有氧运动对治疗慢性下背痛的疗效

目的:探索有氧运动对治疗慢性下背痛疗效的影响.方法:选择社区医疗服务中心40例病史3个月以上的下背痛患者,采用电脑随机方法将受试者分为两组:一组为实验组,进行有氧训练;另一组为对照组,不接受任何训练计划.对照组和实验组分别在干预介入前与介入后进行下背痛失能程度量表和疼痛评分(Visual Analogue Scale,VAS).结果:治疗12周后,发现实验组在治疗后欧式下背痛失能程度显著小于对照组,且VAS评分结果显著优于对照组.结论:有氧运动可以改善慢性下腰痛患者的疼痛程度及改善其失能状况.     

A controlled evaluation of paraspinal EMG biofeedback in the treatment of chronic low back pain.

66 chronic low back pain sufferers (aged 20–65 yrs) were randomly divided into 3 equal groups. Ss completed a psychological test battery that included the Beck Depression Inventory and the State-Trait Anxiety Inventory; pain monitoring measures, including the McGill Pain Questionnaire (MPQ); and measurement of paraspinal electromyogram (EMG). One group then received paraspinal EMG biofeedback, 1 group received placebo treatment, and the 3rd group received no intervention. All Ss were reassessed immediately after treatment and at 3-mo follow-up. Results show that all groups showed significant reductions in pain, anxiety, depression, and paraspinal EMG following treatment and at follow-up, but there were no differences between groups. A regression analysis failed to identify Ss' characteristics that predicted positive outcome in the biofeedback group. However, high scores on the Evaluative scale of the MPQ and high hypnotizability were significant predictors of positive outcome for the placebo group. It is concluded that paraspinal EMG biofeedback is not a specific treatment for chronic low back pain in a nonhospitalized population. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of behavioral therapy for chronic low back pain: A component analysis.

The effects of outpatient group behavioral therapy including aerobic exercise (BE), behavioral therapy only (B), and aerobic exercise only (E) on pain and physical and psychosocial disability were evaluated and compared in a group of mildy disabled chronic low-back-pain patients. Ninety-six Ss were randomly assigned to the 3 treatments and a waiting-list control (WL) condition and assessed on a variety of patient self-report, spouse-rated, and direct observational measures at pretreatment, posttreatment, and 6- and 12-month follow-ups. Patients in the BE condition, but not the B or E conditions, improved significantly more pretreatment to posttreatment than did WL patients on the patient self-report and observer-rated measures. At both follow-ups, all 3 treatment groups remained significantly improved from pretreatment, with no significant differences among treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychophysiologic treatment of chronic lower back pain.

Research concerning the mechanisms and efficacy of psychophysiological treatments for chronic low back pain is reviewed. Despite methodological shortcomings, the literature supports the efficacy of a number of psychophysiological treatments. The mechanism of successful treatment is poorly understood. New models of pathophysiology of muscle pain are presented, and it is hoped that they will clarify treatment issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of operant behavioral and cognitive-behavioral group treatment for chronic low back pain.

To evaluate and compare the efficacy of two widely used behavioral approaches for the treatment of chronic pain, 81 mildly dysfunctional chronic low back pain patients were randomly assigned to operant behavioral (OB) treatment, cognitive-behavioral (CB) treatment, or a waiting-list (WL) control condition. Both treatments, which were conducted in eight-session outpatient groups, resulted in decreased physical and psychosocial disability. The OB patients showed greater pre- to posttreatment improvement as rated by patients and their spouses than did the CB patients. Generally, the OB patients showed a leveling off in improvement at 6- and 12-month follow-ups, whereas the CB patients generally continued to improve over the 12 months following treatment. At 12-month follow-up, patients in both treatments remained significantly improved, with no significant differences between conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

A review of basic science issues in low back pain

This review article is based on a workshop, "New Horizons in Low Back Pain" that was held in November 1995 in San Diego, California. The current article follows the 1995 workshop format of a series of three case study models. Three classical clinical profiles were presented for consideration: lumbar radiculopathy, idiopathic (degenerative disk) low back pain, and degenerative stenosis. This article summarizes the basic science perspectives that were presented and discussed on each topic.     

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.     

Cognitive distortion and psychological distress in chronic low back pain.

Examined the association of cognitive distortion with 5 Minnesota Multiphasic Personality Inventory (MMPI) scales—Depression (D), Psychasthenia (Pt), Schizophrenia (Sc), Hypochondriasis (Hs), and Hysteria (H)—in 138 depressed, chronic low back pain patients (mean age 39.9 yrs). Ss completed a cognitive error questionnaire, the MMPI, a sickness impact profile, and daily pain diaries. Results indicate that cognitive distortion was associated with high scores on the D, Pt, and Sc scales but not the Hs and Hy scales. Thus, cognitive distortion is likely to be an important factor in general distress but not in somatization among back pain patients. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic low back pain. What are the treatment options?

The fragile X mental retardation 1 gene (FMR1) mutation is strongly correlated with specific and marked neurobehavioral and neuroanatomical abnormalities. The protein product, FMRP, is highly expressed in neurons of the normal mammalian brain, and absent or in low levels in leukocytes from individuals with fragile X (FraX)-associated mental impairment. Inferences which arise from these findings are that FMRP has a critical role in the development and functioning of the brain, and that leukocyte-derived molecular assessments provide a good indicator of FMR1 expression in that organ. This latter conclusion appears true in most cases even though the typical FMR1 mutation is an unstable triplet repeat expansion which demonstrates somatic heterogeneity within and across tissues. Blood to brain correspondence in FraX patients has only rarely been confirmed by the direct study of human brain specimens and, to our knowledge, it has never been studied in living individuals with the FMR1 mutation. In this report, we describe the FMR1 patterns in olfactory neuroblasts (ON) from two living brothers with expansion mutations in their leukocytes who are mentally retarded and autistic. ON were chosen for study because they are accessible neurons closely linked to the brain. In both subjects, the ON genotype was highly, but not perfectly, consistent with that observed in leukocytes. Protein phenotypes across tissues were completely consistent showing the absence of FMRP-immunoreactivity (-ir). These results augment the limited amount of direct evidence which indicates that FMR1 mutation patterns in leukocytes are a good, albeit potentially fallible, reflection of such patterns in the brain. This report further demonstrates the feasibility of using ON samples to evaluate the FMR1 mutation in humans in vivo.     

Role of self-efficacy in rehabilitation outcome among chronic low back pain patients.

Examined the role of self-efficacy beliefs in the rehabilitation of 45 low back pain patients participating in a 3-wk rehabilitation program. Increments in self-efficacy beliefs during the rehabilitation program were not associated with improved patient functioning at discharge from the program. However, in support of the theorized role of self-efficacy in behavior change, these increments in self-efficacy significantly predicted better patient functioning and less reported pain at the 6-mo follow-up assessment. Implications of these findings for the rehabilitation of low back pain patients are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute and chronic low back pain: Cognitive, affective, and behavioral dimensions.

Despite strong suppositions concerning differences between patients suffering acute and chronic low back pain, relatively few data-based comparisons have been made. In this study, affective, cognitive, behavioral, and demographic contrasts were conducted. Chronic patients were divided into those who demonstrated signs and symptoms that were either congruent or incongruent with underlying anatomical and physiological principles. Low SES, compensation claims, use of opiate analgesics, greater disability, catastrophizing cognitions, stronger emotionality, and passive coping were more characteristic of both acute and chronic incongruent patients than chronic congruent patients. A relatively stereotyped, spontaneous facial expression of pain was observed in all groups when responding to painful movements during a physical examination. The similarities between acute and chronic incongruent patients have implications for the assessment and treatment of low back pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Linking symptom-specific physiological reactivity to pain severity in chronic low back pain patients: A test of mediation and moderation models.

Symptom-specific reactivity to stress (lower paraspinal muscle reactivity) among chronic low back pain (CLBP) patients may exacerbate chronic pain. It was hypothesized that among CLBP patients (N?=?107) only stress-induced lower paraspinal reactivity, and not reactivity in other indexes, would predict pain severity (PS), and that lower paraspinal reactivity would mediate or moderate links between depression and PS. Electromyogram readings from lower paraspinal and trapezius muscles, systolic and diastolic blood pressures, and heart rate were collected during mental arithmetic (MA) and an anger recall interview. The moderator hypothesis was supported: Only lower paraspinal reactivity during MA was related significantly to PS, but only among patients with high levels of depression. Thus, a profile of lower paraspinal hyperreactivity plus depressed affect may aggravate CLBP. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

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.     

Lumbar strengthening in chronic low back pain patients. Physiologic and psychological benefits

The effects of exercise for isolated lumbar extensor muscles were examined in 54 chronic low-back pain patients. Subjects were randomly assigned to a 10-week exercise program (N = 31) or a wait-list control group (N = 23). Results indicated a significant increase in isometric lumbar extension strength for the treatment group and a significant reduction in reported pain compared with the control group (P 0.05). Treated subjects reported less physical and psychosocial dysfunction whereas the control group increased in pain, and physical and psychosocial dysfunction. There were no concomitant changes in reported daily activity levels. These results show that lumbar extension exercise is beneficial for strengthening the lumbar extensors and results in decreased pain and improved perceptions of physical and psychosocial functioning in chronic back pain patients. However, these improvements were not related to changes in activities or psychological distress.     

Arousal of negative emotions and symptom-specific reactivity in chronic low back pain patients.

Anger may have greater effects on chronic pain severity than other negative emotions and may do so by increasing muscle tension near the site of injury (symptom-specific reactivity). For patients with chronic low back pain (CLBP), relevant muscles are lower paraspinals (LP). Ninety-four CLBP patients and 79 controls underwent anger and sadness recall interviews. EMG and cardiovascular activity were recorded. Patients exhibited greater LP tension increases during anger and slower recovery than controls. Only patients showed greater LP reactivity during anger than sadness. For both groups, trapezius reactivity during anger and sadness did not differ. LP reactivity to anger correlated with everyday pain severity for patients. Anger-induced symptom-specific LP reactivity may be linked to chronic pain aggravation among CLBP patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Isolated lumbar strengthening in the rehabilitation of chronic low back pain

The purpose of this work is to describe our initial clinical experience (in 66 patients) with Resovist and Eovist, two new liver-specific MR contrast agents. We focus our report on safety aspects, dose finding, and optimization and technical parameters. Both contrast agents were well tolerated and improved the detectability of focal liver lesions. With Resovist, postcontrast MRI may be started as early as 10 min following injection. The dose of 8 mumol Fe/kg bodyweight was sufficient to achieve diagnostic tumor-liver contrast levels. Since Eovist can also be administered as a bolus, dynamic enhancement patterns may be studied for tumor characterization as well. Breath-hold T1-weighted FLASH images were superior to other T1-weighted techniques with and without fat saturation.