Living conditions, including life style, in primary-care patients with nonacute, nonspecific spinal pain compared with a population-based sample: a cross-sectional study

Profile of individuals with low back pain and factors defining chronicity of pain: a population-based study in Ethiopia

Purpose

Low back pain (LBP) is the most prevalent public health problem globally, second only to headaches in the ranking of painful disorders that affect human beings. However, evidence about the profile of LBP patients is lacking in low-income countries for appropriate management approaches. This study examined the profile of individuals with LBP and factors defining chronicity of pain in Ethiopia.

Methods

A population-based cross-sectional study design was used to collect data from 1812 adults (≥ 18 years) with LBP at present. Data were collected by interviewing the study participants using an instrument developed and validated in the same study population. The instrument includes socio-demographic information, health behaviours/lifestyle habits, beliefs about pain, and pain and general health-related characteristics of the participants. Data analysis was performed using R version 3.5.1. Both unconditional and conditional logistic regression models were fitted and Odds Ratio (OR) with 95% confidence intervals (95% CIs) were computed to identify factors significantly associated with chronicity of pain at p ≤ 0.05 significance level.

Results

Negative beliefs about pain, a varying degree of pain interference with daily and social activities, complaining of pain in other anatomical sites other than the low back region, general health status rated as not excellent, depressive symptomology, and sleeping problems/insomnia were common within the profile of individuals with LBP. Age, educational level, residential setting, beliefs about pain, and depressive symptomology were found to have a statistically significant association with chronicity of pain.

Conclusions

This study provides an overview of the profile of individuals with LBP and factors defining chronicity of pain, assisting clinicians to design appropriate management strategies to improve patients' outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-022-03148-5.

The prevalence of upper quadrants work-related musculoskeletal disorders and their predictors among registered nurses

BACKGROUND

Work-related musculoskeletal disorders (WMSDs) represent a significant health challenge facing nurses. However, very few studies investigated the prevalence of WMSDs among nurses and their predictors comprehensively using a valid and reliable set of standardized outcome measures.

OBJECTIVE

This study aimed to investigate the prevalence WMSDs of upper quadrants and their predictors among registered nurses in Jordanian hospitals.

METHODS

A cross-sectional study recruited 597 registered nurses from different hospitals in Jordan. A self-administered survey distributed in targeted hospitals wards. Outcome measures included Nordic Musculoskeletal Questionnaire (NMQ), Depression Anxiety Stress Scale (DASS), Pittsburgh Sleep Quality Index (PSQI), International Physical Activity Questionnaire (IPAQ), sociodemographic data, and manual handling and work habits. Prevalence of musculoskeletal complaints was reported using descriptive analysis. Logistic regression analyses were used to identify predictors of WMSDs at each upper quadrant body site.

RESULTS

Twelve-month WMSDs prevalence was the highest at the neck (61.1%), followed by the upper back (47.2%), shoulders (46.7%), wrist and hands (27.3%), and finally at the elbow (13.9%). Being a female, poor sleep quality, high physical activity level, poor ergonomics, increased workload, and mental stress were significant predictors of increased upper quadrant WMSDs among nurses.

CONCLUSIONS

Upper quadrant WMSDs among nurses in Jordan are highly prevalent. Identified significant predictors of these WMSDs should be given full consideration by clinicians and health policymakers. Future studies are needed to reveal the progressive nature of upper quadrant WMSDs and strategies to modify their risk factors.

Concussion/mild traumatic brain injury-related chronic pain in males and females: A diagnostic modelling study

Pain is an unpleasant, complex, and perceived experience that places a significant burden on patients and clinicians. Its severity may be mediated by emotion, attitude, and environmental influences, and pain may be expressed differently in males and females. Traumatic brain injury (TBI) is frequently associated with chronic pain. This diagnostic modeling study examined sex differences in the construct of chronic pain in patients with delayed recovery from concussion/mild traumatic brain injury (mTBI).Data were collected from standardized questionnaires, neuroimaging records, and comprehensive clinical assessments. Bivariate associations were calculated using the Spearman correlation coefficient or analysis of variance. We established sex-specific stepwise multivariate linear regression models of factors associated with pain.Of the 94 participants diagnosed with mTBI (the mean age was 45.20 ± 9.94 years; 61.2% were males; the median time since injury was 197 days [interquartile range 139-416]), head/neck, and bodily pain were reported by 93% and 64%, respectively. No sex differences were identified in pain frequencies or severity. Pain was significantly associated with certain socio-demographic, injury-related, behavioral, and clinical variables. In the multivariable regression analysis, several determinants explained 60% of the pain variance in males and 46% in females.Pain is common in patients with delayed recovery from mTBI and is significantly associated with potentially modifiable clinical and nonclinical variables. Examining the multidimensional construct of pain in concussion/mTBI through a sex lens garners new directions for future longitudinal research on the pain mechanisms involved in postconcussion syndrome.

Risk factors associated with chronic low back pain in Syria

BACKGROUND

We aimed to identify risk factors associated with chronic low back pain (C-LBP) in Syria.

MATERIALS AND METHODS

We conducted the study in a busy outpatient neurology clinic in Damascus city from October 2011 to August 2012. We enrolled all eligible adults presenting with C-LBP along with those who denied any back pain as a controls. We considered C-LBP any LBP lasting over 3 months. We developed our own questionnaire. A clinical nurse interviewed each person and filled in the results.

RESULTS

We had a total of 911 subjects; 513 patients and 398 controls. We found that C-LBP increased with age. Having a sibling with C-LBP was a strong predictor of C-LBP. In women obesity, but not overweight, was a risk factor. Number of children was a risk factor for mothers. Higher level of education decreased the chance of C-LBP in women. Sedentary job increased the risk of C-LBP.

CONCLUSION

This study sheds some light on risk factors for C-LBP in our population and might help find possible preventive measures.

A Health- and Resource-Oriented Perspective on NSLBP

Nonspecific low back pain (NSLBP) is an important health issue of our time. Personal as well as economic factors, like suffering pain and experiencing disability on the one hand and enormous and still increasing costs to the economy and society on the other hand, display the importance of the matter. Tremendous research has been conducted in the last few decades on NSLBP. A PubMed search (June 17, 2013) on “low back pain” provided 22,980 hits, and when specifying for “low back pain, systematic review,” 3,134 hits were still generated. Most research has been done examining the development, risk factors, or therapeutic measures of NSLBP, but hardly any literature exists on resources related to NSLBP. The aims of this review are twofold. In order to shade light on the salutogenetic approach of NSLBP, and thus to focus on health instead of illness, the first aim is to facilitate the understanding of which therapeutic measures enhance the ability to cope with chronic NSLBP and enable (more) normal functioning in life. The second aim is to stimulate the understanding of resources protecting against the onset of NSLBP or against the development of chronic NSLBP and its resulting work absence.

Association between low-back pain and lumbar spine bone density: a population-based cross-sectional study

OBJECT

The authors undertook this study to investigate the relationships between low-back pain (LBP) and spinal bone density. Low-back pain is a major health issue and contributes to increases in medical and economic costs. Epidemiological studies have identified individual, sociodemographic, psychosocial, and occupational risk factors for LBP. However, there have been limited studies addressing the relationships between LBP and spinal bone density.

METHODS

Data were obtained from the population-based Fourth Korea National Health and Nutrition Examination Survey (K-NHANES IV, 2009). From 10,533 K-NHANES participants, the authors identified 7144 (3099 men and 4045 women) 21 years of age or older who underwent dual-energy x-ray absorptiometry and anthropometric measurements for inclusion in this study. Low-back pain patients were defined as those who had been diagnosed with LBP by a medical doctor. Chi-square tests, t-tests, and multivariable logistic regression analyses were used to examine the relationships between LBP and spinal bone density.

RESULTS

The total prevalence of LBP in the patient sample was 17.1%. More females (21.0%) reported LBP than males (12.1%). A number of sociodemographic and medical factors-sex, age, place of residence, occupation, education, hypertension, diabetes mellitus, and depression-were all associated with LBP, while LBP was not associated with income or exercise levels. Regression analyses indicated that higher lumbar spine T-scores (OR 1.11, 95% CI 1.02-1.20) were associated with LBP.

CONCLUSIONS

Higher bone density in the lumbar spine is associated with LBP, independent of confounding factors such as sociodemographic status, education, and medical-psychiatric disorders. Cause and effect relationship between higher bone density and LBP, such as degenerative changes in spine, requires further investigation.

Health resource utilisation costs in acute patients with persistent midline cervical tenderness following road trauma

INTRODUCTION

The costs associated with patients discharged with isolated clinician-elicited persistent midline tenderness and negative computed tomography (CT) findings have not been reported. Our aim was to determine the association of acute and post-acute patient and injury characteristics with health resource costs in such patients following road trauma.

METHODS

In a prospective cohort study, road trauma patients presenting with isolated persistent midline cervical tenderness and negative CT, who underwent additional acute imaging with MRI, were recruited. Patients were reviewed in the outpatient spine clinic following discharge, and were followed up at 6 and 12 months post-trauma. Multivariate linear regression was used to assess the association of injury mechanism, clinical assessment, socioeconomic factors and outcome findings with health resource costs generated in the acute hospital and post-acute periods.

RESULTS

There were 64 patients recruited, of whom 24 (38%) had cervical spine injury detected on MRI. Of these, 2 patients were managed operatively, 6 were treated in cervical collars and 16 had the cervical spine cleared and were discharged. At 12 months, there were 25 patients (44%) with residual neck pain, and 22 (39%) with neck-related disability. The mean total cost was AUD $10,153 (SD=10,791) and the median was $4015 (IQR: 3044-6709). Transient neurologic deficit, which fully resolved early in the emergency department, was independently associated with higher marginal mean acute costs (represented in the analysis by the β coefficient) by $3521 (95% CI: 50-6880). Low education standard (β coefficient: $5988, 95% CI: 822-13,317), neck pain at 6 months (β coefficient: $4017, 95% CI: 426-9254) and history of transient neurologic deficit (β coefficient: $8471, 95% CI: 1766-18,334) were associated with increased post-acute costs.

CONCLUSION

In a homogeneous group of road trauma patients with non fracture-related persistent midline cervical tenderness, health resource costs varied considerably. As long term morbidity is common in this population, a history of resolved neurologic deficit may require greater intervention to mitigate costs. Additionally, adequate communication between acute and community care providers is essential in order to expedite the recovery process through early return to normal daily activities.