Dissertations / Theses on the topic 'Causes of the back pain'

Nugaros skausmais skundžiasi 75% pasaulio gyventojų. Ši problema tampa vis aktualesnė išsivysčiusiose šalyse, kuriose vyrauja sėdimas darbas. Sveikatos apsaugos ministerijos atliktais tyrimais, matome, kad vis daugiau jaunų žmonių skundžiasi jungiamojo audinio ir skeleto-raumenų sistemos ligomis, tačiau nėra aiškios patiriamo nugaros skausmo priežastys, nes jų yra labai daug: jos gali būti skirstomos į šešias grupes (stuburo patologija, pilvo organų ir onkologinės ligos, infekcijos, raumenų patempimai ir psichologinės priežastys) ir rizikos veiksnius, skatinančius stiprėti nugaros skausmus (viršsvoris, bloga laikysena, sėdimas ar sunkus fizinis darbas, stuburo traumos ir iškrypimai). Šio bakalauro darbo tyrimo objektas – studentų nugaros skausmo priežastys. Tyrimo tikslas – išsiaiškinti studentų nugaros skausmų priežastis. Buvo kelti šie uždaviniai: atskleisti nugaros skausmų teorinius aspektus; nustatyti studentų nugaros skausmo paplitimo tendencijas; išsiaiškinti dažniausias studentų patiriamo nugaros skausmo priežastis. Tyrimo metu naudoti metodai, kurių pagalba gauta ir apdorota informacija: mokslinės literatūros analizė; anketinė apklausa; matematinė – statistinė tyrimo duomenų analizė. Tyrimo dalyviai - Šiaulių Universiteto 1 – 4 kurso studentai. Tyrimo imtis – 100 respondentų. Anketine apklausa buvo siekiama išsiaiškinti studentų nugaros skausmų priežastis ir paplitimą. Tyrimo metu gauti duomenys parodė, kad studentai yra jautę nugaros skausmus įvairiu dažnumu: nuo... [toliau žr. visą tekstą]
About 75% of the world population suffer of the back pain. This problem becomes more acute in developed countries with predominantly sedentary work. We see from the studies of the Ministry of Health that more and more young people complain of connective tissue and skeletal-muscle disorder, but there is no clear cause of back pain experienced because they are very much: they can be divided into six groups (spinal pathology, abdominal and oncological diseases, infections, muscle tearing apart and psychological reasons) and the risk factors that contribute to strengthen the back pain (overweight, poor posture, sedentary or heavy physical work, spinal trauma and deformity). The subject of this study - students back pain causes. The aim of the research is to identify causes of the students back pain. The next tasks have been realized in the work: to reveal the theoretical aspects of back pain; to ascertain the spread tendencies of the students back pain back pain; to ascertain the most common causes of the students back pain. The methods of the research have been used: theoretical (analysis of the academic literature), empirical (the quantitative analysis), statistical. The participants of the study – students of the 1-4 year of the Siauliai University. 100 respondents were involved in the research. The survey showed that students felt the back pain at various intervals ranging from several times during his life standing up to the pain. The intensity varies from mild to... [to full text]

Bakalauro darbe analizuojamos 14 – 18 metų moksleivių nugaros skausmų priežastys. Iškelta hipotezė: tikėtina, kad nugaros skausmų priežastys gali būti: 1) mažai judrus gyvenimo būdas (pamokos mokykloje, darbas kompiuteriu, ilgas televizoriaus žiūrėjimas, ilgalaikis buvimas vienoje padėtyje), 2) ilgalaikės netaisyklingos padėtys (netaisyklingas sėdėjimas, stovėjimas, svorių kėlimas, perkėlimas, nešimas), 3) dažnai atliekami nesaugūs pratimai. Tyrime buvo panaudota pusiau uždaro tipo anketa. Ją sudarė: demografinis blokas (duomenys apie tyriamuosius) – lytis, amžius, mokykla, klasė; 2) klausimų blokas, skirtas išsiaiškinti ar tiriamieji skundžiasi nugaros skausmais, 3) klausimų blokas, atskleisti nugaros skausmų pasireiškimo priežastis. Tyrimo tikslas – nustatyti 14 – 18 metų moksleivių nugaros skausmų priežastis. Tyrime dalyvavo 114 IX – XII klasių moksleiviai (nuo 14 iki 18 metų amžiaus), iš dviejų Radviliškio miesto gimnazijų. Atlikus tyrimą paaiškėjo, kad 54% 14 – 18 metų moksleivių skundžiasi nugaros skausmais. Tyrimo hipotezė pasitvirtino, kad nugaros skausmus šiame amžiuje gali sukelti: 1) Nepakankamas mokinių fizinis aktyvumas (69% mokinių renkasi pasyvias laisvalaikio praleidimo formas ir prie kompiuterio praleidžia daugiau nei 2 h per dieną). 2) Netaisyklingos padėtys sėdint bei keliant, perkeliant ir nešant daiktus (tik trečdalis moksleivių pasirinko taisyklingas padėtis). 3) Populiarūs diskutuotini (nesaugūs) pratimai (tik trečdalis moksleivių jų visiškai neatlieka)... [toliau žr. visą tekstą]
This bachelor theses analyses the causes of the back pain of the secondary school students of the age 14 to 18. The hypotheses: it is likely that the causes of the back pain might be: 1) sedentary lifestyle (lessons at school, working on the computer, TV viewing, permanent staying in one position), 2) permanent wrong posture (wrong sitting, standing, weight lifting, movement, bearing), 3) frequent unsafe exercises. The semi-open questionaires were used during the research. The questionaires consisted of: demographic block (exploratory data) – sex, age, school, class; 2) questions block designed in order to explore whether persons under investigation have any complains about the back pain, 3) questions block designed in order to explore the causes of the back pain. The aim of the research is to determine the causes of the back pain of the students of age 14 to 18. 114 students (aged 14 to 18) from the 9-12 classes of the two Radviliškis city gymnasiums participated in the research. The study has shown that 54 per cent of all students aged 14 to 18 has ailments about the back pain. The hypothesis of the research was approved that the back pain of this age may be influenced by: 1) Low levels of physical activity (69 per cent of students prefer passive leisure activites and spends more than two hours using the computer). 2) Wrong positions while sitting, lifting, moving and bearing things (only one-third of the students selected appropriate position). 3) Popular negotiable... [to full text]

Low back pain is a major health and socio-economic problem in Western countries. It is important therefore to learn more about its cause for prevention. To date, research has focused upon identifying risk factors that play a role in recurrent episodes of low back pain to further knowledge for secondary prevention. It can be argued however that it is more important to prevent the very first episode of low back pain from occurring by learning about the primary causative mechanisms. The aim of this thesis therefore is to advance theories about the possible causes of the first ever episode of low back pain for primary prevention. The qualitative, in-depth interview study presented in this thesis approaches the study of the first ever episode of low back pain, its antecedents and causal attributions from the perspective of subtle realism. Thirty participants presenting to NHS hospital physiotherapy and medical outpatient clinics were recruited for interview. The interview data were transcribed verbatim, and the data managed and analysed using Framework, a method developed by the National Centre for Social Research. The study’s findings advance knowledge about the possible role of psychological distress involving loss, anger, low mood and social withdrawal, and ‘pushing worries to the back of the mind’ in the genesis of non-specific symptoms including low back pain. If confirmed by further research, preventive strategies may need to address the perception that low back pain is not a stress-related condition and gender differences in the conceptualisation of stress. An area for new research is a perceived disposition to physical activity since childhood and a lifestyle described as active before the first ever episode of low back pain. Lay definitions of ‘real’ low back pain may assist the design of this research.

Background Lower back pain (LBP) remains a common ailment among adult populations and a superior cluneal nerve (SCN) entrapment accounts for 10% of reported LBP cases. The diagnostic criteria of SCN entrapment include anaesthesia of the SCN. This entrapment can be caused by bone procurement procedures but tends to happen more spontaneously and particularly to sportsmen. This study aimed to describe the location of all three branches of the SCN as well as to estimate the prevalence of entrapment which causes LBP. Methods The SCN was identified as it pierced the thoracolumbar fascia and crossed over the posterior part of the iliac crest on both sides of 50 adult cadavers. A sliding dial calliper was used to measure the distance from the posterior superior iliac spine (PSIS) to the SCN and from the midline lumbar spinous processes to the nerve. A total of 400 patient files were used to estimate the prevalence of SCN entrapment in a South African population. Results The branches of the SCN were found to be 72.6 ± 4.2 mm, 76.6 ± 4.4 mm and 79.6 ± 4.4 mm from the PSIS to the medial, intermediate and lateral branches respectively. From the midline to the medial, intermediate and lateral branches – the SCN was found to be 77.9 ± 4.2 mm, 79.6 ± 4.4 mm and 89.5 ± 4.5 mm. It was estimated that the SCN being the cause of LBP to be 28%. Discussion The measurements found in this study correlate with the measurements found in previous studies. However, this study failed to show sex differences and this could be attributed to sampling as well as chance due to human variation. This study estimated the prevalence of an SCN entrapment as a cause of LBP to be 28% compared to previous studies which estimate it to be 10%. The difference seen here can be a consequence of the limitation of this study in that it was conducted in a private practice.
Dissertation (MSc)--University of Pretoria, 2017.
Anatomy
MSc
Unrestricted

The cause of low back pain in populations of professional drivers is uncertain. A literature review revealed factors that seem to be associated with low back pain (e.g. physical factors: exposure to whole body-vibration, prolonged sitting posture, frequent lifting, pushing and pulling, lack of physical fitness; psychosocial factors: job satisfaction or stress; individual factors: age, gender, anthropometrics, tobacco, alcohol consumption, etc.). This thesis investigates the occurrence of back pain in professional car drivers – a group found to be not focussed upon in previous epidemiological studies. The thesis seeks to advance understanding of response relationships between risk factors and low back pain in populations of car drivers (209 taxi drivers and 365 police drivers) and 485 non-drivers. A longitudinal study with cross-sectional baseline combined with field measurement of driving in selected vehicles was performed to investigate the occurrence of musculoskeletal problems (mainly low back pain) and the relationship between risk factors and low back pain experienced for at least one day during the past 12 months in the two populations of professional drivers (taxi drivers and police drivers) and professional non-drivers. The cross-sectional baseline of the longitudinal study revealed that 45% (38.3-51.7%) of taxi drivers, 53% (48-58.6%)of police drivers and 46% (41-50.1%) of police non-drivers reported low back pain for at least one day during the past 12-months (p = 0.09). The prevalence of low back pain in the non-driving population of police employees fell within prevalence range reported by professional car drivers in this study and in previous epidemiological studies. The cross-sectional study revealed risk factors associated with the prevalence of low back pain (i.e., stature, previous physical demands, increased psychosomatic distress, daily and cumulative driving in taxi drivers; age, lifting, bending, increase psychosomatic distress in police drivers; stature, bending, increased psychosomatic distress in police non-drivers). Measurements of whole-body vibration in selected taxi and police vehicles revealed frequencyweighted accelerations in the dominant vibration direction (i.e., z-axis) to be 0.47 ms-2 r.m.s. in taxi vehicles and 0.58 ms-2 r.m.s. in police vehicles. A study of cumulative exposure to whole-body vibration in a group of taxi drivers pointed to a possible overestimation of their self-estimated duration of vibration exposure by 31% on average. The longitudinal study revealed a lower incidence of low back pain in taxi drivers than in both police drivers and police non-drivers (p = 0.02). The difference might be attributed to a different approach to low back pain in taxi drivers who lose income if unable to work. An alternative explanation for increased low back pain among police employees could be that taxi drivers with low back pain leave their profession and were excluded from the follow-up study – a healthy worker effect. The longitudinal study revealed that increased psychosomatic distress was a risk factor associated with the development of new episodes of low back pain in all three of the studied populations (i.e. taxi drivers and police drivers and non-drivers). In police drivers, increased daily duration of driving was a risk factor for the development of low back pain. Although the results point to increased incidence of low back pain with increasing duration of daily driving, non-drivers were at a similar risk of developing of low back pain. Plausible explanations for this finding include ergonomic factors that were present for both the drivers and the non-drivers (e.g., the duration of sitting or duration in a constrained posture) and the presence of other risk factors not investigated in the study but associated with increased incidence of low back pain in non-drivers.

Chronic low back pain (CLBP) causes ongoing pain, disability and psychological suffering, at a huge personal and socio-economic cost. CLBP is a heterogeneous condition and its mechanisms are poorly understood. Characterisation and classification of low back pain (LBP) is controversial, there is disagreement on the characterisation and diagnosis of neuropathic low back pain (NuLBP) in relation to mechanical LBP (MLBP). Diagnostic uncertainty is coupled with poor clinical outcomes for treatment. There is therefore an urgent need to develop more effective assessment strategies to identify and better differentiate NuLBP from MLBP in order to facilitate a better understanding of underlying mechanisms and more successful treatments. The primary aim of this study was to establish clinical profiles of CLBP, in particular, differences between MLBP and NuLBP using Questionnairebased behavioural evaluation and sensory testing, structural neuroimaging (voxel based morphometry) and functional neuroimaging (arterial spin labelling). Significant differences were identified between CLBP patients and healthy controls and between NuLBP and MLBP patients in multiple behavioural domains measuring pain, function and psychological well-being. Significant differences were demonstrated in CLBP patients compared to controls in both tactile threshold discrimination and two-point discrimination and between NuLBP and MLBP in tactile threshold discrimination. Functional and structural neuroimaging showed significant differences between all groups in widespread brain regions involved in the evaluation of decision making and planning, mood and emotion, modulation of pain and representation of body schema. This study has demonstrated the ability to characterise CLBP using a battery of behavioural, examination and functional and structural neuroimaging methodologies and has been able to differentiate between CLBP patients and controls and importantly, between NuLBP and MLBP patients. This work demonstrates the impact of CLBP across sensory-discriminative, affectivemotivational and cognitive-evaluative dimensions of the pain experience and shows the increased impact and burden on those who suffer with NuLBP compared to MLBP.

PhD
Abstract Low back pain is a significant public health problem in many countries of the world being one of the major causes of work absence and disability. Although the outlook for evidence-based management of low back pain has greatly improved over the past decades, many questions remain. Questions related to treatment options, underlying mechanisms of treatment effects and optimal assessment of low back pain have yet to be fully addressed by researchers. The broad aim of this thesis therefore was to contribute to a better understanding of the contemporary management of low back pain by performing studies in these key research areas. Most clinical practice guidelines recommend exercise as an effective treatment option for chronic low back pain. However the evidence for this recommendation comes from trials that are not placebo-controlled and so this may potentially provide biased estimates of the effects of exercise. Therefore a randomised controlled trial testing the effect of motor control exercise versus placebo in patients with chronic low back pain was conducted. Chapters 2 and 3 describe the trial protocol and the report of the trial respectively. A total of 154 patients with chronic low back pain were randomised to receive a motor control exercise program, or placebo (i.e. detuned short-wave therapy and detuned ultrasound therapy). Primary outcomes were pain, function, and the patient’s global impression of recovery measured at 2 months. The exercise intervention improved function and patient’s global impression of recovery, but not pain, at 2 months. The mean effect of exercise on function was 1.1 points (95%CI, 0.3 to 1.8), the mean effect on global impression of recovery was 1.5 points (95%CI, 0.4 to 2.5) and the mean effect on pain was 0.9 points (95%CI, - 0.01 to 1.8), all measured on 11 point scales. Secondary outcomes also favoured motor control exercise. This is the first study ever to demonstrate that motor control exercise is better than placebo for patients with chronic low back pain. Most of the treatment effects were maintained at 6 and 12 months follow-up. These results suggest that this intervention should be considered for patients with chronic low back pain in order to improve disability, function, and global impression of recovery, and to improve pain intensity in the long term, but not in the short term. Rehabilitative ultrasound imaging (RUSI) has been increasingly used by physiotherapists in order to identify impairments in motor control as well as to monitor progress of patients with low back pain. As with any other clinical measure it is important to know how reproducible the RUSI measures are, and although there are some reproducibility studies in the literature, no systematic review on this topic has been conducted. Therefore a systematic review was performed with the objective of assessing the reproducibility studies of RUSI for abdominal wall muscles (Chapter 4). Eligible studies were indentified via searches in CINAHL, EMBASE and MEDLINE with citation tracking via the Web of Science Index. A total of 21 studies were included. Due to heterogeneity of the studies’ designs, pooling the data for a meta-analysis was not possible. RUSI measures of thickness of abdominal wall muscles were found to be reliable. Few studies analysed the reliability for the measurement of thickness changes (reflecting the muscle activity) finding good to poor results. Evidence for the reproducibility of the difference in thickness changes over time (necessary to evaluate improvements in muscle activity with treatment) was not available. A limitation of the existing literature is that studies typically had suboptimal designs and analysis. The current evidence for the reproducibility of RUSI for measuring abdominal muscle activity is mainly based upon studies with suboptimal designs that included mostly healthy subjects, making generalisability to clinical settings uncertain. Some questions about the reproducibility of RUSI measures of abdominal wall muscles are still unanswered; this is mainly due to design issues, such as inadequate statistics, inadequate sampling and lack of control of sources of bias (e.g. blinding and absence of controlling for ordering effects). In addition the clinically important questions about the reproducibility of thickness changes (reflecting the muscle activity) and differences in thickness changes over time (reflecting the improvement or deterioration of muscle activity) have not been adequately investigated. Therefore a reproducibility study that aimed to answer these questions was performed (Chapter 5). Thirty-five patients seeking care for chronic low back pain participated in this study. RUSI measures were taken at baseline and eight weeks post-baseline. Replicate measures of thickness, thickness changes and differences in thickness changes over time were analysed. The reproducibility of static images (thickness) was excellent (ICC2,1 = 0.97, 95%CI = 0.96-0.97, Standard Error of the Measurement (SEM) = 0.04cm, Smallest Detectable Change (SDC) = 0.11cm), the reproducibility of thickness changes was moderate (ICC2,1 = 0.72, 95%CI 0.65-0.76 SEM = 15%, SDC 41%), while the reproducibility of differences in thickness changes over time was poor. Improvements in the test protocol should be undertaken in order to enhance the reproducibility of RUSI measures, especially for differences in thickness chang over time. Self-report outcome measures (questionnaires) are widely used by health care providers for measuring patient’s health status or treatment outcomes. Most of the questionnaires related to low back pain were developed in English and therefore their usefulness in non-English speaking countries is considerably limited. Cross-cultural adaptation and clinimetric testing are possibly the most efficient methods for solving this problem. Although there are many publications on the topic, a simple guide on how to perform a cross-cultural adaptation and clinimetric testing was not available. Therefore a “clinician-friendly” narrative review for Brazilian physical therapists (Chapter 6) was written. This review aimed firstly to explain the concepts and the relevance of cross-cultural adaptation and clinimetrics testing, secondly to summarise the current guidelines on the topic, thirdly to provide advice on how to choose a relevant questionnaire and finally how to evaluate the quality of an adapted questionnaire. Some examples of cross-cultural adaptations and clinimetrics testing of relevant low back pain questionnaires in the Brazilian-Portuguese language were also provided. Although the number of international versions of low back questionnaires is growing, to date it is unclear which questionnaires have been cross-culturally adapted and into which specific language. To answer these questions a systematic review was conducted in order to describe the available cross-cultural adaptations of low back pain self-report outcome measures and the clinimetric testing that has occurred for each adaptation (Chapter 7). Searches were performed in MEDLINE, EMBASE, CINALH and LILACS; these searches were supplemented with information from experts in the field of low back pain from 27 different countries to ensure that the results were comprehensive. Sixty-one adaptations were identified. While there are a large number of low back pain questionnaires available, very few have been adapted into other languages, particularly commonly spoken languages such as Mandarin, Hindi and Portuguese. The quality and comprehensiveness of clinimetric testing varied considerably, with the evaluation of reliability and construct validity most common. Further cross-cultural adaptation and clinimetric studies are clearly needed and special consideration must be given to study designs for clinimetric testing. The final aim of this thesis was to cross-culturally adapt self-report instruments relevant to the management of low back pain in Brazil. This was achieved by two independent studies. The first study (Chapter 8) aimed to cross-culturally adapt the Functional Rating Index (FRI) into Brazilian-Portuguese and to test the clinimetric properties of the FRI and also of an existing Brazilian-Portuguese version of the Roland Morris Disability Questionnaire (RMDQ) which was not fully evaluated in the original study. Both instruments were tested for internal consistency, reliability, construct validity, ceiling and floor effects and internal responsiveness in 140 chronic low back patients presenting for physiotherapy treatment in Brazil. Both instruments were considered reliable and valid for the measurement of disability in Brazilian-Portuguese speakers with low back pain, no ceiling or floor effects were detected, but the internal responsiveness of both instruments was considered small. The second study (Chapter 9) aimed to cross-culturally adapt the Patient-Specific Functional Scale (PSFS) and to perform a head-to-head comparison of the clinimetric properties of the PSFS, RMDQ and FRI. All instruments were tested for internal consistency, reliability, construct validity, ceiling and floor effects, internal and external responsiveness in 99 acute low back patients presenting for physiotherapy treatment in Brazil. In order to fully test the construct validity and external responsiveness, it was necessary to cross-culturally adapt the Pain Numerical Rating Scale and the Global Perceived Effect Scale. The results of this study demonstrate that the Brazilian-Portuguese versions of the RMDQ, FRI and PSFS have similar clinimetric properties to each other and to the original English versions; however the PSFS was the most responsive instrument. The results from the studies in Chapters 8 and 9 will benefit the understanding of low back pain by enabling international comparisons between studies conducted in Brazil and English speaking countries. In addition it will encourage researchers to include Brazilian- Portuguese speakers in their future clinical trials. Overall, the studies included in this thesis have provided an important contribution to the contemporary management of low back pain. Firstly the use of motor control exercise could be considered for patients with chronic low back pain as it produces improvements in global impression of recovery, function, disability and pain. Secondly RUSI measures of abdominal wall muscles in patients with low back pain were considered reproducible for the measurement of muscle activity, but not as an outcome measure to detect improvement/deterioration of muscle activity over the course of treatment. Thirdly just a few high-quality cross-cultural adaptations and clinimetrics testing for self-report outcome measures relevant to the management of low back pain are available, and clearly more studies in this area are needed. Finally the Brazilian-Portuguese versions of the Functional Rating Index, the Roland Morris Disability Questionnaire and the Patient-Specific Functional Scale have acceptable clinimetric properties and could be used in clinical practice as well as in research studies in Brazil.

Thesis (Ph. D.)--University of Sydney, 2009.
Title from title screen (viewed Aug. 11, 2009) Includes tables and questionnaires. Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Public Health, Faculty of Medicine. Includes bibliographical references. Also available in print form.

Acute low back pain is a commonly occurring symptom that can impact considerably upon a person's life. It is poorly defined, difficult to classify and challenging to measure. However, due to the high prevalence rates of the symptom, cited in the epidemiological literature, and the costs incurred by individuals, health services and society in general, it is vital that clients are encouraged to take more responsibility for their health. This thesis is concerned with perceptions of control in people with acute low back pain. It is about how they respond to this symptom and the way it impacts upon their lives. The underpinning literature is drawn from both medical and social science research, as the work crosses faculty boundaries. Problems are addressed from a physiotherapeutic and social science perspective, as links are formed between the different disciplines. From this literature, a significant theoretical development was the creation of a framework, which enabled the systematic review of existing outcome measures. A number of instruments, relevant to clients with acute low back pain, were reviewed using this framework, for the dimensions of control, function, pain and anxiety. The findings were used to inform the selection of outcome measures in this research. Four studies were then undertaken, all linked to studying clients with acute low back pain. The first study was a survey of general practitioners in Southampton and the New Forest, which identified their strategies for managing clients with acute low back pain. The second study focused on clients' experiences and was a randomized controlled trial, which tested the effectiveness of an information leaflet, designed to encourage clients to take more responsibility for their own health. The third study primarily focused on clients' perceptions of control over time, addressing the question of how these perceptions change during a one-year period. Finally, since recruitment of clients by their doctors was problematic throughout this research, a follow-up survey was undertaken with these health professionals to establish the reasons for this. The results of these studies are used to discuss the importance of clients' perceptions of control and the implications for clinical practice.

This study used a qualitative method to focus on the perspectives, beliefs and expectations of low back pain sufferers. The research was undertaken within a hospital based pain clinic. In recent years low back pain research has proliferated, and the epidemiological evidence suggests that back pain is an increasing problem. Much attention has been paid to the impact of low back pain on the population, and to the increasing cost in economic and health terms. Biomedical and psychological evidence abounds to shape acute and chronic management of low back pain, but there is a dearth of information about the viewpoint of those suffering pain. This study attempted to bring the understanding of the back pain sufferer to the fore. Issues of quality of life, functional ability and the impact of back pain on their lifestyle were explored, along with the influence of contextual factors in relation to how back pain sufferers perceived themselves and how others perceived them. A narrative method was utilized to illuminate the journey with pain. Nine interviews were conducted, and the interpretation and presentation of the narratives generated was influenced by Ricoeur’s interpretative theory. Thematic analysis revealed that doctorability, agency, control, separation or acceptance of the pain and the concept of future life were key features within the narratives. The analysis highlighted that for the majority in this study pain arrived uninvited following a traumatic accident or incident, and back pain became a chronic condition. It was always unwanted and initially it was unexpected as the usual script for pain is one of a transient incapacity followed by recovery. It was precisely this deviation from the norm that resulted in difficulties for the people suffering the pain. Biographical differences did not appear to be identifiable in the themes discerned in the stories, nor in the overall structure.

Prior studies have reported differences in lower back biomechanics during activities of daily living between individuals with and without chronic low back pain (LBP). Nevertheless, the literature on lower back biomechanics of patients with non-chronic LBP is scant. Therefore, the objective of this study, as the first step towards future prospective studies, was to investigate the lower back biomechanics in patients with non-chronic LBP. Case-control studies were conducted wherein measures of lumbo-pelvic coordination during bending and return tasks as well as measures of mechanical demand on the lower back during lifting tasks in the sagittal plane were investigated between patients with non-chronic LBP and matched asymptomatic individuals. Patients were enrolled into the study at the non-chronic stage of their LBP. We found distinct difference in measures of lumbo-pelvic coordination as well as mechanical demands on the lower back between patients with non-chronic LBP and controls. Reduced lumbar range of flexion and slower task pace as well as the more in-phase and less variable lumbo-pelvic coordination observed in patients with non-chronic low back pain, may be the result of a neuromuscular adaptation to reduce the forces and deformation in the lower back tissues and avoid pain aggravation. Such a neuromuscular adaptation, however, resulted in a larger shearing demand on the lower back. Persistent abnormal lumbo-pelvic coordination might play a role in transition to chronic stage or recurrence of LBP. However, such inferences need to be further investigated using prospective studies as well as clinical trials involving a combination of physical and psychological treatments aimed at correction of lumbo-pelvic coordination.

Background Chronic low back pain (LBP) is a common health problem, with a large potential for primary prevention. Health utilities (HU) reflect which proportion of their expected remaining life time individuals would hypothetically trade to be alleviated of a health condition of interest. A value of 0 means “prefer to die immediately”, a value of 1 means “not willing to trade any life time”. The aim of this cross-sectional study was to assess HU for LBP patients and for healthy participants and to examine whether HU for LBP are useful indicators to substantiate preventive and therapeutic decision making. Methods Healthy participants (n = 126) and LBP patients (n = 32) were recruited mainly among the employees of a tertiary care hospital in Germany. Standardized LBP scenarios were presented to all participants and HU values were assessed using the time-trade-off method. Results Median HU for LBP were 0.90 (IQR 0.31) for participants and 0.93 (IQR 0.10) for LBP patients. Measurements were consistent across illness severity ratings with HU and with a visual analogue scale (VAS); in the healthy sample the intraclass correlation coefficient (ICC) was 0.61 (95% CI 0.23–1.00, F(1125) = 190, p < .001), in the patient sample the ICC was 0.66 (95% CI = 0.24–1.00, F(1,31) = 62, p < .001). 8% of participants reported HU of 1. There was no statistically significant relation between HU and age, income, or gender. Conclusion On average, participants chose a 7 to 10% shorter life expectancy to avoid LBP, but almost 1 in 10 participants were not willing to trade any life years. The results indicate a certain stability of HU due to the comparability of HU ratings across patients and healthy participants, the measurement consistency when comparing VAS and HU ratings, and the lack of association between demographic variables and HU. This underlines the usefulness of HU for measuring illness severity in comparative health economics evaluations of preventive and therapeutic measures that address chronic LBP or other pain-characterized diseases. Future studies should focus on different LBP intensities and derive stratified HU that reflect the distribution of pain intensity in the population.

This thesis presents an account of a sociological research project exploring the field of Chronic Back Pain (CBP). This medical condition, despite being prevalent worldwide, is extremely problematic and difficult to treat because of its often ambiguous medical status and fluctuating symptoms. These problems of diagnosis and resolution often have a negative impact on sufferers’ daily lives, social relationships, identity and sense of self, and are often characterised by negative encounters with medical professionals. This study explores these themes via academic work from the field of cultural sociology, and in particular, from the French pragmatic approach. My data is analysed via Lamont’s (1992) theory of ‘symbolic boundary making’ and other related work on boundaries. I also utilize work on accounts to explore respondents’ processes of account-making. In addition, I use Gieryn’s (1983) model of ‘boundary-work’ to explore the issues of professional identity and the professional struggles that are apparent in the practitioners’ accounts. The research was carried out using qualitative methods. In total, I conducted forty in-depth semi-structured interviews with patients with CBP, GPs, physiotherapists, chiropractors, osteopaths, and an acupuncturist.

The thesis aimed to investigate the effectiveness of AT for LBP. A systematic review was conducted to determine the effectiveness of acupuncture. There is strong evidence that acupuncture can be a useful supplement to other forms of conventional therapy for non-specific LBP although the effectiveness of acupuncture compared with other forms of control intervention still requires further investigation.

The thesis describes a number of qualitative and quantitative studies in the investigation of psychosocial risk factors for back pain and absenteeism. A study of information processing 'biases' was completed comparing three diagnostically different chronic pain groups. Back pain and arthritis patients devote greater processing resources towards illness information than healthy controls. Development of a pain schema is suggested to be related to the personal meaning of pain. A further cross sectional investigation of psychosocial factors associated with back pain in a care assistant population was conducted. Work factors including perception of physical strain and job satisfaction; psychological factors such as pain beliefs, emotionality and family pain history and measures of pain in the last month were assessed. Results found that people reporting back pain had significantly lower job satisfaction, were older and worked significantly longer as care assistants than those reporting a mixture of pain symptoms. Reporting of general pain symptoms and absenteeism was also investigated. This was followed by a longitudinal study of care workers at risk of back pain. Negative emotionality and job satisfaction were identified in a logistic regression as being significant predictors of back pain at six months. High negative emotionality scores at baseline were significantly correlated with high numbers of pain symptoms at follow-up. Difficulties in conducting longitudinal risk research are discussed. The development of the pain schema was investigated by distributing word stem tasks to a variable pain population at baseline and follow-up. People reporting three or more pain symptoms and high pain frequencies were more likely to give higher pain sensory completions. At follow-up, as number of pain symptoms increased over six months so did the number of pain affective responses. The final study was a qualitative investigation of the meaning of back pain in thirty two care assistants using semi structured interviews. Findings suggest that patients delay seeking treatment when they perceive high susceptibility of back pain in the iii working environment, low severity of back pain and few benefits of treatment. Such findings are further discussed within the principals of the Health Belief Model (Becker, 1974).

Introduction: Lifetime prevalence of low back pain in the adult population has been estimated to be over 60% and the costs to society are huge. It has been calculated that the direct health care costs of the condition approach £2billion per annum in the UK alone, and further costs are associated with informal care and with lost productivity in the workplace. Prevalence of the condition increases with age from approximately 30% at age 25yrs and studies have shown that, in adults, the greatest predictor of low back pain is a previous history of similar symptoms. It is important, therefore, to examine the aetiology of low back pain in youth. In childhood low back pain is also reasonably common and some authors have published prevalence estimates approaching those in adults. A number of factors have been associated with the occurrence of low back pain in childhood and/or adolescence: physical factors, such as height and weight; mechanical factors, such as the carriage of heavy schoolbags; lifestyle factors, such as sports participation; psychosocial and psychological factors, such as behavioural conditions and a negative affect score; and familial factors, such as the presence of parental pain. However, the majority of published research in this field has been cross-sectional in nature and, therefore, cannot distinguish between cause and effect. To investigate the aetiology of low back pain it is clear that longitudinal studies that examine the onset of the condition are required. Aims: To identify the risk factors for the onset of low back pain in adolescents. Study Design: Population-based prospective cohort study. Methodology: Two cross-sectional surveys were carried out twelve months apart. At baseline, 1040 children aged 11-14yrs, from thirty-nine schools in the Northwest of England, were identified as being free of low back pain. In these children, average daily mechanical load was assessed using schoolbag weight, recorded over a five day period. Using a self-completion questionnaire, exposure to a number of other potential risk factors was assessed: lifestyle factors, psychosocial factors, and the occurrence of other common childhood (somatic) pain complaints. These children were then followed up twelve months subsequently to establish episodes of new onset low back pain. In addition, using a postal questionnaire, information was obtained from parents of the subjects regarding the occurrence of parental pain, and also, in girls, menstrual status. Results: 935 children (89.4%) participated at follow-up, of whom 168 (18.6%) reported low back pain - by definition, new onset low back pain. The occurrence of new onset low back pain increased with age and was more common in girls than boys but was unrelated to menstruation. The onset of low back pain was associated with neither average daily mechanical load, nor mechanical load relative to body weight. In general, lifestyle factors were not predictive of future pain, although sporting activity was significantly, but non-linearly, associated with an increased risk of pain. In contrast, adverse psychosocial factors were consistently and strongly associated with an increased risk of future pain; this was true for conduct problems in particular. Furthermore, the baseline occurrence of headache, abdominal pain and sore throats was associated with an increased risk of low back pain at follow-up. Children whose parents reported pain were no more likely to report low back pain (or indeed, any pain) than other children. Conclusions: This study has provided no evidence that mechanical factors are associated with an increased risk of future low back pain. Adverse psychosocial behaviour, and conduct problems in particular, are associated with an increased risk of new onset low back pain. In addition, the prior occurrence of other common pain conditions was strongly associated with an increased risk of future pain. Thus, this study concludes that low back pain in childhood may be a manifestation of somatisation.

There is currently little primary data looking at the epidemiology of back pain in older people and there are few large-scale population based studies which consider the occurrence or aetiology of back pain within this age group. Some evidence suggests that while non-disabling back pain decreases in the oldest old, the prevalence of disabling back pain may continue to increase. However, the aetiology of back pain in this group remains relatively unknown. Therefore, the overall aim of the current thesis was to investigate the epidemiology of back pain in older people, to examine the occurrence of back pain and age-related patterns in prevalence and incidence (descriptive epidemiology) and to identify potential risk factors for predicting back pain onset in those ≥75 years, specifically, to determine the role of social networks (analytical epidemiology). This was done through secondary analysis of a prospective cohort study from Cambridge looking at older people ≥75 years. It has been shown that while the prevalence of non-disabling back pain did not vary significantly across age, the prevalence of disabling back pain increased with age. In addition, it has been demonstrated, firstly, that aspects and indicators of physical health and a prior history of back pain are associated and independent predictors of back pain in older people; and secondly, that while objective measures of social contact are not risk markers for back pain, low mood, feelings of social isolation and depression are more strongly associated. These findings were further verified and confirmed in a second study, a cross-sectional survey of people ≥65 years living in rural Scotland. It can therefore be concluded that back pain is a common problem in the older population and, while mild back pain may remain constant across older age, disabling back pain continues to increase into the oldest old. The risk profile for back pain in older age is multifactorial, while some risk factors evident in younger populations remain; there is greater emphasis on the impact of mood and psychosocial factors.

This thesis presents a set of studies which investigated chronic low back pain. The specific aim of this thesis was to develop reliable methods for the assessment and rehabilitation of chronic low back pain. The two assessment methods tested were a broad based clinical evaluation and an isokinetic assessment of trunk muscle strength. The first part of the thesis describes the reliability and validity studies of the clinical methods for measuring trunk mobility, trunk muscle strength, spinal shape and palpation. A total of 27 physical tests were studied using 70 patients and 10 normal subjects. Twenty-three of these tests were found to be reliable and were incorporated into the isokinetic assessment study. The second part of the study reports the standardisation and reliability studies for the isokinetic assessment of trunk muscle strength in 70 normal subjects and 120 patients with chronic low back pain. The results showed that the main isokinetic measures were reliable for both normal subjects and patients. There was a significant learning effect from test 1 to test 2 in both normal subjects and patients. The magnitude of this learning effect was greater in patients than normal subjects. The normal subjects were followed up by a postal questionnaire in a two year prospective study to predict future back pain using the isokinetic measures. None of the measures used showed any significant differences between those subjects who developed back pain and those who did not. The third part of the thesis describes studies to develop a rehabilitation programme for patients with chronic low back pain using the isokinetic machines, both as a means of monitoring progress and as an exercise regime. The first study of 26 patients indicated that the programme was safe and effective, but also revealed a major problem with adherence to a six week exercise programme. The second study investigated the problem of adherence and examined the time course of response to isokinetic exercise by repeating the tests at three weeks and six weeks.

Low back pain is a debilitating condition that afflicts millions of people each year. It is characterized by complex biochemical, morphological, and biomechanical changes. However, most believe low back pain arises due to abnormal mechanical loading, inflammation, and disc degeneration. Several studies have investigated radial back pain, but to date, there is only one in vivo animal model for low back pain. Despite advances in science, the causes of low back pain remain unclear and treatments fail to relieve the pain. To better understand the causative factors of low back pain, a reliable animal model is needed. This study was designed to advance the knowledge of the previous in vivo animal model for low back pain by investigating the effects of shear loading on disc degeneration (for a longer duration of time) and discogenic low back pain (in terms of immunohistochemistry) in hopes developing better treatment strategies for low back pain sufferers and to help elucidate the etiology of low back pain. Adult male Sprague Dawley rats (n=31) were shear loaded for 4- and 8- weeks. Pain behavioral testing was done prior to and after surgery. After sacrifice, immunohistochemistry was used to detect the presence of pain in the intervertebral discs and the spinal cord. Results of this study indicate that the application of an abnormal shear load gives rise to disc degeneration. Histology revealed that all loaded levels as well as the adjacent levels degenerated due to the shear load. Pain behavior testing revealed that the rats did experience pain, however, when combined with the immunohistochemical results, we were able to exclude the pain as pain stemming from the degenerated discs. Surprisingly, we observed that shear loading caused scoliosis of the thoracolumbar spine.

Low back pain is a common but severe health problem. Chronic low back pain accounts for the bulk of the burden of low back pain. Exercise interventions are effective in the management of chronic low back pain. Current clinical thinking in physical therapy treats low back pain as a heterogeneous entity seeking to match specific interventions to subpopulations. None of these subgroups assess the role of gluteus medius dysfunction in chronic low back pain. These projects seek to describe the prevalence of gluteus medius weakness in people with chronic low back pain and test the effectiveness of a gluteus medius strengthening exercise intervention in people with chronic low back pain. Gluteus medius strength was assessed in 150 people seeking care for chronic low back pain and 75 healthy people without low back pain. Gluteus medius was found to be weaker on affected sides compared to unaffected sides within people with chronic low back pain and weaker than people without low back pain. Gluteus medius weakness was a strong predictor of the presence of low back pain. A gluteus medius strengthening program was compared with lumbar stabilization exercises in 56 people with chronic low back pain. Although there was a clinically significant improvement in pain in people who performed the gluteus medius strengthening exercise program, this was not significantly different from the stabilization exercise intervention. Adherence to exercise was significantly correlated with reduction in pain and perceived improvement of low back pain. Although gluteus medius weakness is common in people with low back pain and treating this weakness with a targeted exercise intervention is effective, it is not better than a standard stabilization exercise intervention. Doing exercise is likely more important than what exercise is done.

Low back pain has long been estimated to be the most prevalent and debilitating source of chronic pain. The present study first reviews the literature addressing the various theories of pain, the physiological and psychological variables important in pain research, and the psychotherapeutic approaches that have been used to date to reduce pain. Thirty-seven hospitalized chronic back pain patients were administered the cold-pressor test and a medical pain stimulus procedure which was medically relevant to their back pathology. A card-sort method was utilized in order to assess the coping strategies employed by the patients during these two pain stimulus tasks. These procedures were repeated following treatment. Coping strategies used by patients during the two pain tasks were compared. Results demonstrated that there was a significant difference in the manner in which patients coped with the two types of pain. Cold-pressor measures of pain threshold and tolerance were not significantly different between pretreatment and post-treatment. These measures were also not positively correlated with treatment outcome. A multiple regression approach demonstrated that particular coping strategies were significantly predictive of treatment outcome. The medical pain stimulus procedure was found to provide more significant pedictor variables than the cold-pressor test. At pre-treatment assessment, patients who relied on dramatized coping strategies were less likely to be successful in treatment. Breathing activity and pain acknowledgement were positive coping techniques highly predictive of successful outcome in this study. The use of computers for assessment and other recommendations for future research were discussed.

Abstract The etiology of musculoskeletal disorders remains largely unclear, pain being the predominant complaint. The prevalence of neck pain (NP), shoulder pain (SP), and low back pain (LBP) increases drastically during adolescence. Potentially modifiable risk factors of NP, SP, and LBP should be identified at that age. First, this study evaluated the prevalence of NP, SP, LBP and peripheral pains (upper or lower extremities) and the prevalence of multiple pains. Second, the study determined the role of a set of potentially modifiable risk factors for adolescents’ NP, SP, and LBP (physical activity, inactivity, sedentary activities in cross-sectional study design and quantity and quality of sleep in follow-up study design). The study population belongs to the 1986 Northern Finland Birth Cohort (NFBC 1986), consisting of 9,479 children with an expected date of birth between July 1, 1985 and June 30, 1986 in the two northernmost provinces of Finland, Oulu and Lapland. NP, SP, and LBP were common at the ages 16 and 18, while medical consultations for these pains were less frequent. The prevalence of pain increased with age. Peripheral pains were rare. Surprisingly many adolescents reported multiple musculoskeletal pains. Girls were more likely to report pain than boys. Both low and high level of physical activity, some risk sport activities, high amount of sedentary activities, and insufficient quantity and quality of sleep increased the risk of NP, SP, and LBP in adolescence. It may be possible to reduce the occurrence of musculoskeletal pain by having a positive impact on potentially modifiable risk factors, such as physical activity, sedentary activities and sleep hygiene. Therefore, intervention studies focusing on these factors are needed in the future
Tiivistelmä Useimmiten tuki- ja liikuntaelinsairauksien tarkka syy jää epäselväksi ja kipu on niiden pääasiallinen ilmentymä. Niska-, hartia- ja alaselkäkipujen esiintyvyys väestössä nousee merkittävästi teini-iässä. Tämän vuoksi niska-, hartia- ja alaselkäkivun riskitekijöitä tulisikin tutkia nuoruudessa, jotta niihin päästäisiin vaikuttamaan ajoissa. Tässä väitöskirjassa selvitettiin niska-, hartia-, alaselkä- ja laaja-alaisten tuki- ja liikuntaelinkipujen esiintyvyyttä nuorilla. Päätavoite oli kuitenkin tutkia liikunnan, eri urheilulajien, liikkumattomuuden, istumisen ja unen laadun ja määrän yhteyttä niska-, hartia- ja alaselkäkipujen esiintyvyyteen. Tutkimusaineisto muodostui Pohjois-Suomen syntymäkohortin 1986 nuorista, joiden laskettu syntymäaika oli 1.7.1985–30.6.1986. Nuorille lähetettiin 16-vuotiaana postikysely, joka sisälsi tuki- ja liikuntaelinoirekyselyn, kysymyksiä liikunnan, istumisen ja unen määrästä ja laadusta, sekä muista elämäntavoista. Kahden vuoden kuluttua, 18-vuotiaana lähetettiin toinen kysely joka sisälsi mm. tuki- ja liikuntaelinoirekyselyn. Tulokset osoittavat että niska-, hartia- ja alaselkäkivut olivat yleisiä nuoruudessa, joskin hoitoa vaativat kivut ja raajojen kipuoireilu olivat harvinaisia. Laaja-alaiset tuki- ja liikuntaelinkivut olivat odotettua yleisempiä. Tytöt oireilivat enemmän kuin pojat ja oireilu lisääntyi iän myötä. Hyvin aktiivinen liikunnan harrastaminen (6h/vko tai enemmän ripeää liikuntaa) ja erityisesti tietyt riskilajit olivat yhteydessä suurempaan niska-, hartia- ja alaselkäkipujen esiintyvyyteen. Samoin suuri istumisen määrä, riittämätön uni ja huono unen laatu lisäsivät kipujen todennäköisyyttä. Nuorten tuki- ja liikuntaelinkipuja voitaisiin mahdollisesti vähentää vaikuttamalla muunneltavissa oleviin riskitekijöihin, kuten vähentämällä istumista, lisäämällä terveysliikuntaa, sekä parantamalla unitottumuksia. Tämän takia jatkossa tarvitaan näihin riskitekijöihin kohdistuvia interventiotutkimuksia

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Recent studies have shown the efficacy and practicality of the integration of complementary and alternative therapies and biomedical treatments for various diseases and illnesses, including high blood pressure, diabetes, epilepsy, and cancer. Saper et al. (2013) demonstrated that once-weekly yoga classes were equally as effective for relieving chronic low back pain in low-income, minority populations than twice-weekly yoga classes. Pain medication data collected from this 12-week study was used to examine the effect of yoga on analgesic use. Pain medications were categorized into four major groups: (1) acetaminophen, (2) opiates, (3) non-steroidal anti-inflammatory drugs (NSAIDS), and (4) other. The average number of NSAID pills taken daily decreased from baseline to 12 weeks. In addition, there was no statistically significant difference in the average number of any type of analgesic taken between once- and twice-weekly yoga groups from baseline to 12 weeks. Our findings suggest that yoga is most useful for individuals with mild to moderate chronic low back pain; however, further studies with more powerful sample sizes must be conducted in order to make more precise conclusions.
2031-01-01

The aim of this study was to uncover and understand the reality of living with chronic, intractable nonmalignant back pain, as it is understood by sufferers themselves. A narrative autoethnographic research design was chosen, enabling me to interact with participants during the interview process, as well as have the opportunity to further explore my own experiences, as a long time sufferer of chronic, intractable nonmalignant back pain. Thematic analysis of participant interviews, and a deep, introspective scrutiny of my own journey, resulted in four stories being written. These stories illustrate the startlingly similar experiences we share. Although each story is written around one central character, they are in fact composite characters, representing the participants’ experiences as well as my own. The stories are: ‘The merry-go-round: Searching for a cure’, describing the endless visits to various specialists, in search of the elusive ‘cure’. ‘Mourning the loss’, illustrating the grief-like process we must go through when it becomes apparent that a cure is not possible and pain will be with us for the rest of our lives. ‘Walk a mile in my shoes’, giving a snapshot of issues facing us in our daily lives, and ‘Here we go again’, a description of a ‘typical’ pain management hospital stay. A fifth story, ‘We’re not in Kansas anymore’, was added following a bizarre emergency admission I was forced to endure during the course of my research. It is therefore a story where I am the central character. These stories illustrate the impact chronic back pain has on a sufferer’s life, ranging from loss of mobility to an altered body image. They also illustrate the struggle to maintain normality, including masking the pain and facing labelling and stigma. These stories identify and demonstrate the often hidden aspects of chronic intractable back pain, and have the power to inform practicing nurses, students, teachers and the community of the ‘lived experience’.

The prevalence of low back pain has assumed an upsurge trend in the last five decades despite the many interventional strategies. One interventional strategy that has been unsuccessful has been patient education. Lack of positive results from many of the existing patient education programmes is probably due to the type of health information that has been presented and the method that has been used. Many of the health education programmes have been planned according to what the medical professionals assumed the individuals needed to know, assumptions that could have ignored some crucial aspects. This study explored the perceived health education needs of individuals with low back pain at the Nairobi Hospital Rehabilitation Unit in Kenya, the method used to educate the individuals, the appropriateness of the method according to the individuals in addition to identifying the source of the health education that the individuals had.

Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2006.
Title from electronic title page (viewed Oct. 10, 2007). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Epidemiology, School of Public Health." Discipline: Epidemiology; Department/School: Public Health.