Epidemiology of occupational low back pain

Lack of awareness of mental disorder in schizophrenia has been increasingly identified by researchers during recent years due to a resurgence of interest in the subject. In addition, better measurement methods have led to more valid and detailed investigations on insight in schizophrenia. Poor insight has been reported as a common phenomenon which may have both nosological and prognostic value. Specifically, due to recent studies indicating that lack of insight in schizophrenia may lead to poor treatment outcome, research focused on this phenomenon could lead to increasingly effective and efficient treatment strategies. However, many past and present studies reporting a correlation between insight and outcome in schizophrenia demonstrate significant theoretical or methodological limitations which may limit the implications and generalization of findings. This article lists and critically analyzes historical and contemporary research focusing on insight, illness, and outcome in schizophrenia. The role of insight is outlined, as are current methods for assessing awareness of mental disorder in schizophrenia. Cumulative research in this area is then reviewed, in terms of hypotheses, methods, conclusions, and limitations. Finally, suggestions for future research in this area are delineated.     

Manipulation for the treatment of occupational low back pain

Female colour polymorphism is a perplexing characteristic of many damselfly species. In Ischnura elegans three female phenotypes occur, one of which has the same blue coloration as the male (androchromes) whilst the others are inconspicuous brown gynochromes (infuscans and infuscans-obsoleta morphs). By marking a natural population near Rome, Italy, we found that all female phenotypes have similar survivorship, but they differ in mating frequency. Androchromes represented 55% of females but were involved in 43% of matings, whereas infuscans females represented 27% of females and 40% of matings and the infuscans-obsoleta phenotype 18% of females and 17% of matings. Old androchromes stored significantly less sperm in their spermatheca than old gynochromes, suggesting that they had mated less often. The majority of mature androchromes were observed alone (54%) when the majority of gynochromes (82-84%) were mating. When live tethered conspecifics were presented to males, blue models (male and androchrome female) were less attractive than brown models (gynochrome females). In contrast, all female colour morphs and males were equally (highly) attractive to males when the models were dead. Androchromes were significantly larger than gynochromes. Our results indicate that androchrome females mate less often than gynochromes, which could be a means of avoiding unnecessary and costly matings, but some androchrome females failed to reproduce (mate or oviposit) probably because they were unable to mate at all. The different explanations for the maintenance of this polymorphism in I. elegans are discussed. Copyright 1998 The Association for the Study of Animal Behaviour.     

Functional correlates in the rehabilitation of occupational low back pain

The aim of this preliminary report was to identify physiological parameters related to functional improvement in industrial workers with occupational low back pain (LBP) undergoing an intensive rehabilitation program. Four able-bodied and four LBP industrial workers were evaluated before and after a 4-week rehabilitation program. Dynamic and static strength tests, namely sustained isometric contractions, were performed in conjunction with surface electromyographic (EMG) measurements. Significant pre-rehabilitation differences were found between the two groups. Measured forces changed significantly in LBP subjects immediately after rehabilitation. No significative changes were found in the control subjects after the rehabilitation program. After rehabilitation, the slope of decay of the median frequency of the EMG power spectrum at L4 level, during a 60-sec isometric submaximal (60% MVC) contraction, decreased significantly (p < 0.02) indicating a lower fatigue level.     

Chronic low back pain

Most episodes of low back pain are mechanical in origin and resolve within a 12-week period. These acute episodes of back pain are associated with muscle strain and intervertebral disc herniation with radiculopathy. A smaller proportion of individuals have back pain with a duration greater than 12 weeks. These patients have back pain secondary to a wide variety of mechanical and nonmechanical disorders. The mechanical disorders associated with chronic low back pain include osteoarthritis and lumbar spinal stenosis; the nonmechanical disorders include infectious, neoplastic, rheumatologic, endocrinologic, vascular, and gynecologic. The clinical symptoms associated with each variety of disorder helps guide the appropriate diagnostic evaluation. Plain roentgenograms are useful in documenting the presence of spinal stenosis, benign or malignant tumors, osteoporosis, sacroiliitis, and spondylitis. CT scan is helpful in defining the bony alterations associated with malignant tumors and the vascular abnormalities associated with aneurysms. MR imaging is the technique of choice to document the extent of malignant processes and the presence of endometriosis in the pelvis. The therapy of these entities are specific for the disease entity causing the chronic low back pain. Although most of the disorders that cause chronic low back pain cannot be cured, therapy can decrease pain and improve function of the symptomatic patient.     

Patients with low back pain

OBJECTIVES: The aim of this study was to examine the clinical utility of low-dose oral prednisone in preventing severe paclitaxel-associated arthralgias and myalgias. METHODS: Patients treated with paclitaxel in the gynecologic oncology program of the Cleveland Clinic Foundation who developed arthralgias/myalgias which were uncontrolled through the use of nonsteroidal anti-inflammatory medications received low-dose oral prednisone (10 mg B.I.D. starting 24 h after the completion of chemotherapy and continuing for a total of 5 days) with their next paclitaxel course. RESULTS: Of 46 patients meeting the criteria for treatment with the oral prednisone regimen (i.e., subjective feeling of unacceptable discomfort despite the use of nonsteroidal anti-inflammatory agents), 39 (85%) experienced substantial relief of symptoms. All but one of the responding patients requested continuation of the oral prednisone regimen with subsequent paclitaxel treatment cycles. There were no significant toxicities noted in any patient receiving prednisone. CONCLUSION: This low-dose oral prednisone regimen results in substantial improvement in the majority of patients experiencing significant paclitaxel-associated arthralgias/myalgias.     

Clinical evaluation of low back pain

To properly diagnose and treat low back pain, a thorough history and physical examination are the cornerstones. The most important diagnoses for the physician to be aware of are cauda equina syndrome, back strain, herniated disc, stenosis, and spondylolisthesis.     

Physical therapy in low back pain

We report on physical measures in the treatment of patients with lower back pain due to mechanical factors. Acute low back pain improves mostly without specific measures. Intervention for this condition is useful for prevention of relapses. More demanding and difficult is the treatment of chronic lumbar back pain. After an exact diagnosis, information about the disease, the therapeutic procedure and the prognosis follow in order to agree on a common therapeutic goal. To this goal, a close cooperation between physician, physiotherapist, possibly a psychologist and a social worker, is optimal. The employer should be involved in the rehabilitation on the workplace. Patients should become mobilized inspite of pain, and the return to their workplace should be prepared step by step. The most important physiotherapeutic modalities are demonstrated.     

Conservative management of low back pain

The importance of using appropriate conservative care in the management of low back pain has been increasingly stressed in recent years, initially as a backlash to the many failures following surgical intervention (particularly repeated surgeries), and, more recently, as a means of controlling health care costs and instituting patient-centered systems of care. It is difficult to define and determine just what "appropriate conservative care" is and should be. Perhaps even more important in this current era of health care reform is the question of who makes this determination.     

Whole body vibrations and low back pain

Whether exposure to whole body vibration (WBV) in transport vehicles and moving machinery constitutes a health risk is unclear. The literature on this subject is vast, but most is of limited scientific value. A recent review covering the literature up to 1992 has been used as a basis for a further search concerning the period 1992-1996. Fifty-three articles were found: 14 epidemiological studies, 15 human laboratory experiments, four animal experiments, seven field studies and 13 reviews. Almost all epidemiological studies yielded insufficient information and had methodological shortcomings. Of the reviews, only three were critical. Experimental data support the hypothesis that WBV can have a negative effect on the spine. Epidemiological studies have shown drivers to have an increased prevalence of low back pain, probably in a dose-related fashion. Hence, it is likely that long-term exposure to WBV can contribute to back disorders. Present studies do not allow for a quantitative specification of the association between exposure and effect.     

The surgical treatment of low back pain

If nonoperative management fails to relieve a clearly identifiable and surgically treatable cause of lumbar pain, then surgery may be beneficial. Certain "red flags" indicate the need for urgent or emergent surgical intervention. Low back pain is associated with several degenerative conditions in the lumbar spine, including degenerative disc disease, spinal stenosis, spondylolisthesis, degenerative scoliosis, facet joint syndrome, and disc herniation.     

Meta-analysis of psychological interventions for chronic low back pain.

The purpose of this meta-analysis of randomized controlled trials was to evaluate the efficacy of psychological interventions for adults with noncancerous chronic low back pain (CLBP). The authors updated and expanded upon prior meta-analyses by using broad definitions of CLBP and psychological intervention, a broad data search strategy, and state-of-the-art data analysis techniques. All relevant controlled clinical trials meeting the inclusion criteria were identified primarily through a computer-aided literature search. Two independent reviewers screened abstracts and articles for inclusion criteria and extracted relevant data. Cohen's d effect sizes were calculated by using a random effects model. Outcomes included pain intensity, emotional functioning, physical functioning (pain interference or pain-specific disability, health-related quality of life), participant ratings of global improvement, health care utilization, health care provider visits, pain medications, and employment/disability compensation status. A total of 205 effect sizes from 22 studies were pooled in 34 analyses. Positive effects of psychological interventions, contrasted with various control groups, were noted for pain intensity, pain-related interference, health-related quality of life, and depression. Cognitive-behavioral and self-regulatory treatments were specifically found to be efficacious. Multidisciplinary approaches that included a psychological component, when compared with active control conditions, were also noted to have positive short-term effects on pain interference and positive long-term effects on return to work. The results demonstrated positive effects of psychological interventions for CLBP. The rigor of the methods used, as well as the results that reflect mild to moderate heterogeneity and minimal publication bias, suggest confidence in the conclusions of this review. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meteorological conditions and self-report of low back pain

STUDY DESIGN: Six months of daily low back pain ratings for 94 individuals were tested for the influence of prevailing weather conditions during the spring, summer, and fall seasons. Intergroup differences were tested for study participants who reported weather sensitivity and for those who did not. OBJECTIVES: To investigate the relation between pain ratings and prevailing weather conditions in a population with chronic or recurrent low back pain. SUMMARY OF BACKGROUND DATA: Weather conditions have been reported to influence pain perception in some disease states, including low back pain. Investigations of this relation in chronic or recurrent low back pain have involved varied methodologies, and conflicting results have been reported. METHODS: The effects of eight weather variables reported to influence musculoskeletal pain were tested on daily pain ratings. A post hoc weather sensitivity questionnaire was used to disperse 73 individuals into groups based on perceived weather sensitivity, and group differences were tested. RESULTS: Significant effects on pain scores were found, most notably for temperature and vapor pressure. The magnitude of the effects were small compared with autocorrelation of an individual's own pain scores. Significant differences were found between the group of individuals who were insensitive to weather conditions and that of individuals with perceived sensitivity to cold temperatures. No significant intergroup differences were found for damp, rainy conditions or changes in barometric pressure. CONCLUSIONS: Weather conditions may influence subjective reporting of low back pain significantly. Although the effects are small in magnitude, they should be considered in clinical treatment of the patient with chronic, nonspecific low back pain. Pain scores may demonstrate greater interaction with certain weather conditions in individuals perceiving sensitivity to those conditions.