Articles: low-back-pain.
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Comparative Study
Low back pain and lifestyle. Part II--Obesity. Information from a population-based sample of 29,424 twin subjects.
A cross-sectional postal survey of 29,424 twin subjects aged 12-41 years obtained from a population-generated panel. ⋯ Obesity is modestly positively associated with low back pain, in particular with chronic or recurrent low back pain. However, because the association is weak, because there is no consistent positive monotonic dose response, and because the link disappears in monozygotic twins who are dissimilar in body mass index, it is unlikely that this association is causal. It is possible, however, that obesity plays a part in the chronicity of simple low back pain. Therefore, those with recurring or long-term low back pain deserve further attention.
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A prospective, consecutive study of patients' outcome at three subsequent follow-up times after lumbar disc surgery. ⋯ Patients whose outcome after lumbar disc surgery does not remain stable present a major problem in the calculation of prognostic factors.
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Outcome quality of medical treatment depends on structure quality of the treatment facility. In the present study we tried evaluate structural parameters of outpatient treatment facilities relating to management of headache, low back pain and cancer pain. ⋯ There are considerable structural deficits in outpatient treatment facilities involved in management of patients suffering from chronic headache, chronic back pain and cancer pain. Realisation of standards according to the "Schmerztherapievereinbarung" needs organisation of an interdisciplinary network between the different specialties necessary for pain management. Interdisciplinary cooperation should be supported by the official organization of the medical self-government in Germany--the Kassenärztliche Vereinigung--which has to assure optimal conditions for outpatient treatments.
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Comparative Study
Segmental roentgenographic analysis of vertebral inclination on sagittal plane in asymptomatic versus chronic low back pain patients.
Two homogenous groups of 120 volunteers and 120 low back pain (LBP) patients, age range 20-79 years, underwent a prospective roentgenographic segmental vertebral analysis of the thoracic and lumbar spine to compare several roentgenographic parameters useful for planning spine surgery. The following roentgenographic parameters were measured: thoracic kyphosis, lumbar lordosis, sacral inclination, distal lordosis (L4-S1), inclination of each vertebra from T4-S1, and relative vertebral inclination between adjacent vertebrae. Thoracic kyphosis increased (p < 0.0001) and sacral inclination decreased (p < 0.05) with age in the control group. ⋯ Sacral inclination was significantly more in the female than in male volunteers (p < 0.05). Distal lordosis (L4-S1) represents 55% and 49% of total lumbar lordosis in controls and low back patients, respectively. Spine surgeons frequently deal with sagittal spinal deformities and the deviations of sagittal spinal curvatures and vertebral inclination in the sagittal plane, both in normal subjects and LBP patients should be clinically helpful.
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The Western Ontario MacMaster (WOMAC) is a validated instrument designed specifically for the assessment of lower extremity pain and function in osteoarthritis (OA) of the knee or hip. In the clinic, however, we have noted that OA patients frequently have other musculoskeletal and non-musculoskeletal problems that might contribute to the total level of pain and functional abnormality that is measured by the WOMAC. In this report, we investigated back pain and non-articular factors that might explain WOMAC scores in patients with OA, rheumatoid arthritis (RA) and fibromyalgia (FM) in order to understand the specificity of this instrument. ⋯ The WOMAC captures more than just knee or hip pain and dysfunction, and is clearly influenced by the presence of fatigue, symptom counts, depression and low back pain. WOMAC scores also appear to reflect psychological and constitutional status. These observations suggest the need for care in interpreting WOMAC scores as just a measure of function, pain or stiffness, and indicate the considerable importance of psychological factors in rheumatic disease and rheumatic disease assessments.