Articles: low-back-pain.
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Aggregation of low back symptoms in families of children with low back pain (LBP) has been described. However, this may be due to genetic factors or common exposure to environmental factors. The aim of this study was to evaluate the relative contribution of genetic and environmental factors to childhood LBP by comparing the pairwise similarity of LBP in pairs of monozygotic (MZ) and dizygotic (DZ) twin children. ⋯ Results obtained from the best-fitting genetic model suggests that, of the total variance in LBP, 41% (95% CI 34-48) could be attributed to shared environmental factors within families; and 59% (52-66) to unique (unshared) environmental factors. Our results suggest that genetic factors play, at most, a minor role in LBP in children; instead, symptoms seem to be related to a mixture of shared and unshared environmental factors. This study underscore the need for further high-quality research, preferably prospective studies, to identify important modifiable risk factors in order to guide interventions that may prevent LBP in childhood.
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The 80,000 or so patients a year who continue to have chronic, disabling back pain after one or more spinal surgeries are said to have failed back surgery syndrome. There are no controlled studies to guide physicians in the management of these patients. ⋯ This approach is focused on determination of the specific anatomical abnormality responsible for ongoing symptoms, an abnormality that may or may not be related to the initial abnormality for which surgery was performed. One or more of 5 nonsurgical treatment options may be useful to prevent the need for further surgery, as each subsequent surgery has a lower likelihood of success.
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Background. The treatment of chronic low back and leg pain remains a difficult medical challenge, particularly for patients with postlaminectomy syndrome. While spinal cord stimulation (SCS) has been a significant addition to the available options, it is often inadequate in relieving both the back and leg pain components. We hypothesized that for some patients the combination of SCS with peripheral nerve field stimulation (PNFS) would be a safe, effective alternative that would be more effective than either modality alone. ⋯ Conclusions. Due to the availability of 16 contact capacity generators, neurostimulation with multiple leads in various combinations-including both epidural and peripheral nerve field stimulation simultaneously-can be applied safely and effectively. The availability of this combined approach for a trial of stimulation prior to implant allows patients to compare SCS to PNFS and to indicate a preference for one over the other or for the combination. We conclude that PNFS may be used in combination with SCS as a safe and effective alternative treatment for patients with chronic low back and leg pain, and further suggest that the combined approach should be considered as a treatment option for this population.
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Recent research has demonstrated a relationship between healthcare practitioner beliefs about low back pain and recommendations about activity, work restrictions and work absence. None of the research to date has looked at the relationship between practitioner beliefs and actual behaviour. This study investigated the internal consistency of the pain attitudes and beliefs scale (PABS) and if general practitioner (GP) beliefs about back pain were more predictive of sickness certification for non-specific low back pain (NSLBP) than a general predisposition to sick certify patients with other non-specific conditions (common mental illness and non-specific upper respiratory disorders). ⋯ Multiple regression analysis demonstrated that neither the biomedical nor the psychosocial subscale of the PABS predicted the number of sickness certificates issued even after controlling for the time employed as a GP, number of hours worked per week and the number of NSLBP patients seen. Certification for other conditions was predictive of NSLBP certificates issued. These results demonstrate that sickness absences certification for NSLBP is predicted by sickness certification behaviour in general and not by scores on the PABS.
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Clinical rehabilitation · Apr 2008
Randomized Controlled TrialThe effect of exercise on adrenocortical responsiveness of patients with chronic low back pain, controlled for psychological strain.
To investigate the effects of high-intensity aerobic exercise on adrenocortical responsiveness and on standard outcome measures in patients with chronic low back pain. ⋯ Exercise alleviated pain, functional disability and anxiety/depression, also improved adrenocortical responsiveness in patients with chronic low back pain with dexamethasone suppression test positive values.