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Back pain is an important health and economic problem affecting a significant part of our population. It is of interest to both medical and behavioral professionals concerned with the complex role of the social and psychological factors in the etiology of somatic ailments. Although there has been much written about back injuries in military and industrial settings, little is known about the epidemiological patterns in a general population (Nagi et al., 1973). The objective of this study is to find: a) the major factors connected to back pain, b) whether the general work-stress index is related to back pain, where the general work-stress index is the sum of job stressors including psychological demands, job insecurity, physical exertion, decision latitude and the social support at work, and c) the relationship especially amongst back pain, activity restriction, age, job satisfaction and income. The National Population Health Survey (NPHS) database is used in this project. Some statistical techniques such as logistic regression and log-linear models are used for data analysis. In this project all explanatory variables in logistic regression models are treated as continuous variables; all variables when used in log-linear models are treated as categorical data. Results are compared between these different methods. They are in close agreement with each other. We conclude that age has very high impact on back pain with significance level being lower than 1 %; activity restriction also has a strong relationship with back pain; chronic stress, childhood and adult stressors all have high association with back pain; job stressor and recent life bad events are related fairly to back pain at significant level 5%; and income and job satisfaction do not have direct impact on back pain. Although there is not much that can be done to change the normal aging process of the spinal column, some of the predictors identified such as job stressors are amenable to change. / Thesis / Master of Science (MS)

Introduction: Low back pain (LBP) is a common, globally occurring, and difficult to treat health issue. In Swedish primary health care, there is an issue with health care providers not using up-to-date practice when dealing with LBP. BetterBack😊 is an evidence-based model of care (MOC) providing guidelines for assessment and treatment of LBP to facilitate working with LBP for caregivers. Purpose: To investigate if patients treated by clinicians educated in the BetterBack😊 MOC in primary care leads to (a) patients having greater improvements in functional impairments and activity limitations according to physiotherapist assessment and (b) are receiving different treatment, compared to controls, compared to usual care. Method: Prospective cluster randomised trial with linear mixed model analysis was used to compare functional impairment and activity limitations based on the Clinical Reasoning and Process Evaluation tool. Chi2-test was used to analyse differences in choice of treatment between groups. Result: Analysis showed statistically significantly greater reduction in level of exercise tolerance and movement related functional impairments (0.25, 95%CI=0.04-0.46, p=0.02) and limitations of dynamic activities of daily living (0.35, 95%CI=0.17-0.69, p=0.04) in the intervention compared to control group. The intervention group was more frequently treated with behavioural medicine interventions and less with manual therapy interventions (18.4% vs. 30.1%, p<0.05) and physical modalities (4.9% vs 10.8%, p<0.05) compared to the control group. Conclusion: The use of the BetterBack😊 MOC can lead to better treatment outcomes, more use of behavioural medicine interventions and less use of manual therapy and physical modalities. / Introduktion: Ländryggssmärta (LBP) är ett vanligt förekommande globalt och svårbehandlat hälsoproblem. I svensk primärvård finns ett problem att vårdgivare inte följer senaste evidens vid hantering av LBP. BättreRygg😊 är ett evidensbaserat vårdprogram med riktlinjer för undersökning och behandling för att underlätta för vårdgivare att möta patienter med LBP. Syfte: Undersöka om patienter som behandlats av kliniker utbildade i BättreRygg😊 i primärvården leder till att (a) patienter, enligt utvärdering av fysioterapeut, har förbättrats mer gällande funktionsnedsättningar och aktivitetsbegränsningar samt (b) behandlas med andra interventioner, jämfört med ordinarie behandling vid tre månaders uppföljning. Metod: Prospektiv klusterrandomiserad studie med mixed model-analysjämförde funktionell och aktivitetsbaserad status genom Clinical Reasoning and Process Evaluation-verktyget. Chi2-test genomfördes för att analyseraskillnader av behandlingsval mellan grupperna. Resultat: Analysen visade att interventionsgruppen hade signifikant mer minskning av aktivitetstolerans och rörelserelaterade funktionsnedsättningar(0,25, 95%CI=0.04-0.46, p=0,02) och relaterade till dynamiska vardagsaktiviteter (0,35, 95%CI=0,17–0,69, p=0,04) jämfört med kontrollgrupp. Interventionsgruppen använde mindre sällan manuell terapi (18,4% vs. 30,1%, p <0,05) samt fysiska modaliteter (4,9% vs 10,8%, p <0.05). Konklusion: BättreRygg😊 kan bidra till bättre behandlingsresultat av LBP, ökat användande av beteendemedicinska åtgärder och minskat användande av manuell terapi och fysiska modaliteter.

The objective of this study was to evaluate effects of extracorporeal shockwave therapy (ESWT) on spinal mechanical nociceptive threshold (MNT) and multifidus muscle cross-sectional area (CSA) in horses with thoracolumbar pain. We hypothesized that ESWT would increase MNT and multifidus CSA. Twelve horses with thoracolumbar pain were included. Prior to treatment, each thoracolumbar spine was radiographed to document existing pathology. Horses received 3 ESWT treatments, 2 weeks apart (days 0, 14, 28). Palpation scores were documented (days 0, 45, 65) and ultrasonographic CSA of left and right multifidus was recorded at T12, T14, T16, T18, L3 and L5 (days 0, 45, 65). MNT was measured at T12, T14, T16, T18, L3 and L5 every 7 days (day 0-56). Change in MNT in 10/12 horses was significant at each timepoint compared to day 0 (P<0.05). MNT increased at all timepoints at 6 sites in 2/12, at 5 sites in 3/12, at 4 sites in 4/12 and at 1 site in 1/12 (P<0.05). MNT average percent increase from day 0-56 was 64% for T12-T18 and 29% for L3-L5. There was no statistical difference in MNT from day 35-56 (P=0.25). A bimodal analgesic trend was observed following ESWT. Degree of radiographic change was not associated with response to treatment and no significant change in multifidus CSA was observed. In conclusion, 3 treatments of ESWT 2 weeks apart raised MNT over a 56-day period in horses with back pain, but did not influence change in CSA of the multifidus. / Master of Science / Back pain in the horse is a frequently diagnosed and treated cause of back stiffness, lameness, poor performance and/or avoidance behavior under saddle. Treatment is focused on reducing pain and inflammation and on strengthening and promoting proper muscle development to maintain long term results. Recently, rehabilitation of the deep spinal stabilizer multifidus muscle, particularly with regard to increased cross-sectional area (CSA), has become a focus of targeted physiotherapy. Assessment of the degree of pain is subjective due to individual interpretation and palpation technique. In an attempt to standardize quantification of pain, pressure algometry has become a validated, objective and repeatable measure of axial skeleton mechanical nociceptive threshold (MNT), which is defined as the minimum pressure required to induce a pain response. Although many treatment options for back pain exist, there is limited research documenting the efficacy of these treatments in horses. Extracorporeal shockwave therapy (ESWT), which consists of focused, high velocity acoustic waves, is one type of non-invasive, well-tolerated treatment for back pain. Despite its popularity, there is no research documenting the effects of ESWT on equine spinal MNT or multifidus muscle CSA. This is the first study to document the effects of ESWT on spinal MNT and multifidus muscle CSA in horses with back pain. We hope that the results of this study will help guide treatment decisions for horses with back pain.

Low back pain (LBP) is a common occupational problem and continues to be the leading cause of occupational disability.  Among diverse known risk factors, sitting is commonly considered as an important exposure related to LBP.  Both modern living and contemporary work involve increased sedentary lifestyles, including more frequent and prolonged sitting.  At present, however, the causal role of sitting on LBP development is controversial due to the contribution of several moderating factors (e.g., task demands, duration of exposures, and presence of muscle fatigue).  A few studies have assessed low back loads in seated postures, but none has investigated the effects of prolonged sitting or time-dependent variations on spinal structure and spinal loading.  Adverse effects of muscle fatigue on low back pain are well documented, yet the specific relationship between muscle fatigue and sitting-related low back pain are not fully established.  In addition to these fundamental limitations in our understanding of the physical consequences of sitting, there is also little evidence regarding the effects of task requirements on muscle fatigue and spine loading.   Therefore, the main objectives of this work were, in the context of sitting, to: 1) develop and evaluate a method to assess paraspinal muscle fatigue using electrical stimulation; 2) develop and evaluate a method (model) to quantify biomechanical loads on the lumbar spine in a seated posture; and 3) quantify the effects of prolonged seated tasks on low back loads, body discomfort, and localized muscle fatigue (LMF).  The primary hypothesis was that exposure to sitting-related LBP risks is influenced by task requirements and sitting duration.   A muscle stimulation protocol was developed to measure stimulation responses in the lumbar extensors.  A stimulation protocol, which included one conditioning train along with three 16-second stimulation train at 2 Hz, was recommended as appropriate to measure those muscles potentially fatigued during prolonged seated tasks.  A three-dimensional, sitting-specific, fatigue-sensitive, time-dependent, electromyography (EMG)-based biomechanical model of the trunk was developed to investigate the effects of seated tasks and time-dependent variations on lumbosacral loading during sitting. Reasonable levels of correspondence were found between measured and predicted lumbosacral moments under a range of seated tasks.  Lastly, the effects of prolonged sitting and psychosocial work stress on low back were quantitatively identified.  Only prolonged sitting significantly increased trunk flexion angles and led to muscle fatigue.  Relatively weak correlations were found between subjective and objective measures, though the two fatigue measurement methods (based on EMG and stimulated responses) showed a good level of correspondence.   Overall, this work provides a quantitative assessment of biomechanical exposures associated with seated tasks.  The methods developed in this work make a contribution in terms of measurement/modeling approaches that can be used to assess LBP-relevant risks during prolonged sitting.  The results of this work provide a better understanding of the effects of prolonged sitting on the risk of developing sitting-related LBP.  Finally, results regarding the influences of prolonged sitting and psychosocial demands can be used to guide future job design. / Ph. D.

Yes / / Chronic low back pain (CLBP) is a global musculoskeletal challenge, resulting in pain and disability on individuals. Laser therapy can be used to treat CLBP. This review evaluates the effectiveness of laser therapy including high level laser therapy (HLLT) and low level laser therapy (LLLT) on CLBP in relation to pain or functional disability. Methods: The authors conducted a systematic review of randomised controlled trials (RCTs) and searched the Cochrane Library, MEDLINE, CINAHL, AMED and PEDro from their start to June 2015. All studies that met predetermined inclusion and exclusion criteria were appraised with The Cochrane Collaboration’s tool for assessing risk of bias and Critical Appraisal Skills Programme Tools in June, 2015. Findings: Six RCTs met the inclusion criteria: two RCTs reported significant improvement in pain and functional disability with the use of HLLT but with small sample size (n=103); one RCTs (n=61) reported significant improvement and three RCTs (n=215) reported insignificant improvement in pain and functional disability with the use of LLLT. Conclusion: On the strength of the evidence available HLLT and LLLT are not currently recommended to be replaced or be offered in addition to conventional treatment. Further rigorous research is required to confirm the potential use of laser therapy on individuals presenting with CLBP.

Bakgrund:  Långvarig smärta är en subjektivt ihållande smärta som pågår i mer än tre månader. Smärtan återkommer i skov där lokalisation, intensitet och smärttyp kan skilja sig åt mellan episoderna. Inom långvarig smärta är ryggsmärta den vanligast förkommande och är lokaliserad till ländrygg-, skulder- eller nacksmärtor. Smärtupplevelsen behöver ses i sin helhet där individer använder sig av olika resurser och strategier för att ta sig igenom smärtepisoderna. Syfte: Syftet med litteraturöversikten var att belysa individers upplevelser och hanterbarhet av att leva med långvarig ryggsmärta Metod: Artiklarna söktes fram i databaserna CINAHL Complete, PubMed och PsycINFO som resulterade i tolv kvalitativa artiklar. Artiklarna analyserades slutligen enligt Fribergs modell. Resultat: Resultatet består av tre huvudteman. Det första temat är Individers känslomässiga uppfattning av långvarig ryggsmärtainnehållande fyra underkategorier bestående av Uppkomst av negativa känslor, Sociala aspekter, Upplevelse av sömnsvårigheter och Rädsla. Det andra temat är Hur individer tar sig an långvarig ryggsmärtainnehållande tre underkategorier bestående av Hanteringsstrategier, Läkemedels inverkan och Acceptans. Tredje temat är Individers erfarenheter av sjukvården. Diskussion: Individer med långvarig ryggsmärta påverkas dagligen av sitt fenomen. För att kunna leva med och hantera smärtan behöver de ett gott omhändertagande från sjukvården. Den sociala omgivningen spelar en avgörande roll i hur de hanterar fenomenet. Bemöts dem inte på ett tillfredställande sätt bidrar det till rädsla för att förvärra smärtupplevelsen. / Background: Long-lasting pain is a subjectively persistent pain that lasts for more than three months. The pain recurs in relapces where localization, intensity and type of pain can differ between the episodes. In long-lasting pain is back pain the most common type and mostly localized in lumbar, shoulder or neck. The pain experience needs to be seen in its entirety, where individuals use different resources and strategies to get through the pain episodes. Aim: The purpose of this literature review was to illuminate individuals’ experiences and manageability of living with long-lasting back pain Method: The databases used to search for articles were CINAHL Complete, PubMed and PsycINFO, which resulted in twelve qualitative articles. The articles were finally analyzed according to Friberg's model for analysis. Results: The result consists of three main themes. The first theme is Individuals emotional perception of long-lasting back paincontaining four sub-categories. These sub-categories are Emergence of negative emotions, Social aspects, Experience of insomnia and Fear. The second theme is How individuals approach long-lasting back paincontaining three sub-categories. These sub-categories are Management strategies, Impact of medicines and Acceptance. The third theme is Individuals experiences of health care. Discussion: Individuals with long-lasting back pain are affected daily by their phenomenon. In order to live with and manage the pain, they need a good assistance from the health care. The social environment plays a crucial role in how they handle the phenomenon. If they are not treated satisfactorily, it contributes to fear of aggravating the pain experience.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 5 uppsatser.

Background:Lower back pain is one of the most common health-related complaints in the adult population. Thirty percent of Americans 65 years and older reported symptoms of lower back pain in 2004. With an aging population, the proportion of people over the age of 65 is expected to reach 20% by the year 2030. Because of this increase in older adults, lumbar spinal stenosis (LSS) associated with arthritic changes will also likely increase. In older adults, lower back pain is most often caused by degenerative lumbar spinal stenosis. Stenosis is the narrowing ofthe spinal canal, causing pressure on the nerve roots and is frequently treated surgically. Lumbar spinal stenosis is one of the most common reasons for back surgery in patients 65 years and older 2. However, risks associated with surgery increase with age 3-5 and older patients may choose non-surgical treatment for their lower back pain, including injection treatment. Injection treatment, usually consisting of anti-inflammatory medications and analgesics, has improved since the mid-1990's when fluoroscopic guidance was developed. Information about injection treatment for lower back pain is limited, especially in the older population. An extensive review of published literature regarding injection treatment revealed a paucity of information about older adults diagnosed with lumbar spinal stenosis. In this study, three aims were designed to gain more information about the effectiveness of injection treatment in older patients with lumbar spinal stenosis. In the first (retrospective) study, information about receipt of second injections and time between injections was collected to examine injection usage. In the second and third (prospective) studies, information about pain relief and functional return following injection treatment was collected to examine the effectiveness of injection treatment in patients age 60 and older diagnosed with lumbar spinal stenosis. To our knowledge, such results have not been repolted for this population in the literature. Objective:Injection treatment is a commonly used non-surgical procedure to alleviate lower back pain in older adults. However, older patients do not have enough information about how long pain relief will last after treatment or the amount of pain relief and functional return they will experience. These studies focused on three topics: 1) usage of injection treatment; 2) effectiveness of injection treatment on pain relief; 3) effectiveness of injection treatment on functional return. In addition, the variations of the effectiveness were examined by selected patient attributes. Methods:In a retrospective study, medical records of patients aged 60 years or older from a high volume dedicated spine center at the University of Massachusetts Memorial Hospital were retrospectively reviewed. This study included those diagnosed with degenerative LSS, who had not received an injection for lower back pain within six months, and whom were treated between June I, 2006 and May 31, 2007. In two prospective studies, patients scheduled for lumbar injection treatment between January 1 and June 30, 2008 were selected from the University of Massachusetts Memorial Hospital Spine Center. Selection criteria included patients age 60 and over, diagnosed with degenerative lumbar spinal stenosis and no previous lumbar injection within 6 months or lumbar surgery within 2 years. The Pain sub-score of the SF-36 questionnaire was used to measure pain at baseline and at one and three months post injection. The Physical Component Score (PCS) of the SF-36 questionnaire and the Oswestry Disability Index (ODI) were used to measure function at baseline and at one and three months post injection. Variations in longitudinal changes in scores by patient characteristics were analyzed in both unadjusted (univariate) analyses using one-way analysis of variance (ANOVA), and adjusted (multiple regression) analyses using linear mixed effects models. Results: In the retrospective cohort, the mean age of the cohort was 68, 64% were female, 59% were married, with a mean Body Mass index of 32 kg/m2. Of 92 eligible patients, 57% returned for a second injection within six months of the first. The mean number of months between injections was 4.8 for all patients, ranging from 1 to 22 months. When patient characteristics were examined, the only variable that showed a statistically significant difference was age. Patients aged 70 years and older were found to be 67% less likely to return for a second injection when compared to patients age 60-69 (OR=0.33 (0.12 - 0.94)p In the prospective cohort, information was collected on 62 patients. Mean Pain scores improved significantly from baseline to one month (14.1 points), and from baseline to three months (8.3 points). Post injection changes in Pain scores varied by Body Mass Index (BMI) and baseline emotional health. Based on a linear mixed effects model analysis, higher baseline emotional health, as measured by the SF-36 Mental Component Score (MCS>50), was associated with greater reduction in pain over three months when compared to lower emotional health (MCS Conclusion: Patients over age 70 do not return for repeat injection as frequently as patients age 60-69. In addition, each year a patient ages over age 60, they are 10% less likely to return for a repeat injection. Lower back pain in older adults with LSS is clinically significantly alleviated after injection treatment. In addition, injection treatment for LSS is associated with return of lost function needed for daily living activities in older adults. Pain relief and functional return varies by patient personal and clinical characteristics. Higher emotional health was associated with more pain relief and more functional return experienced over three months following injection treatment. Additional information is needed about why older patients do not return for second injections at the same rate as younger patients and how emotional health affects response to injection treatment in older adults.

The Efficacy of Kinesio Taping as an Adjunct Intervention to Traditional Physical Therapy in the Treatment of Nonspecific Acute Low Back Pain: A Prospective Randomized Controlled Trial Background: Acute low back pain (LBP) is a significant health problem worldwide and is one of the leading causes of disability. Objective: The purpose of this study was to examine the effect of Kinesio Taping (KT) on disability, fear-avoidance beliefs, and pain intensity in patients with acute, nonspecific LBP. Research Design and Methods: A prospective, randomized controlled study of consecutive patients referred to physical therapy with a primary complaint of LBP. Seventy-eight patients with acute, nonspecific LBP were randomized to an experimental group that received traditional physical therapy plus KT and a control group that received traditional physical therapy alone. Interventions were administered twice a week for 4 weeks. Assessment tools used were Ronald Morris Disability Questionnaire (RMDQ) for disability, Fear-Avoidance Beliefs Questionnaire (FABQ) for fear-avoidance beliefs, and Numerical Pain Rating Scale (NPRS) for pain intensity. Assessments were conducted at baseline, end of week 1, end of week 2, end of week 3, and end of week 4. Analysis: Repeated measures mixed model analysis of variance (ANOVA) was used to examine the effect of treatment on each variable. The group type was the between-subjects variable and the time was the within-subjects variable. A significance level of .05 was used in the analyses. Results: Both groups showed statistically significant lower disability, fear-avoidance beliefs, and pain levels over time compared with baseline scores (p < .0001). The experimental group showed statistically significant lower RMDQ scores at week 2, 3, and 4 (p < .05), statistically significant lower FABQ-physical activity subscale scores at the end of week 1 (p < .01), at the end of week 2 (p < .01), at the end of week 3 (p < .01), and at the end of week 4 (p < .05), statistically significant lower FABQ-work subscale scores at week 3 (p < .05) and week 4 (p < .01), and statistically significant lower NPRS scores at week 1, 2, 3, and 4 (p < .05). Conclusion: Kinesio Taping can be considered a useful adjunct intervention to reduce disability and pain and to modulate fear-avoidance beliefs in patients with acute, nonspecific LBP.