What can be done about the increasing prevalence of low back pain and associated comorbid factors?

Young people's low back pain and awareness of postural habits: A cross-sectional study

BACKGROUND

Young people tend to spend most of their time in activities involving inappropriate positions, which can promote musculoskeletal alterations and disorders.

OBJECTIVE

To investigate the prevalence of low back pain (LBP) in young people and analyse its associations with daily postural habits.

METHODS

Cross-sectional and retrospective study evaluating 679 Brazilian young people (15 to 18 years old), using questionnaires about LBP and awareness of postural habits. The prevalence values were calculated for the present moment, the last three months and throughout life. The Mann-Whitney U test and the Chi-square test were applied.

RESULTS

The prevalence of LBP at the present moment was 27.2%, 57.7% over the last three months and 73.9% throughout life. Boys and girls presented significantly different values, a larger number of girls manifesting pain for the three moments. The associated postural habits were: turning the body, reduction of lumbar lordosis when seated, not placing the feet on the floor, crossing the legs when sitting in the classroom and at home, sitting or lying in an inappropriate position, and distributing the body asymmetrically on the legs when standing.

CONCLUSIONS

Young people from 15 to 18 years of age show a high prevalence of low back pain. Inadequate postural habits adopted during everyday activities are associated with this complaint. These findings could contribute to the implementation of prevention and rehabilitation strategies.

Use of a passive lumbar back exoskeleton during a repetitive lifting task: effects on physiologic parameters and intersubject variability

Objectives. This study evaluated the effects of wearing the Laevo v2.56 exoskeleton (Laevo, The Netherlands) on physiological parameters related to working load and metabolic cost (MC) during a lifting task, explored the variability in exoskeleton performance among users and determined whether perceived discomfort negatively correlates with a reduction in MC. Methods. Twenty participants completed a 4-min repetitive lifting task with/without the exoskeleton. Respiratory gases, heart rate, blood lactate and ratings of perceived exertion and experienced discomfort were collected, and MC was calculated. Results. Wearing the exoskeleton significantly reduced MC and oxygen uptake during the lifting task by 4.8 and 3.8%, respectively. Workload reduction occurred in 65% of the participants. Conclusion. The Laevo v2.56 exoskeleton reduced MC and workload in a repetitive lifting task in a subject-dependent manner. Future studies should focus on identifying factors that could cause performance variability such as user-robot interaction forces.

Prevalence of low back pain in young Brazilians and associated factors: Sex, physical activity, sedentary behavior, sleep and body mass index

BACKGROUND

Low back pain (LBP) has become increasingly common, but the prevalence of this complaint and associated factors in young people remains controversial.

OBJECTIVE

This study aimed to identify the prevalence of LBP and to explore the existence of associated factors (sex, physical activity, sedentary lifestyle, sleep, body mass index and waist circumference).

METHODS

This study considered all complaints of the lumbar region (acute or chronic) as LBP, which can irradiate to the backside and legs, lasting a minimum of 24 hours. Youngsters aged 15 to 18 years from a school in the south of Brazil were evaluated. Descriptive statistics was used, in particular Chi-square, Mann-Whitney U tests and binary logistic regression. A significance level of p< 0.05 was adopted.

RESULTS

A total of 330 youngsters answered a questionnaire and had their anthropometric measurements measured (response rate 84%). The prevalence of LBP in the present was 30%, quarterly 63% and throughout life 77%. There was a significant association between LBP and sex: girls have an increased risk of LBP in the last three-month period (PR = 1.3, 95% CI 1.06-1.56) and throughout life (PR = 1.2, 95% CI 1.04-1.43). The practice of physical activities was also associated with LBP, but as a protection factor in the present and in the last three-month period (PR = 0.7, 95% CI 0.47-0.90). Physical education at school has demonstrated a protective factor regarding LBP throughout life (PR = 0.9, 95% CI 0.77-0.97). Most of the students did not comply with recommendations related to sleep and time spent doing activities in front of a screen, and no association of these factors with LBP was detected. This exposure (physical activity, sleep time, sedentarism) did not present significant association with LBP when adjusted by the confusion factors (sex, age, BMI).

CONCLUSIONS

Youngsters reported a high prevalence of LBP. Girls were at greater risk of LBP than boys. It is recommended that prevention strategies focus on the practices of physical activities and scholar physical education. No association of LBP with sedentary lifestyle (TV and computer use time, sleep time), anthropometric measures and sleeping duration was observed.

The comorbidity of mental and physical disorders with self-reported chronic back or neck pain: Results from the China Mental Health Survey

BACKGROUND

To investigate mental and physical health comorbidity with chronic back or neck pain in the Chinese population, and assess the level of disability associated with chronic back or neck pain.

METHODS

Data were derived from a large-scale and nationally representative community survey of adult respondents on mental health disorders in China (n = 28,140). Chronic back or neck pain, other chronic pain conditions and chronic physical conditions were assessed by self-report. Mental disorders were assessed by the Composite International Diagnostic Interview (CIDI). Role disability during the past 30 days was assessed with the World Health Organization Disability Assessment Schedule (WHO-DAS-II).

RESULTS

The 12-month prevalence of chronic back or neck pain was 10.8%. Most of respondents with chronic back or neck pain (71.2%) reported at least one other comorbid condition, including other chronic pain conditions (53.4%), chronic physical conditions (37.9%), and mental disorders (23.9%). It was found by logistic regression that mood disorders (OR = 3.7, 95%CI:2.8-4.8) showed stronger association with chronic back or neck pain than anxiety disorders and substance disorders. Most common chronic pains and physical conditions were significantly associated with chronic back or neck pain. Chronic back or neck pain was associated with role disability after controlling for demographics and for comorbidities. Physical and mental comorbidities explained 0.7% of the association between chronic back or neck pain and role disability.

CONCLUSIONS

Chronic back or neck pain and physical-mental comorbidity is very common in China and chronic back or neck pain may increase the likelihood of other physical and mental diseases. This presents a great challenge for both clinical treatment and public health education. We believe that further study needs to be conducted to improve the diagnostic and management skills for comorbidity conditions.

Lumbosacral Radiculopathy: Inciting Events and Their Association with Epidural Steroid Injection Outcomes

Objective

Low back pain is the leading cause of worldwide disability, with lumbosacral radiculopathy accounting for over one-third of these cases. There are limited data on the relationship between etiologies and lumbosacral radiculopathy, and it is unknown whether specific causes predict treatment outcomes.

Design, Setting, and Subjects

This study explores patient-reported etiologies for lumbosacral radiculopathy in a chronic pain clinic between January 2007 and December 2015 and examines whether these causes affected epidural steroid injection outcomes.

Methods

We reviewed the medical records of 1,242 patients with lumbosacral radiculopathy who received epidural steroid injections. The recording of an inciting event was done contemporaneously based on note templates. A positive outcome following an epidural steroid injection was defined as ≥30% pain relief sustained for six or more weeks without additional intervention. Factors associated with epidural steroid injection outcome were analyzed by multivariable logistic regression.

Results

Fifty point seven percent reported an inciting event, and 59.9% of patients experienced a positive epidural steroid injection outcome. The most commonly reported causes were falls (13.1%), motor vehicle collisions (10.7%), and lifting (7.8%). Individuals with a herniated disc (56.3%) were more likely to report a precipitating cause than those with stenosis (44.7%) or degenerative discs (47.8%, P = 0.012). An inciting event did not predict treatment outcome. Factors associated with negative treatment outcome included opioid consumption (odds ratio [OR] = 0.61, 95% confidence interval [CI] = 0.39–0.95, P = 0.027), secondary gain (OR = 0.69, 95% CI = 0.50–0.96, P = 0.030), and baseline pain score (OR = 0.90, 95% CI = 0.84–0.97, P = 0.006). The number of levels injected was associated with a positive outcome (OR = 2.72, 95% CI = 1.28–6.47, P = 0.008).

Conclusions

Reported inciting events are common in patients with lumbosacral radiculopathy but are not associated with outcome following epidural steroid injection, and their occurrence is not always consistent with the purported mechanism of injury.

Questionnaire on body awareness of postural habits in young people: construction and validation

Abstract Introduction: The postural deviations associated with the changes in the habits of young people have increased over the last decades. Investigating the subject by way of a self-perception questionnaire allows one to understand the level of awareness the individual has concerning his/her postural habits. Objective: Designing a self-perception evaluation questionnaire about the postural habits of young people and to validate, pre-test, verify the reliability and the internal consistency of this instrument. Methods: The validity of the content was determined by 10 judges. The study involved young people (15 - 18 years old) from Florianopolis/Brazil. The questionnaire was pre-tested, applied to 15 youthful who provided qualitative information about it. The reproducibility was analyzed by way of a test-retest with 40 students, in a one-week gap, and was analyzed by interclass correlation coefficient. The internal consistency was analyzed by Cronbach’s alpha with 679 students. A 5% significance level was adopted. Results: Concerning to the validation of content, the questionnaire presented a total coefficient of 0.28 and 72% concordance was observed amongst the reviewers. The interclass correlation coefficient (test-retest) indicated acceptable reproducibility values (R = 0.66, 0.74 and 0.59; p < 0.001), with a decrease in the object-carrying dimension (R = 0.32; p = 0.04). The questionnaire was considered suitable, quick and easy to fill in. The internal consistency presented a value of 0.80. Conclusion: The questionnaire on body awareness of postural habits in young people is a valid instrument with good repeatability and reliability, its use can be recommended with teenagers showing the same profile as those used in this study.

Increased spinal height using propped slouched sitting postures: Innovative ways to rehydrate intervertebral discs

BACKGROUND

Upright and slouched sitting are frequently adopted postures associated with increased intradiscal pressure, spinal height loss and intervertebral disc pathology.

OBJECTIVES

To examine the effects of two sustained propped slouched sitting (PSS) postures on spinal height after a period of trunk loading.

METHODS

Thirty-four participants without a history of low back pain (LBP) were recruited (age 24.4 ± 1.6 years). Subjects sat in (1) PSS without lumbar support and (2) PSS with lumbar support for 10 min, after a period of trunk loading. Spinal height was measured using a stadiometer.

RESULTS

Mean spinal height increase during PSS without lumbar support was 2.94 ± 3.63 mm and with lumbar support 4.74 ± 3.07 mm.

CONCLUSIONS

Both PSS with and without lumbar support significantly increased spinal height after a period of trunk loading (p < 0.001). Such PSS postures can provide a valuable alternative to upright sitting and may be recommended for recovering spinal height in the working environment following periods of loading.

Chronic low back pain and the risk of depression or anxiety symptoms: insights from a longitudinal twin study

BACKGROUND CONTEXT

Pain is commonly associated with symptoms of depression or anxiety, although this relationship is considered bidirectional. There is limited knowledge regarding causal relationships.

PURPOSE

This study aims to investigate whether chronic low back pain (LBP) increases the risk of depression or anxiety symptoms, after adjusting for shared familial factors.

STUDY DESIGN

This is a longitudinal, genetically informative study design from the Murcia Twin Registry in Spain.

PATIENT SAMPLE

The patient sample included 1,269 adult twins with a mean age of 53 years.

OUTCOME MEASURES

The outcome of depression or anxiety symptoms was evaluated with EuroQol questionnaire.

METHODS

Using logistic regression analyses, twins were initially assessed as individuals in the total sample analysis, followed by a co-twin case-control, which was partially (dizygotic [DZ] twins) and fully (monozygotic [MZ] twins) adjusted for shared familial factors. There was no external funding for this study and no conflict of interest was declared.

RESULTS

There was a significant association between chronic LBP and the risk of depression or anxiety symptoms in the unadjusted total sample analysis (odds ratio [OR]: 1.81, 95% confidence interval [CI]: 1.34-2.44). After adjusting for confounders, the association remained significant (OR: 1.43, 95% CI: 1.05-1.95), although the adjusted co-twin case-control was non-significant in DZ (OR: 1.03, 95% CI: 0.50-2.13) and MZ twins (OR: 1.86, 95% CI: 0.63-5.51).

CONCLUSIONS

The relationship between chronic LBP and the future development of depression or anxiety symptoms is not causal. The relationship is likely to be explained by confounding from shared familial factors, given the non-statistically significant associations in the co-twin case-control analyses.

Research Priorities in the Field of Posttraumatic Pain and Disability: Results of a Transdisciplinary Consensus-Generating Workshop

Background. Chronic or persistent pain and disability following noncatastrophic “musculoskeletal” (MSK) trauma is a pervasive public health problem. Recent intervention trials have provided little evidence of benefit from several specific treatments for preventing chronic problems. Such findings may appear to argue against formal targeted intervention for MSK traumas. However, these negative findings may reflect a lack of understanding of the causal mechanisms underlying the transition from acute to chronic pain, rendering informed and objective treatment decisions difficult. The Canadian Institutes of Health Research (CIHR) Institute of Musculoskeletal Health and Arthritis (IMHA) has recently identified better understanding of causal mechanisms as one of three priority foci of their most recent strategic plan. Objectives. A 2-day invitation-only active participation workshop was held in March 2015 that included 30 academics, clinicians, and consumers with the purpose of identifying consensus research priorities in the field of trauma-related MSK pain and disability, prediction, and prevention. Methods. Conversations were recorded, explored thematically, and member-checked for accuracy. Results. From the discussions, 13 themes were generated that ranged from a focus on identifying causal mechanisms and models to challenges with funding and patient engagement. Discussion. Novel priorities included the inclusion of consumer groups in research from the early conceptualization and design stages and interdisciplinary longitudinal studies that include evaluation of integrated phenotypes and mechanisms.