News Category: Lumbar Spine

If you break a vertebra in your lower back, having screws surgically implanted into the broken bone is one way to relieve pain and correct the injury. But like any surgery, the procedure is expensive and can lead to other problems. Is surgery always the best choice?

To answer this question, researchers followed 80 patients with a fractured vertebra in the lower spine. None of the patients had nerve problems due to the fracture. Thirty-three of the patients had surgery shortly after their injuries. Surgeons put three screws in the spine–one at the level of the fracture, one above, and one below. The other 47 patients didn’t have surgery. They were fitted with a special brace to wear at all times except when bathing. And they were encouraged to get up and move around unless the pain was too great.

At first, patients who had surgery seemed to do better than those who didn’t. Patients in the surgery group reported less pain at one month and three months after the injury. They also showed better overall health in their backs for up to six months. However, after one year, patients in both groups were doing about the same. Surgery or not, less than half of the patients who did heavy work were able to get back to their original jobs.

In general, surgery is thought to allow patients to get up and move earlier and more safely, to keep the spine aligned better, and to prevent problems in the nerves near the fracture. But this study showed that patients who didn’t have surgery were safe to get up and move right away and were free of nerve problems, too. Alignment of the bones wasn’t as good as in those who had surgery, but this didn’t seem to have an effect on peoples’ pain or their ability to do activities. So the authors question whether the risks of surgery outweigh the added benefits for getting optimal alignment.

Patients who had surgery seemed less satisfied with their treatment two years later, possibly because they had higher hopes than those who didn’t opt for surgery. Not surprisingly, there was a huge difference in the cost of treatment, with surgery costing four times more.

The authors conclude that although patients who have surgery for a fracture of this kind may recover more quickly, the difference between having surgery or not disappears after a year. As always, the choice to have surgery needs to be weighed against the risks.

People sometimes need time off work for chronic back pain. Research tells us that age makes a difference in whether people with serious back pain return to their jobs. Older workers with back pain are less likely to go back to work and, if they do, less likely to stick with it. Popular opinion says it’s the physical pain that makes work impossible for these people, but are we missing part of the picture? Is the work environment itself part of the problem?

In this editorial, the author suggests that the workplace may be the straw that breaks the worker’s back–literally. A stressful or unstable work environment can challenge a person’s health, and studies prove it. The author points to a study of British social servants in which greater job status–and job stress–were related to earlier death. In other research, people who were threatened with downsizing had a serious decline in health over a period of three years. These effects very likely extend to spine health as well.

The author believes that older workers are particularly prone to the challenges a workplace can put on workers’ health. For older workers especially, a stressful work setting makes back pain less tolerable and potentially more disabling. And older workers may be less free to change jobs to relieve the mental or emotional strain of work.

The effects of a rough day at work aren’t all in your head; they may be in your back, too. More humane work settings could really give workers’ health a boost. The author hopes that workplaces will learn to value people–and their backs–more in the years ahead.

The sacroiliac joint is formed where the lower spine and pelvis meet. It is the connection of the sacrum,the last bone of the spine, and the ilium, the two wide bones that form the waist. Sacroiliac joint problems can make it painful to bend forward. People with sacroiliac joint pain may find it difficult to work over a counter, bend over a sink to shave or brush their teeth, make a bed, or even wash dishes.

The sacroiliac joint can be treated with surgery, braces, injections, or physical therapy. In this study, the authors wanted to find out whether physical therapy alone would give some relief to people with sacroiliac joint pain.

Sixty-nine patients were diagnosed with sacroiliac joint dysfunction through a series of tests. Fifty-five of the patients (80 percent) were women, and 14 (20 percent) were men. Their average age was 40. 

All of the patients were treated by the same physical therapist. The goal of therapy was to create movement in the sacroiliac joint and strengthen the muscles around it. Patients exercised to stabilize the pelvis and strengthen the abdomen. They also learned good bending and lifting techniques, and which activities to avoid.

Two years after treatment, 95 percent of the patients rated their treatment results as good or excellent. Only 5 percent said their results were fair or poor. Patients who were still having a lot of pain after the physical therapy treatments ended (5 percent) had chronic pain–pain that lasted at least 50 days–before treatments began.

After having physical therapy, everyone could do at least the same activities they were doing before treatments started. Thirty people had problems with routine activities before getting treatment. Of these, 22 returned to all their normal activities with treatment. Only six patients reported no change in ability to do activities after treatment. Once again, these patients had chronic pain.

The authors conclude that physical therapy can have excellent long-term results when the therapist has experience treating the sacroiliac joint. The results seem to be better for patients who haven’t been in pain for a long time. However, patients with chronic pain may also see some improvement. For patients who don’t get any relief from physical therapy, surgery or injections may be suggested.

The number of lumbar (lower) spine operations is increasing–and they are increasingly complex. As with any type of surgery, there can be complications. Neurologic complications are an uncommon but very serious potential side effect of lumbar spine surgery. The spinal cord and the spinal nerve roots are much more fragile than nerves away from the spine. This means that spine surgeons need to be especially careful during procedures. It also means that post-surgical swelling and other fairly common surgical complications can have major consequences. 

These authors summarized the neurological problems that can happen after spine surgery, as well as precautions to help avoid or recognize problems. Neurological problems can develop during surgery, shortly after surgery, or more than two weeks after surgery. Different problems develop at different rates. Problems can stem from many causes, including:

• anesthesia


• surgical techniques and tools


• patient positioning


• postoperative swelling


• changes in spine alignment


• hardware placement


• bone graft sites


• previous surgeries


• abnormal anatomy

Long-term studies of surgery outcomes can help doctors and patients determine if surgery is the best treatment for their needs. Currently, there are few such studies of people who’ve had standard discectomy surgery for a herniated disc in the low back. This procedure involves shaving the edge of bone that covers the back of the injured disc. Then the surgeon takes out the herniated portions from center of the disc (the nucleus pulposus) and any other fragments of the injured disc. The idea is to remove just enough of the disc to prevent the disc from herniating again.

Researchers conducted this study by contacting 72 patients who’d had this surgery at least 10 years earlier. Nine of the patients also required further surgery, so their data was analyzed separately.

So what kind of results does lumbar discectomy show 10 years down the road? Using a specialized scoring method, the authors calculated a favorable recovery rate (about 74%). Significantly, about 40% of all the patients kept up with their recreational activities, including sports, 10 years after surgery.

Over half the patients reported occasional mild low back pain, but only about 13% said their pain was severe. Of those with severe pain, most were under age 35 and showed greater disc degeneration before surgery. The authors suggest that younger patients may have more active lifestyles compared to older patients, which may explain why they had a lot more pain after surgery. The researchers also compared rates of leg pain. Only 44% of patients had no remaining leg pain or tingling, and about 10% experienced occasional severe leg pain.

The authors used X-rays at the follow up to measure the height of the injured disc. Discs appear thinner if more of the nucleus spurts out of the disc during the initial herniation, or if the surgeon takes out a larger portion of the nucleus. As it turns out, the patients with greater disc heights had the best results. However, they were also found to have a slightly higher risk of having the disc herniate again. It’s a trade-off that should be studied further to help surgeons know how much is too much when removing the nucleus during standard lumbar discectomy.

Interferential therapy (IFT) is a popular form of electrical stimulation treatment used to treat low back pain. The unit has four pads (electrodes), which are placed on the skin in the form of a square. The current from each pad crosses through the body’s tissues in a path toward the opposite pad. In this way, the current forms an “X” between the corners of the four pads. The current collides in the center of the X. The place where they collide is called the interference point.

IFT is believed to help relieve both acute and chronic low back pain, although there is little evidence to support its use. There simply hasn’t been much research on the effectiveness of IFT. Still, this type of therapy is used in many parts of the world. The authors suggest this may be because therapists believe it works, and because it is easy to set up and use.

The authors designed this study as a first step toward a larger study comparing IFT to other treatments for low back pain. This particular study was used to see if pad placement made a difference. Currently, there are no guidelines on how to apply treatments. Individual therapists use different set-ups for IFT, including different placement of the electrodes. This study helped zero in on the best place to put the electrodes. It compared two different choices. The “spinal nerve root” technique is done by spacing the pads along the sides of the spinal column. More commonly, therapists position the electrodes using the “painful area” technique, which involves putting the pads over the spot where it hurts the most.

This study included 60 people who had back pain that had lasted for one to three months. Participants were placed into three groups. All groups answered surveys about their low back pain, disability related to the pain, and general health. One group got IFT with the spinal nerve root method for 30 minutes, two to three times a week. Another group received the same amounts of treatment with electrodes placed over the painful area. Both these groups also got a copy of The Back Book, an educational booklet with information on back problems that encourages early return to activity. The third group got the book only and just came in every other week for assessment.

The subjects answered the same surveys three months later. The authors found that all groups showed significant improvement over the course of the study. However, the group that got IFT treatments using the spinal nerve root technique showed significantly better scores on the questionnaires.

This study doesn’t answer any questions about how or why IFT helps relieve low back pain. It also doesn’t prove that IFT is more effective than other types of conservative treatments for low back pain. The results do show that pad placement probably makes a difference in how people with back pain are doing three months into treatment.

The authors will use this information to design a controlled trial of IFT, comparing the spinal nerve root technique with different forms of treatment for treating low back pain.

Sitting in a swaying train car. Balancing while perched on the edge of a bench. Both those situations could be somewhat hazardous for people with low back pain (LBP). LBP is related to problems with holding a steady posture while sitting or standing. LBP for some reason affects proprioception, the body’s sense of where it is and how it is moving in relation to everything else.

These authors studied the way people with LBP swayed while sitting on unstable seats. They also measured muscle responsiveness when force was released while sitting in a special type of machine. The tests were run both with eyes open and with eyes closed. This is because vision helps people compensate for problems with proprioception.

The authors tested 16 people with LBP and 14 people with healthy backs. The results showed that the group with LBP had worse balance and had delayed muscle responses compared to the healthy group. The group with LBP also did significantly better with their eyes open, which supports the idea that visual cues help compensate for proprioception problems. Balance problems and muscle response delays appear to be related.

This study is unique because the tests were done while the subjects were seated. Most research has focused on people who are standing, so it is hard to tell whether the problem is coming from the low back or the legs. This study didn’t determine the exact cause of the problem in the low back. But the tests used in this study seem to be a reliable way to screen for problems with posture control in the low back. This type of testing might help clinicians prevent or treat low back problems, putting patients back in the driver’s seat when dealing with back pain.

Turn this way, bend over, walk across the room. Doctors put patients with back problems through all sorts of physical tests during an exam. The idea is to see which movements and positions hurt and how much the back problems interfere with the activities of daily life. But how well do the physical tests really reflect how patients function at home or on the job?

In this study, researchers assessed the functional mobility of patients with lumbar spinal stenosis (LSS) and people with healthy backs. All of the subjects were elderly. The researchers used three tests of functional mobility. The first involved walking on a treadmill at gradually increasing difficulty until reaching 70% of maximum heart rate or until feeling pain. The other two tests timed subjects as they rose from a chair without using their arms, and as they walked for 20 meters carrying small amounts of weight. Subjects repeated these last two tests three times.

Part of the reason that the researchers had subjects repeat the tests was to see if they got similar results all three times. They did, which suggests that these tests are reliable indicators of back problems. The researchers also tried to design these tests to mimic the physical demands of everyday activities. Carrying the weights, for example, is something like carrying groceries from the car to the house.

The researchers were also interested in comparing the results of the healthy and LSS groups. As expected, the healthy group showed better functional mobility than the group with LSS. The differences were especially significant in the treadmill test. Almost half of the group with LSS couldn’t finish the test because of pain, which pull the scores in the LSS group down. At first, it might be assumed that patients with the worst back problems were more likely to have problems with the treadmill. But patients with moderate and severe LSS also had problems completing the treadmill test. The authors suggest that the real reason for problems on the treadmill might be that patients with LSS tend to limit their exercise. Over time, this causes them to become out of shape.

The authors feel these types of tests show evidence of being a valid way to check how elderly patients with LSS are getting along with their daily activities. This suggests the tests could be done again at a later date to see if treatments that are being used are actually helping.

Find your center. Center of balance. Centering yourself. We talk vaguely about the “center” of our body when we talk about gaining physical and mental control of ourselves.

This study suggests that centering might also be a way to better understand low back pain. Researchers followed 23 people with acute low back pain for one year. Over the course of treatment, physical therapists did specific physical tests to identify pain locations. People were grouped as centralizers if pain was beginning to locate on or near the center of their low back. Noncentralizers continued to have more widespread back pain or radiating leg pain.

Patients with pain that centered toward their spine over a few weeks of treatment tended to have better results than people with pain that continued to radiate across their backs and hips or down their leg. At the one-year mark, the noncentralizers were less likely to be working and were more likely to have pain, problems with certain activities, and continuing medical care for their back pain. People with leg pain at the beginning of the study were also more likely to have continuing problems one year later.

The researchers also tested psychosocial factors as a way to predict chronic back problems. Some past research has found a link between certain psychosocial factors–for example, a lack of control over working conditions or weak social relations–and chronic back pain. This study showed no link between psychosocial factors and continuing problems with low back pain.

More study is needed to solidify physical tests that help predict chronic low back pain. Having a way to predict future problems could help doctors and therapists choose the best treatments for their patients with back pain. It would also help identify which patients need the help of other specialists early in the recovery period.

Guidelines for the treatment of low back pain (LBP) were released in 1994. But when helping their patient with LBP, do physical therapists follow these guidelines? These authors surveyed physical therapists in Ontario, Canada, to find out.

The survey was answered by 274 physical therapists who regularly saw patients with LBP. The survey presented three case studies of people with LBP who referred themselves for physical therapy. Therapists listed how they would assess each patient’s condition and what treatments they would choose.

The authors found that the therapists generally followed the guidelines. Education and exercise were the most commonly used treatments, and few of the therapists recommended long bed rest. However, the therapists still preferred to use treatments such as ultrasound and biofeedback, which have not been proven to be very effective in treating low back pain. Also, very few of the therapists used spinal manipulation, which is recommended in the guidelines for treating acute low back pain. Yet the authors found that few of the therapists had been trained in joint manipulation. They suggest that physical therapy practice could improve by expanding its training in spine manipulation.

The survey also asked the therapists’ opinions about the guidelines. A majority of them thought the guidelines could be useful in managing LBP. But less than half found the current guidelines useful. Is this because these therapists are set in their ways, or is it because they believe their treatments work–despite a lack of solid evidence? Is LBP too difficult to treat by following a single set of guidelines? Since physical therapists have such a paramount role in helping people with back pain, this article serves as a good starting point to help highlight the guidelines for effectively treating low back pain.

There are more than 100 different types of lumbar supports on the market worldwide. Some lumbar supports are designed to prevent back problems from starting; others are used to protect people with back problems from further injury. But there is little evidence to show how effective lumbar supports actually are.

The authors reviewed all the research they could find on the ability of lumbar supports to prevent or treat low back pain without any specific cause. They found only a few high quality studies. Only seven studies of preventive effects and six studies of treatment effects were judged good enough to be included in the review.

The results showed no strong evidence either for or against lumbar supports. The prevention studies showed moderate evidence that lumbar supports are not effective in preventing LBP, and that supports are no more effective than other prevention efforts. But the treatment studies were somewhat conflicting. There was limited evidence that suggested that a lumbar support with a stiff insert in the back was helpful in patients with low back pain.

The authors suggest that more studies should be done to compare the different types of lumbar supports. They also suggest research on using lumbar supports to prevent further back pain in patients who have already developed back problems. There was almost no research in this area. Based on their research, the authors conclude that there is little support for lumbar supports. Their research showed no real benefits for using a support in the prevention or treatment of low back pain.

It is estimated that well over half of pregnant women develop pelvic or back pain. Of all women with chronic low back pain, one quarter of those developed the problem during pregnancy. That’s a lot of people, and a lot of pain.

What can be done? As with many conditions, there are only theories. In this case, the pain is thought to be caused by a wobbly pelvis. During pregnancy, the pelvic joints and muscles become loose because women’s bodies produce joint-relaxing hormones. The pressure of the pregnancy in the pelvis also causing stretching. Would strengthening the muscles that support the pelvis and back help reduce the problems? Or would exercising put more force on the already pressured joints and muscles? This study found that unsupervised exercise did not help any more than instructions to avoid exercise. And some of the exercises actually made symptoms worse.

These researchers assigned 44 women with post-delivery pelvic pain to one of three groups. One group was assigned to do exercises for the muscles that connect diagonally on the front and back of the trunk. The second group worked the muscles running up and down from the ribs and spine to the pelvis bone. The third group didn’t do any exercise; they were instructed to do their usual day-to-day activities. Participants had completed their pregnancy an average of just over four months before taking part in the study.

Each woman was sent a video tape describing pelvic pain, how to move and lift safely, what to do when pain strikes, and how to use a pelvic belt (an elastic band that wraps around the waist to hold the pelvis steady). Each person got the same information, but members of the two exercise groups also watched sections on how to do their exercise routine, which they followed for eight weeks.

Many of the women who worked their diagonal muscles found that training made the pain or fatigue worse. One-fourth had to stop the training because they felt too much pain. The routine for this group included an exercise for the large hip extensor muscles, requiring them to lift their leg up while lying face down. The authors think this exercise may have put too much pressure on the pelvis, leading to the increase in pain.

Although most of the participants showed improvement over the eight weeks of the study, there weren’t any remarkable differences between either exercise routine. In fact all three groups, even those who didn’t do any exercise, improved at about the same rate.

Looking back, the researchers wondered if the way the training was done could have affected the outcome in the exercise groups. They consider that having one-on-one coaching might make a difference. At this point, however, exercising the diagonal trunk muscles does not appear to offer an advantage over instructions only.

The authors emphasize the need for additional research to see if pelvic pain can be eased by avoiding hip extensor exercises, and whether there are other types of abdominal exercises that would be more helpful for patients with pelvic pain after pregnancy.

Low back pain is a real pain for doctors, too. It’s hard to find a specific cause, and it’s almost impossible to predict who will develop chronic problems. There aren’t even any foolproof tests to help doctors determine which back patients should get disability status. Much medical research has focused on developing better ways to accurately measure patients’ disability.

These authors compared the results of two common tests that take place in the doctor’s office. The idea was to figure out if the results from the two tests related well. The study involved 83 patients with low back pain. Doctors measured the patients’ mobility using six common physical tests. The patients also filled out a widely used questionnaire. It asked questions about their activities and limitations because of low back pain.

Neither type of test is perfect. Questionnaires are obviously very subjective. But physical exams can also be affected by patients’ states of mind. Patients may exaggerate their symptoms–maybe they don’t want to go back to work, or maybe they’re afraid of even worse injury. Patients might also play down their symptoms, feeling like they should just “tough it out.”

The authors found a weak to moderate correlation between the physical exams and the questionnaires. This led them to conclude that both types of tests are important in determining patients’ disability levels. Neither test is perfect, but together they give more complete information than alone.

Injections of steroids such as cortisone are widely used to ease joint pain. The use of epidural steroid injections in the spine, however, is more controversial.

The spinal cord travels in a tube within the bones of the spinal canal. The spinal canal is covered by a material called dura. The space between the dura and the spinal cordis the epidural space It is thought that injecting steroid medicaiton into this space fights inflammation around the nerves, the discs, and the facet joints of the spine.

These researchers used epidural steroid injections in 50 patients to try to assess the injections’ usefulness. All 50 patients had low back pain, many with pain into their legs (sciatica). All had tried conservative treatments–such as rest, ice, and anti-inflammatory medications–for at least two months without relief. All 50 patients experienced some pain relief soon after the injection. An average of two years later, 68% of the patients had no pain, 12% had less pain than before the injection, and 20% had the same symptoms as before the injection.

The authors conclude that epidural steroid injections may be helpful for some patients who don’t get relief from conservative treatment. They suggest that injections are generally less helpful for patients with degenerative facet joint disease and disc space narrowing, among other conditions. But for many patients, an epidural injection might be just what the doctor orders to knock down the symptoms of low back pain.

Millions of Americans suffer from low back pain. The costs of missed work and loss of quality time with family and friends are enormous. A lot of medical research is directed at finding the causes of low back pain to help find effective cures and prevention measures.

This study focused on whether hamstring flexibility affects patients with low back pain. Researchers looked specifically at back pain sufferers whose problems did not have a known cause–for example, arthritis or obvious disc or vertebrae problems. The researchers found that muscle stiffness was not the issue, as has been traditionally thought. Instead, patients with back pain didn’t tolerate stretching very well, specifically in their hamstring muscles.

Researchers compared 20 people with low back pain and 20 people with no back problems. Researchers divided the healthy group into a “flexible” group and a “stiff” group by having them bend at the waist and try to touch the ground. Then the subjects were placed on a leg-stretching table, where they had complete control over how far the stretch could go. They were asked to report what they felt as the stretch progressed. The subjects would stop the stretch when the tension, usually felt in the hamstrings, became too uncomfortable.

Both the stiff group and the back-pain group noticed the first sensation of pain at similar times, which happened much earlier than the flexible group. Yet there was a significant difference in how the stiff group and the back-pain group reacted to the stretching. During the stretch–often early–people with back pain had more sensitivity or irritability in the muscles of the back and leg. It is possible that fear of pain during stretching may have caused this unconscious reaction in the muscles.

Stretching is one of the common suggestions given to patients with muscle stiffness or back pain. This study makes it clear that stretching is not always the best choice. In fact, people with low back pain may actually get better results by using relaxation techniques to calm their overly sensitive back and hamstring muscles.

When a disc in a person’s lower back becomes herniated, it can put pressure on the joints, ligaments, and nerves of the low back. In some cases, the pressure is so bad that it can cause pain and numbness in the pelvis, low back, and down one or both legs. It can also result in a condition called cauda equina syndrome, which causes serious problems with bladder and bowel control.

While about 56% of women have low back pain during pregnancy, only about one in 10,000 pregnant women actually shows symptoms from a disc herniation. In rare cases, the symptoms from a herniated disc require immediate back surgery. Putting surgery off can mean the pain, numbness, and incontinence become permanent. But what if the patient is pregnant? Is lumbar surgery safe during pregnancy?

These authors reviewed available medical literature. They also reported on three case studies of their own patients. The three women were in their first pregnancies when they developed symptoms of numbness or pain in one or both legs. One woman also had cauda equina syndrome. The women were all between 16 and 20 weeks into their pregnancies when they sought care for their symptoms.

In all three cases, lumbar surgery was successful. All the patients reported having fewer symptoms after surgery. And all three of their babies were born healthy and on time. The woman with cauda equina syndrome had been having symptoms for six weeks before she had surgery, and she continued to have some problems with constipation and incontinence, although she was much improved. The other two women made full or nearly full recoveries.

Based on their research and the case studies, the authors conclude that MRI scans, epidural and general anesthesia, and lumbar disc surgery can be done safely during pregnancy. The surgery should only be used when other types of care aren’t working or in an emergency–such as cauda equina syndrome. The authors also recommend using a special four-poster frame that allows the woman to lie face-down during surgery without putting any pressure on the uterus or developing baby.

Low back pain is one of the most common–and most costly–conditions in the U.S. Every year, about 2% of all workers suffer low back injuries on the job. Yet low back pain is one of the hardest conditions for doctors to measure and understand. Common tests, such as X-rays and MRI scans, can’t always pinpoint the underlying problem. They also don’t tell much about a patient’s level of disability.

To make matters worse, patients often don’t give a good idea of their symptoms in the doctor’s office. Consciously or unconsciously, they exaggerate their symptoms. This can happen when patients want disability status, or when they are nervous, scared of causing themselves pain, or depressed. But this makes it even harder for doctors to determine if the back condition is just painful, or if it is actually causing disability.

These researchers were looking for a way to measure spine function that isn’t consciously influenced by the patient. They studied test results of 91 patients with low back pain. Patients answered questions about their pain and their ability to do certain tasks. Patients then underwent standard tests of spine range of motion and strength. In addition, they also had a spinoscopic exam. A spinoscope measures coordination of the spine through movements of the individual vertebrae. Unlike range of motion or strength, it is nearly impossible for patients to influence these movements consciously.

Researchers then compared the results of the different kinds of tests. They found a weak relationship between disability, functional status showed by the tests, and patients’ reports of pain. Patients who rated their pain and disability highly tended to do somewhat worse on the standard range-of-motion and strength tests. However, there was a much smaller link between patients’ reports and the results of the spinoscopic examination.

The authors conclude that the weak link between the questionnaires and the functional tests means that doctors need to be careful in using patients’ self-reports to determine disability levels. They suggest that more complex measurements of spinal coordination, such as those from the spinoscope, could prove helpful in getting a better idea of patients’ disability levels.

Low back pain (LBP) is unpredictable. It can go away within a few weeks, or it can become an ongoing, lifelong problem. People with LBP (and their doctors) would love to have a crystal ball to show them what to expect for their back in the future.

These authors don’t supply a crystal ball. But they did look for ways to predict which patients with LBP will have long-term problems. They looked at records of more than 1200 patients with LBP to see if there were common factors in those whose pain became chronic. They interviewed patients six times over 22 months.

Patients answered questions about their pain levels, medical care, work status, and ability to do certain tasks. Patients who were still having symptoms after three months were considered to have chronic LBP. Patients who had symptoms throughout the 22 months were considered to have unremitting LBP.

The authors found that the 96 (7.7%) patients who had chronic LBP were more likely to be nonwhite and in a lower income bracket when they developed LBP. They were more disabled by their back pain and more likely to have pain that affected their legs (sciatica). The authors also found that the prognosis for these patients was poor. At 22 months, only 16% had no back symptoms. And 67% of patients still had symptoms that limited their ability to function normally.

Surprisingly, the authors found that patients with the worst LBP often got the least medical care. Of the 59 patients categorized with unremitting LBP, only 58% sought health care for their back problems from month three to month 22.

The authors conclude that, in their study, only two variables seemed to be of much use in predicting chronic LBP. Patients with less ability to function on their first doctor visit were especially likely to develop chronic LBP. And patients’ functional ability at the four-week mark was also strongly related to having future problems with chronic LBP. 

More research is needed to know exactly how these results can be used. And though it’s no crystal ball, this study can help doctors give their low-back patients an idea of what to expect in the future.

“Low back pain remains a thorn in the side of modern medicine,” write the authors of this article. It’s no wonder. The causes of low back pain (LBP) can be difficult to diagnose, and LBP can be expensive and frustrating to treat. It also causes problems on the job with absenteeism, lost wages, and workers’ compensation costs.

Determining the level of disability caused by LBP is an ongoing problem for health care providers. Tests such as X-rays and MRI scans don’t always help doctors make a diagnosis. Research shows that the results of these tests can’t predict levels of pain or disability. As a result, much research has focused on finding reliable ways to measure the disability caused by LBP. The researchers of this study looked at spine degeneration shown on X-rays to see if it related to levels of pain or disability.

This study included 172 patients with LBP. They answered questions about their pain and ability to do certain tasks. Patients also reported if their back pain was caused by an injury. Patients then had X-rays of taken of their lower back.

The authors found that the patients who reported a past back injury tended to have more degeneration in the joints of their spine. However, no differences were found in disability or pain levels between patients who had an injury and those who hadn’t. There was also a weak link between how much pain a person had and the amount of degeneration seen on X-ray.

The authors conclude that much more research is needed to put together the pieces of the LBP disability puzzle. Researching disability is especially hard because there are often other factors involved. Consciously or unconsciously, patients commonly exaggerate their symptoms. In some cases, patients may want disability status in order to get time off work or to gain the upper hand in a lawsuit. The authors note that disability studies done in countries where lawsuits are common may influence research results.

About 39% of patients with chronic low back pain have problems that arise from the disc in the spine. Doctors call this condition discogenic back pain. In an earlier study, these authors found that patients were helped by a technique called percutaneous intradiscal radiofrequency thermocoagulation (PIRFT). PIRFT involves putting a needle directly into the painful disc and then using a set radiofrequency for a specific amount of time. The idea is that the heat inside the disc will build up enough to stop the nerves around the disc from sending pain impulses.

This study was designed to test the effectiveness of PIRFT. Researchers chose 28 patients with specific symptoms of discogenic pain in the low back. All patients were tested for pain levels using two different scoring systems, and they filled out a form about their functional abilities. The patients were divided into two groups. The treatment group received a specified PIRFT treatment. The control group got a fake treatment.

The authors then followed up on the patients’ symptoms after treatment. Success was based on whether patients showed at least a 50% improvement in their scores on the first pain questionnaire and if they had at least a two-point drop in pain on the other system.

Eight weeks after treatment, only one patient in the treatment group had a successful result, compared to two patients in the control group. At eight weeks the two groups had no real difference in their pain levels or functional abilities.

Unlike the earlier study, this new research suggests that PIRFT treatment is not helpful in treating discogenic low back pain. However, the authors note that PIRFT might have been successful if the technique had been done differently or if it had been done only in patients with certain types of symptoms. They conclude that more research is necessary to determine the role of PIRFT in treating low back pain.