such as CRP, IL-6, TNF-α, s-Ca, s-BAP, s-OC, and s-NTX were significantly reduced in severe LBP cases compared to those with minimal LBP scores. The expressed circulating miRNAs were significantly associated with the measured muscle performance, adiposity, PA score, inflammation, and bone metabolism cofounders in subjects with higher LBP-OSW scores. The expressed miRNAs, along with other LBP cofounders, were significantly associated with ∼63.9-86.4% of the incidence of LBP in older adults. Conclusions In older adults with vitamin D deficiency, the severity of LBP was significantly associated with the expression of circulating miRNAs, adiposity, bone metabolism, inflammation, and muscle performance. In addition, the expressed miRNAs, along with other LBP cofounders, were significantly associated with ∼63.9-86.4% of the incidence of LBP in older adults. These results suggest the possibility of using microRNAs as therapeutics to alleviate established pain and as biomarkers in old adults with painful conditions.
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Affiliation(s)
- Hadeel A. Al-Rawaf
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- Departments of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Sami A. Gabr
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad H. Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Kanaujia V, Yadav RK, Verma S, Jain S, Patra B, Neyaz O. Correlation between Vitamin D deficiency and nonspecific chronic low back pain: A retrospective observational study. J Family Med Prim Care 2021; 10:893-897. [PMID: 34041094 PMCID: PMC8138361 DOI: 10.4103/jfmpc.jfmpc_1478_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/17/2020] [Accepted: 10/08/2020] [Indexed: 11/16/2022] Open
Abstract
CONTEXT Chronic lower back pain (CLBP) and Vitamin D deficiency are two common conditions presenting to primary care physicians. AIMS To study the vitamin D status in North Indians presenting with nonspecific CLBP and the correlation between vitamin D levels and pain severity by the Visual Analogue Scale (VAS). SETTINGS AND DESIGN An observational study. Record of all CLBP patients presenting to the outpatient department in 2019, were analyzed, retrospectively. METHODS AND MATERIALS All the patients of age 18 to 65 and either sex with nonspecific CLBP were included. Patients were divided into two: Vitamin D deficient (Group 1) and normal (Group 2) with cut off Serum Vitamin D values at 30 ng/mL. Demographic data and Visual Analogue Scale scores (VAS) of both groups were recorded. STATISTICAL ANALYSIS USED Correlations between Vitamin D values and VAS scores were investigated using the Spearman coefficient, and the results with P of ≤ 0.05 were contemplated significant. RESULTS Of total 376 patients with nonspecific CLBP, the majority were adults, females, married, vegetarians, overweight or obese, and had a mean sun exposure time of two hours. Vitamin D deficient Group 1 had 302 (80.32%) patients with significantly lower (P < 0.0001) mean vitamin D levels compared to Group 2 (74 patients i.e., 19.68%). Spearman's rho coefficient between vitamin D and VAS, showed a negative correlation (-0.554), with a P value < 0.00001. CONCLUSIONS This study indicated a high probability of vitamin D deficiency in the nonspecific CLBP population and a negative correlation between vitamin D status and pain severity.
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Affiliation(s)
- Vinay Kanaujia
- Department of Physical Medicine and Rehabilitation (PMR), AIIMS Rishikesh, Uttarakhand, India
| | - Raj Kumar Yadav
- Department of Physical Medicine and Rehabilitation (PMR), AIIMS Rishikesh, Uttarakhand, India
| | - Shipra Verma
- Department of Anesthesia, AIIMS Rishikesh, Uttarakhand, India
| | - Sakshi Jain
- Department of Physical Medicine & Rehabilitation (PMR), VMMC & Safdarjung Hospital, New Delhi, India
| | - Binayak Patra
- Department of Physical Medicine and Rehabilitation (PMR), AIIMS Rishikesh, Uttarakhand, India
| | - Osama Neyaz
- Department of Physical Medicine and Rehabilitation (PMR), AIIMS Rishikesh, Uttarakhand, India
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Kumar M, Ahmed M, Hussain G, Bux M, Ahmed N, Kumar S. Assessment of Vitamin D Levels in Patients Presenting With Chronic Low Back Pain at a Tertiary Care Hospital. Cureus 2020; 12:e11867. [PMID: 33282609 PMCID: PMC7714737 DOI: 10.7759/cureus.11867] [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] [Accepted: 12/03/2020] [Indexed: 11/05/2022] Open
Abstract
Objective To evaluate the association of chronic low back pain with levels of vitamin D in the affected population. Methodology This observational study was carried out from August 2016 to August 2019 at Khairpur Medical College and Shaheed Mohatarma Benazir Bhutto Medical College, Karachi, Pakistan. Patients aged 18 years and above suffering from chronic low back pain with pain persisting for more than 12 weeks were the study participants after written consent and prior approval from the ethical review committee was obtained for conducting the study. Data was recorded on predesigned performa and analyzed on SPSS Version 20 (IBM Corp.). Results There were 1,152 cases with chronic lower back pain, of whom 632 (54.9%) were females and 520 (45.1%) were males. The mean age of the patients was 41.76 ± 11.18 years. The mean visual analog scale (VAS) level was 5.36 ± 1.65; 707 cases (61.4%) had moderate pain according to VAS, 292 (25.3%) had severe pain, and 153 (13.3%) had mild pain. Concerning vitamin D levels, the mean levels were 22.74 ± 13.80, with 599 (52%) of the patients having deficient levels of vitamin D, 347 (30.1%) having insufficient levels, and only 204 (17.7%) of the cases having normal vitamin D levels. Conclusions Lower back pain is one of the common presenting problems in orthopedic clinics. We found no relationship between chronic lower back pain and vitamin D levels in our study.
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Affiliation(s)
- Mukesh Kumar
- Orthopedic Surgery, Begum Haji Yousuf (BHY) Jamiyiat Hospital Karachi, Karachi, PAK
| | - Masroor Ahmed
- Orthopedic Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Ghulam Hussain
- Orthopedic Surgery, Sheikh Zayed Taluka Headquarter Hospital, Karachi, PAK
| | - Muhammad Bux
- Orthopedic Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Naveed Ahmed
- Orthopedic Surgery, Khairpur Medical College, Sindh, PAK
| | - Sunil Kumar
- Trauma and Orthopedic Surgery, Dow University of Health Sciences, Karachi, PAK
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Lakkireddy M, Karra ML, Patnala C, Iyengar R, Cherukuri N, Hussain KA, Chodavarapu LM, Kiran Kumar KK, Aluka SK, Bodla AK, Badavath RR, Peddamadyam SK. Efficiency of vitamin D supplementation in patients with mechanical low back ache. J Clin Orthop Trauma 2019; 10:1101-1110. [PMID: 31708636 PMCID: PMC6834986 DOI: 10.1016/j.jcot.2019.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 06/23/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Preliminary evidence suggests an association of hypovitaminosis D (hypo.D) with mechanical Low back ache (mLBA). AIM This study was designed to 1. Explore the relationship of hypovitaminosis D with mLBA in the absence of other confounding factors 2. Formulate and validate an appropriate treatment protocol and 3. Explore the differences in outcomes with various oral formulations of vitamin D available in Indian market. MATERIALS & METHODS Three randomised groups of patients with mLBA and hypo.D between 18 and 45 years of age without any co morbid conditions were studied for the effectiveness of adjunctive vit.D supplementation of 6,00,000 IUs (60,000 IUs/day for ten consecutive days) in the form of granule or nano syrup or soft gel capsule for the treatment of mLBA. Review evaluation of pain, functional disability and vit.D was done at three weeks and an additional evaluation of vit.D was done at nine months. Evaluation with 3,00,000 IUs of vit.D (60,000 IUs/day for five consecutive days) was done with nano syrup in a different cohort. RESULTS High prevalence of hypo.D (96%) was noted in patients with mLBA. Significant improvement was noted after supplementation of vit.D. The subjects of nano syrup group have shown significantly better improvement compared to others (P < 0.000). Non obese and chronic patients have shown significantly better results than their peers. Though there was significant difference in vit.D before treatment, the difference of improvement between the genders, deficiency and insufficiency, in-door and out-door, smokers and non smoker subgroups was not significant. Seasonal variation in vit.D before and after the treatment was significant. CONCLUSION Hypovitaminosis D can be a potential causative factor for mLBA in addition to the other known causes. Proper evaluation and adjunctive vit.D supplementation can effectively break the vicious cycle of low back ache with significant improvement in serum vit.D level, effective relief of pain and significant functional improvement without any adverse effects. Improvement in vit.D was not significantly related to its initial status and obese individuals have shown significantly lesser improvement. The results with nano syrup formulation were significantly better compared to others. Formulation based dosage adjustments assume significance in view of these results.
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Affiliation(s)
- Maheshwar Lakkireddy
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India,Corresponding author.
| | - Madhu Latha Karra
- Department of Biochemistry, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Chandrasekhar Patnala
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Raju Iyengar
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Nagesh Cherukuri
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - K.S. Asif Hussain
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Lalith Mohan Chodavarapu
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | | | - Sundeep Kund Aluka
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Arvind Kumar Bodla
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Raja Ramesh Badavath
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Shravan Kumar Peddamadyam
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
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Gokcek E, Kaydu A. Assessment of Relationship between Vitamin D Deficiency and Pain Severity in Patients with Low Back Pain: A Retrospective, Observational Study. Anesth Essays Res 2018; 12:680-684. [PMID: 30283175 PMCID: PMC6157211 DOI: 10.4103/aer.aer_96_18] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Vitamin D is associated with musculoskeletal function in our body, and its deficiency is a common health problem all over the world. Low back pain (LBP) is an important health problem in terms of low quality of life, loss of work power, and cost of diagnosis and treatment approaches. AIMS The purpose of this study is to investigate the relationship between pain severity and Vitamin D deficiency in patients who applied to pain polyclinic with LBP. SETTINGS AND DESIGN This was a retrospective, observational study. SUBJECTS AND METHODS The files of patients aged between 18 and 70 years who applied to our hospital between January and February 2018 were examined retrospectively by a specialist. Serum 25-hydroxyvitamin D (25(OH)D) level, Visual Analogue Scale (VAS), age, education level, marital status, working status, and body mass index (BMI) values recorded in patient files were included in the study. The limit value of Vitamin D was accepted as 20 ng/mL. Patients were divided into two groups according to their levels of Vitamin D. Patients with serum 25(OH)D levels below 20 ng/mL were considered as the deficiency of Vitamin D (Group 1) and patients with 20 ng/mL and over 20 ng/mL values were considered as normal in terms of Vitamin D (Group 2). STATISTICAL ANALYSIS USED Descriptive statistical data were presented as mean, standard deviation, numbers, and percentage. There was no difference between the normally distributed group and the non-normally distributed group in terms of vitamin D levels. To compare the frequencies, the Chi-square test was used. To define the linear association between independent variables and Vitamin D level, Spearman's rho correlation coefficients were calculated. RESULTS The level of Vitamin D was measured in 98 patients aged 18-70 years who applied to our hospital's polyclinic due to LBP during the study period. The deficiency of vitamin was detected in 84 (85.7%) of the patients, while Vitamin D was found in 14 (14.3%) as normal. Groups were similar in terms of age, gender, BMI, educational level, marital status and working status (p> 0.05); however, there was a statistically significant difference between the two groups in terms of VAS score and levels of Vitamin D (P < 0.001 and P < 0.001, respectively). While there was a negative correlation between D vitamin level and VAS score (r = -0.594, P < 0.001), there was no correlation between age, gender, BMI, education level, marital status, and working status (P > 0.05). CONCLUSIONS The deficiency of Vitamin D is often asymptomatic, and also, it can cause bone and muscle pain. In our study, we determined that the severity of pain increased in patients with LBP as the deficiency of Vitamin D increased. For this reason, we recommend to be evaluated the level of Vitamin D in patients with LBP.
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Affiliation(s)
- Erhan Gokcek
- Department of Anesthesiology, Diyarbakir Selahaddini Eyyübi State Hopital, Diyarbakir, Turkey
| | - Ayhan Kaydu
- Department of Anesthesiology, Diyarbakir Selahaddini Eyyübi State Hopital, Diyarbakir, Turkey
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Teboul-Coré S, Roux C, Borderie D, Kolta S, Lefèvre-Colau MM, Poiraudeau S, Rannou F, Nguyen C. Bone mineral density and bone remodeling markers in chronic low back pain patients with active discopathy: A case-control exploratory study. PLoS One 2018; 13:e0196536. [PMID: 29958270 PMCID: PMC6025861 DOI: 10.1371/journal.pone.0196536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 03/10/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We aimed to compare bone mineral density (BMD) and bone remodeling markers in chronic low back pain (cLBP) patients with and without active discopathy (Modic 1 changes). DESIGN We conducted a single center case-control exploratory study. For 18 months, all patients referred to a tertiary care physical medicine and rehabilitation department in France were consecutively screened. Patients fulfilling the inclusion criteria were prospectively enrolled. Cases were defined as cLBP patients with lumbar active discopathy detected on MRI and controls as cLBP patients without active discopathy. Bone mineral density (BMD) at the spine, femoral neck and total femur was assessed by dual-energy X-ray absorptiometry, and bone remodeling markers were assessed in fasting serum samples. Overall, 37 cLBP patients (13 cases and 24 controls) fulfilled inclusion criteria and were included. RESULTS The median age was 42.0 years (Q1-Q3: 36.0-51.0) and mean (SD) LBP duration 72.3 (57.4) months. We found that BMD and levels of bone remodeling markers in cLBP patients did not differ with and without active discopathy. CONCLUSION Our results do not support the association between active discopathy and systemic bone fragility.
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Affiliation(s)
- Stéphanie Teboul-Coré
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christian Roux
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Service de Rhumatologie B, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne Cité (CRESS), ECaMO Team, Paris, France
| | - Didier Borderie
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Service de Biochimie, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMR 1124, Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, Faculté des Sciences Fondamentales et Biomédicales, UFR Biomédicale des Saints-Pères, Paris, France
| | - Sami Kolta
- Service de Rhumatologie B, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne Cité (CRESS), ECaMO Team, Paris, France
| | - Marie-Martine Lefèvre-Colau
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Serge Poiraudeau
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne Cité (CRESS), ECaMO Team, Paris, France
- Institut Fédératif de Recherche sur le Handicap, Paris, France
| | - François Rannou
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMR 1124, Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, Faculté des Sciences Fondamentales et Biomédicales, UFR Biomédicale des Saints-Pères, Paris, France
| | - Christelle Nguyen
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMR 1124, Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, Faculté des Sciences Fondamentales et Biomédicales, UFR Biomédicale des Saints-Pères, Paris, France
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Heuch I, Heuch I, Hagen K, Mai XM, Langhammer A, Zwart JA. Is there an association between vitamin D status and risk of chronic low back pain? A nested case-control analysis in the Nord-Trøndelag Health Study. BMJ Open 2017; 7:e018521. [PMID: 29175890 PMCID: PMC5719329 DOI: 10.1136/bmjopen-2017-018521] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To explore potential associations between vitamin D status and risk of chronic low back pain (LBP) in a Norwegian cohort, and to investigate whether relationships depend on the season of blood sample collection. DESIGN A nested case-control study in a prospective data set. SETTING The Norwegian community-based Nord-Trøndelag Health Study (HUNT). Data were collected in the HUNT2 (1995-1997) and HUNT3 (2006-2008) surveys. MAIN OUTCOME MEASURE Chronic LBP, defined as LBP persisting at least 3 months continuously during the past year. PARTICIPANTS Among individuals aged 19-55 years without LBP in HUNT2, a data set was generated including 1685 cases with LBP in HUNT3 and 3137 controls without LBP. METHODS Blood samples from the participants collected in HUNT2 were analysed for serum 25-hydroxyvitamin D (25(OH)D) level. Associations with LBP in HUNT3 were evaluated by unconditional logistic regression analysis with adjustment for age, sex, work status, physical activity at work and in leisure time, education, smoking, and body mass index. RESULTS No association between vitamin D status and risk of chronic LBP was found in the total data set (OR per 10 nmol/L 25(OH)D=1.01, 95% CI 0.97 to 1.06) or in individuals with blood samples collected in summer/autumn (OR per 10 nmol/L 25(OH)D=0.99, 95% CI 0.93 to 1.06). For blood samples drawn in winter/spring, associations differed significantly between women and men (p=0.004). Among women a positive association was seen (OR per 10 nmol/L 25(OH)D=1.11, 95% CI 1.02 to 1.20), but among men no significant association was observed (OR per 10 nmol/L 25(OH)D=0.90, 95% CI 0.81 to 1.01). CONCLUSIONS Overall, no association between vitamin D status and risk of LBP was demonstrated. The association suggested in women for the winter/spring season cannot be regarded as established.
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Affiliation(s)
- Ingrid Heuch
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Ivar Heuch
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Knut Hagen
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian National Headache Centre, Department of Neurology, St Olavs Hospital, Trondheim, Norway
| | - Xiao-Mei Mai
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arnulf Langhammer
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - John-Anker Zwart
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Vitamin D supplementation attenuates oxidative stress in paraspinal skeletal muscles in patients with low back pain. Eur J Appl Physiol 2017; 118:143-151. [DOI: 10.1007/s00421-017-3755-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 10/29/2017] [Indexed: 12/17/2022]
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Panwar A, Valupadas C, Veeramalla M, Vishwas HN. Prevalence of vitamin D deficiency in chronic and subacute low back pain patients in India: a triple-arm controlled study. Clin Rheumatol 2017; 37:1367-1374. [PMID: 28842760 DOI: 10.1007/s10067-017-3798-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 08/12/2017] [Accepted: 08/17/2017] [Indexed: 11/26/2022]
Abstract
Vitamin D is vital for musculoskeletal health and may be associated with subacute and chronic low back pain. The objective of this study was to estimate the prevalence of vitamin D deficiency among chronic low back pain (CLBP) and subacute low back pain (SLBP), and compare the same with healthy controls. This study was designed as triple-arm case-control study comprising of CLBP, SLBP, and controls. SLBP and CLBP cases were consecutively enrolled over 3 months of winter season from November 2016 to January 2017. Serum 25- (OH) vitamin D was estimated for the study subjects and categorical comparison of severity of vitamin D deficiency was done for the cases and controls. A total of 250 CLBP, 177 SLBP cases, and 248 controls were included in the study. Mean (± SD) serum vitamin D levels among CLBP, SLBP, and controls were 20.36 (± 12.56), 21.42 (± 13.20), and 20.84 (± 6.93) ng/ml respectively, the difference being statistically insignificant. There was no significant difference in the prevalence of vitamin D deficiency among CLBP, SLBP, and controls which was 53.6, 50.8, and 51.6% respectively, in the three arms. However, the categorical analysis revealed that CLBP and SLBP cases had a significantly higher prevalence of worse categories of vitamin D deficiency. Cases had significantly larger frequency (CLBP vs. controls, 43.6 vs 20.1%, P<0.001; SLBP vs. controls, 43.5 vs 20.1%, P = 0.001) of individuals with vitamin D levels ≤ 16 ng/ml (moderate deficiency upper threshold level). Thus, the severe forms of vitamin D deficiency may be causally associated with CLBP and SLBP. The results of the present study revealed that increasing severity of vitamin D deficiency may have a pathogenetic association with chronic low back pain and subacute low back pain. These results may prove to be of significance in framing of future management guidelines for the above clinical conditions.
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Affiliation(s)
- Ajay Panwar
- Department of Neurology, Kakatiya Medical College and Mahatma Gandhi Memorial Hospital, Warangal, 506007, India.
| | - Chandrasekhar Valupadas
- Department of Medicine, Kakatiya Medical College and Mahatma Gandhi Memorial Hospital, Warangal, India
| | - Madhavarao Veeramalla
- Department of Neurology, Kakatiya Medical College and Mahatma Gandhi Memorial Hospital, Warangal, 506007, India
| | - Hunsur N Vishwas
- Department of Clinical Pharmacy, Talla Padmavathi College of Pharmacy, Warangal, India
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Çalık Y, Aygün Ü. Evaluation of vitamin D levels in patients with chronic low back-leg pain. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:243-247. [PMID: 28438384 PMCID: PMC6197560 DOI: 10.1016/j.aott.2017.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 11/21/2016] [Accepted: 01/31/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We aimed to examine the relationship between the levels of vitamin D and patients with chronic low back-leg pain (CLBLP) and to investigate its effects on pain and functional capacity. METHODS 145 patients (female/male:103/42) with CLBLP, aged between 35 and 65 years (mean age: 53,06 ± 8,14), participated in the study. Visual Analog Pain Scale (VAS) was used to measure the state of pain. Pain-related functional capacity was evaluated through Oswestry Disability Index (ODI). Patients were classified into three groups based on their serum vitamin D levels: normal (≥30 ng/ml), vitamin D insufficiency (21-29 ng/ml), and vitamin D deficiency (≤20 ng/ml). RESULTS We found that 22,8% of patients (n:33) had vitamin D deficiency, 42,8% (n:62) had vitamin D insufficiency, and 34,5% (n:50) had normal levels of vitamin D. VAS scores were 4,75 ± 0,93; 4,66 ± 0,97 and 4,52 ± 0,90 for patients with vitamin D deficiency, vitamin D insufficiency, and normal levels of vitamin D, respectively. We found that there was no significant relationship between vitamin D level and VAS score (p>0,05). ODI scores were 18,78 ± 7,89; 15,46 ± 5,57 and 14,52 ± 7,19 for patients with vitamin D deficiency, vitamin D insufficiency, and normal levels of vitamin D, respectively. CLBLP-related functional capacity was found to be significantly lower in patients with vitamin D deficiency when compared to other two groups (p < 0,05). CONCLUSION Vitamin D deficiency may lead to lower functional capacity, and clinically, Vit D levels should be checked in musculoskeletal pain patients at risk of Vit D deficiency. LEVEL OF EVIDENCE Level IV, Diagnostic study.
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Affiliation(s)
- Yalkın Çalık
- Abant Izzet Baysal University, İzzet Baysal Physical Medicine and Rehabilitation Training and Research Hospital, Bolu, Turkey.
| | - Ümit Aygün
- Abant İzzet Baysal University, İzzet Baysal Training and Research Hospital, Department of Orthopaedics and Traumatology, Bolu, Turkey
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Alghadir AH, Gabr SA, Al-Eisa ES. Mechanical factors and vitamin D deficiency in schoolchildren with low back pain: biochemical and cross-sectional survey analysis. J Pain Res 2017; 10:855-865. [PMID: 28442927 PMCID: PMC5396951 DOI: 10.2147/jpr.s124859] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study was designed to evaluate the role of vitamin D, muscle fatigue biomarkers, and mechanical factors in the progression of low back pain (LBP) in schoolchildren. BACKGROUND Children and adolescents frequently suffer from LBP with no clear clinical causes, and >71% of schoolchildren aged 12-17 years will show at least one episode of LBP. MATERIALS AND METHODS A total of 250 schoolchildren aged 12-16 years were randomly enrolled in this study. For all schoolchildren height, weight, percentage of daily sun exposure and and areas of skin exposed to sun, method of carrying the bag, and bag weight and type were recorded over a typical school week. Pain scores, physical activity (PA), LBP, serum vitamin 25(OH)D level, serum bone-specific alkaline phosphatase, creatine kinase (CK), and lactate dehydrogenase (LDH) activities and calcium (Ca) concentrations were estimated using prevalidated Pain Rating Scale, modified Oswestry Low Back Pain Disability Questionnaire, short-form PA questionnaire, and colorimetric and immunoassay techniques. RESULTS During the period of October 2013-May 2014, LBP was estimated in 52.2% of the schoolchildren. It was classified into moderate (34%) and severe (18%). Girls showed a higher LBP (36%) compared with boys (24%). In schoolchildren with moderate and severe LBP significantly higher (P=0.01) body mass index, waist, hip, and waist-to-hip ratio measurements were observed compared with normal schoolchildren. LBP significantly correlated with less sun exposure, lower PA, sedentary activity (TV/computer use), and overloaded school bags. In addition, schoolchildren with severe LBP showed lower levels of vitamin 25(OH)D and Ca and higher levels of CK, LDH, and serum bone-specific alkaline phosphatase compared with moderate and healthy schoolchildren. Stepwise regression analysis revealed that age, gender, demographic parameters, PA, vitamin D levels, Ca, CK, and LDH associated with ~56.8%-86.7% of the incidence of LBP among schoolchildren. CONCLUSION In children and adolescents, LBP was shown to be linked with limited sun exposure, inadequate vitamin D diets, adiposity, lower PA, sedentary lifestyles, vitamin 25 (OH) D deficiency, and lower levels of Ca, CK, and LDH.
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Affiliation(s)
- Ahmad H Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Sami A Gabr
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Department of Anatomy, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Einas S Al-Eisa
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Thörneby A, Nordeman LM, Johanson EH. No association between level of vitamin D and chronic low back pain in Swedish primary care: a cross-sectional case-control study. Scand J Prim Health Care 2016; 34:196-204. [PMID: 27189389 PMCID: PMC4977943 DOI: 10.1080/02813432.2016.1183557] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Assessment of vitamin D levels and deficiency status in individuals with chronic low back pain (CLBP) in a Swedish general population, compared with controls matched for sex and age. DESIGN Cross-sectional case-control study. SETTING Primary care, southern Sweden. SUBJECTS Participants (n = 44) with self-reported low back pain for at least 3 months and individually sex- and age-matched controls without a chronic pain condition (n = 44), recruited from the general population by random letter of invitation. MAIN OUTCOME MEASURE Association between vitamin D level and CLBP when adjusting for possible confounders in a multivariate forward conditional logistic regression model. RESULTS Mean S-25-hydroxyvitamin D levels were 81 and 80 nmol/L in the CLBP and control group, respectively. The prevalence of vitamin D deficiency was low and similar in the CLBP group and the control group. Vitamin D level was not associated with CLBP when potential confounders were taken into account. CONCLUSIONS No difference in vitamin D levels between participants with CLBP and matched controls could be demonstrated in the present sample. Assessment of vitamin D level and deficiency status may be of questionable value in the management of CLBP in primary care settings at similar latitudes, unless there are additional risk factors for deficiency or specific indicators of osteomalacia. Key points Vitamin D deficiency is common and reported in many chronic pain conditions, including chronic low back pain (CLBP), but evidence for an association and causality is insufficient. • The present study found no association between vitamin D levels and CLBP in a case-control sample of 44 + 44 individuals from the Swedish general population. • Prevalence of vitamin D deficiency was low and comparable in individuals with CLBP and controls without chronic pain, matched for sex and age. • Assessment of vitamin D status, for the purpose of finding and treating an underlying cause of pain, may be of limited value in the management of CLBP in primary care settings at similar latitudes.
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Affiliation(s)
- Andreas Thörneby
- Department of Research and Development, Primary Health Care, Research and Development Center Södra Älvsborg, Region Västra Götaland, Borås, Sweden;
- Närhälsan Kinna Vårdcentral, Region Västra Götaland, Sweden;
- CONTACT Andreas Thörneby Research and Development, Primary Health Care, Research and Development Center Södra Älvsborg, Sven Eriksonsplatsen 4, SE-503 38 Borås, Sweden
| | - Lena Margareta Nordeman
- Department of Research and Development, Primary Health Care, Research and Development Center Södra Älvsborg, Region Västra Götaland, Borås, Sweden;
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Else Hellebö Johanson
- Department of Research and Development, Primary Health Care, Research and Development Center Södra Älvsborg, Region Västra Götaland, Borås, Sweden;
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Seyithanoglu H, Aydin T, Taşpınar O, Camli A, Kiziltan H, Eris AH, Hocaoglu IT, Ozder A, Denizli E, Kepekci M, Keskin Y, Mutluer AS. Association between nutritional status and Modic classification in degenerative disc disease. J Phys Ther Sci 2016; 28:1250-4. [PMID: 27190462 PMCID: PMC4868222 DOI: 10.1589/jpts.28.1250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/08/2016] [Indexed: 01/07/2023] Open
Abstract
[Purpose] This study was conducted to examine the association between Modic classification and the eating habits in patients with degenerative disc disease (DDD) and to determine the influence of nutrition on disease severity. [Subjects and Methods] Sixty patients with DDD visiting a low back pain outpatient clinic were enrolled. Through face-to-face interviews, they completed questionnaires regarding their demographics, disease activity, smoking and alcohol use, concomitant diseases, disease duration, and nutritional status.Exclusion criteria were age <20 years or >65 years, other comorbidities, missing MRI data, and inability to speak Turkish. [Results] Forty patients were finally included in the study. The frequency with which they consumed water, salt, fast food, eggs, milk, yogurt, cheese, whole wheat bread, white bread, butter, and margarine was recorded. A weak negative correlation was observed between the Modic types and fish and egg consumption. [Conclusion] Modic changes, which indicate the severity of DDD, seem to be correlated to patients' dietary habits. However, studies with comparison groups and larger samples are needed to confirm our promising results before any cause-and-effect relationship can be proposed.
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Affiliation(s)
- Hakan Seyithanoglu
- Department of Neurosurgery, Faculty of Medicine, Bezmi Alem Vakıf University, Turkey
| | - Teoman Aydin
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmi Alem Vakıf University, Turkey
| | - Ozgur Taşpınar
- Department of Physical Medicine and Rehabilitation, Cınarcik State Hospital, Turkey
| | - Adil Camli
- Department of Internal Medicine, Faculty of Medicine, Bezmi Alem Vakıf University, Turkey
| | - Huriye Kiziltan
- Department of Radiation Oncology, Faculty of Medicine, Bezmi Alem Vakıf University, Turkey
| | - Ali Hikmet Eris
- Department of Radiation Oncology, Faculty of Medicine, Bezmi Alem Vakıf University, Turkey
| | | | - Aclan Ozder
- Department of Family Medicine, Faculty of Medicine, Bezmi Alem Vakıf University, Turkey
| | - Ebru Denizli
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmi Alem Vakıf University, Turkey
| | - Muge Kepekci
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmi Alem Vakıf University, Turkey
| | - Yasar Keskin
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmi Alem Vakıf University, Turkey
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Kent P, Kongsted A, Jensen TS, Albert HB, Schiøttz-Christensen B, Manniche C. SpineData - a Danish clinical registry of people with chronic back pain. Clin Epidemiol 2015; 7:369-80. [PMID: 26316820 PMCID: PMC4540159 DOI: 10.2147/clep.s83830] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Large-scale clinical registries are increasingly recognized as important resources for quality assurance and research to inform clinical decision-making and health policy. We established a clinical registry (SpineData) in a conservative care setting where more than 10,000 new cases of spinal pain are assessed each year. This paper describes the SpineData registry, summarizes the characteristics of its clinical population and data, and signals the availability of these data as a resource for collaborative research projects. Methods The SpineData registry is an Internet-based system that captures patient data electronically at the point of clinical contact. The setting is the government-funded Medical Department of the Spine Centre of Southern Denmark, Hospital Lillebaelt, where patients receive a multidisciplinary assessment of their chronic spinal pain. Results Started in 2011, the database by early 2015 contained information on more than 36,300 baseline episodes of patient care, plus the available 6-month and 12-month follow-up data for these episodes. The baseline questionnaire completion rate has been 93%; 79% of people were presenting with low back pain as their main complaint, 6% with mid-back pain, and 15% with neck pain. Collectively, across the body regions and measurement time points, there are approximately 1,980 patient-related variables in the database across a broad range of biopsychosocial factors. To date, 36 research projects have used data from the SpineData registry, including collaborations with researchers from Denmark, Australia, the United Kingdom, and Brazil. Conclusion We described the aims, development, structure, and content of the SpineData registry, and what is known about any attrition bias and cluster effects in the data. For epidemiology research, these data can be linked, at an individual patient level, to the Danish population-based registries and the national spinal surgery registry. SpineData also has potential for the conduct of cohort multiple randomized controlled trials. Collaborations with other researchers are welcome.
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Affiliation(s)
- Peter Kent
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark ; Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Tue Secher Jensen
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark ; Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
| | | | - Berit Schiøttz-Christensen
- Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
| | - Claus Manniche
- Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
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Lodh M, Goswami B, Mahajan RD, Sen D, Jajodia N, Roy A. Assessment of Vitamin D status In Patients of Chronic Low Back Pain of Unknown Etiology. Indian J Clin Biochem 2014; 30:174-9. [PMID: 25883425 DOI: 10.1007/s12291-014-0435-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 04/15/2014] [Indexed: 11/25/2022]
Abstract
Low back pain is very disabling and dispiriting because of the physical impediment it causes and its psychological effects. Innumerable factors have been implicated in its etiology. In spite of improvements in diagnostic modalities, a considerable number of such cases fall in the ambiguous zone of unknown etiology or 'idiopathic.'Early diagnosis of low back pain will allow effective prevention and treatment to be offered. This study was conducted to assess the contribution of vitamin D levels and other biochemical factors to chronic low back pain in such cases. All patients attending the orthopedics OPD for low back pain in whom a precise anatomical cause could not be localized, were prospectively enrolled in this study. We measured serum levels of glucose, calcium, phosphorus, uric acid, rheumatoid factor, C reactive protein, alkaline phosphatase, total protein, albumin and 25 (OH) D concentrations in 200 cases and 200 control samples. The patients showed significantly lower vitamin D levels compared to controls with p value < 0.0001. The maximum number of low back pain patients were in the age group of 31-50 years (42 %).The average BMI was 23.27 ± 5.17 kg/sq m, 73 % of total patient population were females and 27 % were known case of type 2 diabetes mellitus. Calcium, alkaline phosphatase, was positively correlated with vitamin D and glucose showed a negative correlation with vitamin D in the patient population. The problem of low back pain provides a challenge to health care providers. The problem in developing countries is compounded by ignorance to report for early treatment and occupational compulsions in rural areas and sedentary lifestyle in urban youth. The authors strongly recommend early frequent screening for vitamin D along with glucose, protein, albumin, calcium, phosphorus, CRP as part of general health checkup for non-specific body pain, especially low back pain.
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Affiliation(s)
- Moushumi Lodh
- Department of Biochemistry, The Mission Hospital, Durgapur, West Bengal India
| | - Binita Goswami
- Department of Biochemistry, Lady Hardinge Medical College (LHMC) & SSK Hospital, New Delhi, 110001 India
| | | | - Dipankar Sen
- Department of Orthopedics, The Mission Hospital, Durgapur, West Bengal India
| | - Nirmal Jajodia
- Department of Orthopedics, The Mission Hospital, Durgapur, West Bengal India
| | - Abhishek Roy
- Department of Orthopedics, The Mission Hospital, Durgapur, West Bengal India
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Baykara B, Dilek B, Nas K, Ali Ulu M, Batmaz İ, Çağlayan M, Çevik R. Vitamin D Levels and Related Factors in Patients with Chronic Nonspecific Low Back Pain. ACTA ACUST UNITED AC 2014. [DOI: 10.3109/10582452.2014.883025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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von Känel R, Müller-Hartmannsgruber V, Kokinogenis G, Egloff N. Vitamin D and central hypersensitivity in patients with chronic pain. PAIN MEDICINE 2014; 15:1609-18. [PMID: 24730754 DOI: 10.1111/pme.12454] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Low vitamin D is implicated in various chronic pain conditions with, however, inconclusive findings. Vitamin D might play an important role in mechanisms being involved in central processing of evoked pain stimuli but less so for spontaneous clinical pain. OBJECTIVE This study aims to examine the relation between low serum levels of 25-hydroxyvitamin D3 (25-OH D) and mechanical pain sensitivity. DESIGN We studied 174 patients (mean age 48 years, 53% women) with chronic pain. A standardized pain provocation test was applied, and pain intensity was rated on a numerical analogue scale (0-10). The widespread pain index and symptom severity score (including fatigue, waking unrefreshed, and cognitive symptoms) following the 2010 American College of Rheumatology preliminary diagnostic criteria for fibromyalgia were also assessed. Serum 25-OH D levels were measured with a chemiluminescent immunoassay. RESULTS Vitamin deficiency (25-OH D < 50 nmol/L) was present in 71% of chronic pain patients; another 21% had insufficient vitamin D (25-OH D < 75 nmol/L). After adjustment for demographic and clinical variables, there was a mean ± standard error of the mean increase in pain intensity of 0.61 ± 0.25 for each 25 nmol/L decrease in 25-OH D (P = 0.011). Lower 25-OH D levels were also related to greater symptom severity (r = -0.21, P = 0.008) but not to the widespread pain index (P = 0.83) and fibromyalgia (P = 0.51). CONCLUSIONS The findings suggest a role of low vitamin D levels for heightened central sensitivity, particularly augmented pain processing upon mechanical stimulation in chronic pain patients. Vitamin D seems comparably less important for self-reports of spontaneous chronic pain.
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Affiliation(s)
- Roland von Känel
- Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland
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Danda D. A secosteroid and not just a food for thought. Int J Rheum Dis 2013; 16:111-3. [DOI: 10.1111/1756-185x.12142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Debashish Danda
- Clinical Immunology & Rheumatology; Christian Medical College & Hospital; Vellore; India
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