Fundamental Concepts in the Diagnosis of Low Back Pain
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
The more common causes of low back pain are discussed in this chapter: Erector spinae muscular strainRadiculopathyCentral canal stenosisArthritic changes of the facet (zygapophyseal) jointPiriformis syndromeMetastatic lesions of the vertebrae from a primary cancerSacroiliac joint painArachnoiditisSecondary gain and/or drug-seeking behavior
Evaluating Outcomes in the Interdisciplinary Treatment of Chronic Pain: A Guide for Practicing Clinicians
Michael E. Schatman, Alexandra Campbell, John D. Loeser in Chronic Pain Management, 2007
For low back pain only, another option exists as well. Waddell et al., (99) devised a measure, called the Physical Impairment Scale, which was intended to be a reliable assessment of physical functioning in low back pain patients. The measure uses empirically derived cutoff scores for specific physical tasks and allows the calculation of a total score representing global level of physical impairment. It involves seven separate measures of impairment: four involving flexibility (measured in degrees of movement), two involving strength (measured in endurance time), and one assessing the presence or absence of spinal tenderness over a specific area of the lumbar spine. The measure has adequate interrater reliability (99,100), although the spinal tenderness item has been relatively unreliable, with a K = 0.35 (100). Additionally, the scale has proven utility in discriminating individuals with and without chronic low back pain (sensitivity 76%; specificity 86%) and explained significant variance in self-reported disability levels (99). Finally, it has been shown to be responsive to intervention (100,101).
Validity of Waddell’s Sign
Alan R. Hirsch in Neurological Malingering, 2018
Lower back pain is the leading cause of chronic pain and it has become very difficult to treat, as clinicians contemplate whether or not physical exercise, medical, or surgical treatment are the best options. Often times, the treatment management is ineffective in providing relief, so much so that severe “temporary” measures are taken to alleviate the pain. Thus, the administration of opiate medications has become a very common practice amongst both medical and surgical physicians for temporary pain relief. In some ways, this has intensified the opiate epidemic in the United States. In 2012, 259 million prescriptions were written for opioid medication, with a prescribing rate of 81.3 prescriptions per 100 persons (CDC Centers for Disease Control and Prevention, 2017). However, the overall national opioid prescribing rate declined over four years, such that in 2016 it had decreased to 66.5 prescriptions per 100 persons (over 214 million total opioid prescriptions), the lowest it had been in over 10 years (CDC Centers for Disease Control and Prevention, 2017). From 2010 to 2015, the amount of opioids prescribed in the United States decreased from 782 to 640 morphine milligram equivalents (MME) per person. This means that every American is medicated 24 hours a day, 7 days a week, for 3 weeks; moreover, 640 MME per person equals approximately 5 milligrams of hydrocodone every four hours, for every living person in the United States from babies to centenarians (Guy et al., 2017).
The impact of musculoskeletal diseases on the presence of locomotive syndrome
Published in Modern Rheumatology, 2019
Manabu Akahane, Akie Maeyashiki, Yasuhito Tanaka, Tomoaki Imamura
Low back pain is a common symptom associated with musculoskeletal disorders. Although the mortality caused by low back pain is generally quite low, its effect on disability and the quality of life is significant, due to the associated pain. Suka et al. [18] reported that 41.2% of the Japanese adult population has musculoskeletal pain, and that musculoskeletal pain has a substantial impact on the quality of life in Japan. The lower back is the most common site of pain, from among five anatomical areas which also include the neck/shoulder area, elbow/wrist/hand area, ankle/foot area, and hip/knee area. It is estimated that the prevalence of low back pain will reach 26.5% by 2055 [19]. It is reported that low back pain is the fourth leading cause of interference in daily activities, after adjustment for age and sex. The neck/shoulder area and elbow/wrist/hand area ranked first and second, respectively. In our study, however, the impact of low back pain on the presence of locomotive syndrome was large compared to the symptoms pertaining to the joints of the upper extremities. We assumed that our study focused on locomotive syndrome, which is a condition wherein the status of mobility functions such as sit-to-stand or gait are declined due to locomotive organ impairment [6]. In contrast, the daily activities in that study included general activities involving the upper extremity as well as legs and spinal region. Therefore, low back pain could rank higher in our study compared to the symptoms of the joints of the upper extremities, as reported by others.
Paracetamol for low back pain: the state of the research field
Published in Expert Review of Clinical Pharmacology, 2020
Bart Koes, Marco Schreijenberg, Alexander Tkachev
In most people with low back pain, the precise cause of the pain is unknown. In only a small proportion (up to 5–10%) of patients presenting in primary care underlying pathologies, such as malignancies, fracture, infections can be identified. When specific pathologies explaining the back pain are not present, the complaints are labeled as being nonspecific. It hampers adequate treatment that in most cases no cause of the pain can be found, since no causal treatment can thus be applied. Consequently, many treatments for low back pain are focused on reduction of symptoms. There are many treatments available for people with back pain. This includes non-pharmacological treatments (patient education, exercises, manual therapies) and pharmacological treatments (mostly pain medications, including paracetamol) [16]. Some patients suffering from low back pain also receive surgery. Especially patients with persisting radicular pain (>6–8 weeks) in the leg due to a herniated disk are regarded as surgical candidates. At the same time, there is good evidence that recovery rates after 1 and 2 years follow up are more or less similar between patients receiving disc surgery or prolonged conservative care [17]
The fidelity of comparison intervention in manual therapy trial for patients with low back pain: a systematic review
Published in Physical Therapy Reviews, 2019
Mackenzie Snow, Sean Trexler, Christine Gates, Kathryn Pudoka, Mark Wilhelm
The present terminology to describe the comparison interventions in studies looking at low back pain is variable. There are treatments being utilized in the literature as comparison groups without being supported by evidence-based practice. Many treatments have already been shown to be effective in the care of low back pain, such as patient education, manual therapy, and exercise, as stated in the CPG. While comparing interventions to placebo, sham, or control groups may demonstrate superiority compared to no intervention, in order to progress interventions and healthcare professions, comparison to established and effective treatments is necessary. Researchers should compare their new treatment interventions to comparison groups that receive either no treatment or treatment that is already supported in the literature. In doing so, this will show a true cause and effect relationship of the new intervention on patient outcomes.
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