Background: Chronic low back pain can be a manifestation of lumbar degenerative disease, herniation of intervertebral discs, arthritis, or lumbar stenosis. When nerve roots are compromised, low back pain, with or without lower extremity involvement, may occur. Local inflammatory processes play an important role in patients with acute lumbosciatic pain. The purpose of this study was to assess the value of erythrocyte sedimentation rate (ESR) and high sensitivity C-reactive protein (hsCRP) measurements in patients with chronic low back pain or radiculopathy. Methods: ESR and hsCRP were measured in 273 blood samples from male and female subjects with low back pain and/or radiculopathy due to herniated lumbar disc, spinal stenosis, facet syndrome, and other diseases. The hsCRP and ESR were measured prior to lumbar epidural steroid injection. Results: The mean ESR was 18.8 mm/h and mean hsCRP was 1.1 mg/L. ESR had a correlation with age. Conclusions: A significant systemic inflammatory reaction did not appear to arise in patients with chronic low back pain.
The purpose of this study is to identify the relation between functional limitation, functional disability and back pain during pregnancy. Data was collected by interview or self-report from 66 pregnant women between the gestational ages of 17 and 22 weeks who had experienced back pain from February 17 through July 28, 2001. The results of this study are as follows; 1. The prevalent mean week of back pain starting during pregnancy was 12.8. The mean pain intensity scores on the VAS during the past week and now were 5.6 and 3.7. The mean score on the functional limitations was 38.9. The mean score on the functional disability was 19.7. 2. The pain intensity on the past week was correlated with the pain intensity now (r=.339, p<0.01) and the functional limitations (r=.251, p<0.05). The pain intensity now was correlated with the functional limitations (r=.295, p<0.05) and the functional disability (r=.429, p<0.01). The functional limitations was correlated with the functional disability (r=.229, p<0.01). The higher pain intensity was the more functional limitation and functional disability occurred. 3. There was a statistically significant correlation between the pain intensity now and the type of housing (t=-2.051, p=.045), and back pain history before pregnancy (t=-2.429 p=.003). 4. There was a statistically significant correlation between the functional limitation and income (F=2.803, p=.047) and back pain history before pregnancy (t=-3.225, p=.002). There was a statistically significant correlation between the functional disability and back pain history before pregnancy (t=-3.058 p=.003). In conclusion, we found that a history of back pain was an important factor when predicting back pain and functional disability and limitation during pregnancy. The nurse and the prenatal educator should detect risk factors of back pain early in pregnancy and manage continuously though pregnancy.
Purpose: The purpose of the study was to identify low pain prevalence rate and factors affecting low back pain in emergency medical technicians. Method: A descriptive relationship research design was utilized. The participants were 74 emergency medical technicians who worked at fire stations in W and J city and agreed to participate in this study. Data were collected between April and August 2008 using a questionnaire, which included demographic factors, severity of low back pain using a visual analog scale, factors related to low back pain and health behavior, and BMI. Descriptive statistics and multiple regression were performed for data analysis. Results: 85.1% of emergency medical technicians experienced low back pain. The mean score of low back pain was relatively low (M=4.0, SD=2.33). Significant factors affecting low back pain were found to be age, marital status, exercise, hours of standing work, and BMI. These variables explained 35.1% of variance in low back pain (F=8.45, p<.001). Conclusion: These results suggest that further research is needed to develop interventions for prevention and management of low back pain among emergency medical technicians.
Purpose: The purpose of this study was to classify patients with chronic back pain according to the degree of their back pain, and to compare the pain dysfunction index with the qualitative changes in abdominal muscles. Therefore, we aimed to provide a basis for the treatment intervention method for patients with back pain. Methods: Twenty patients with chronic back pain were purposive sample to a group of 10 patients with a back pain index of 60 % or more and a group with less than 60 % of back pain, and the subjects who voluntarily participated in the study After receiving the letter, I conducted the research the dysfunction of back pain was measured by the Korean version of the Oswestry Disability Index (KODI), and the ultrasonic wave (Ultrasound MyLabOne, ESAOTE, Italy) And the white area index, and the abdominal muscle movement was used as the exercise instrument POWER breathe K5 (Hab direct, UK), which strengthens the respiratory muscles through threshold-muscle traction. Result: In this study, patients with chronic back pain were subjected to breathing exercises, which led to the decrease in back pain dysfunction. The ultrasonographic analysis of abdominal muscles revealed that both the white area index and muscle image density in the skeletal muscle and in the outer muscle of the abdomen gradually decreased over time. Conclusion: It is thought that introducing back pain patients to abdominal muscle reinforcement training is effective in improving the functions of the patients' muscles, thus increasing their quality of life.
The result of studying papers about management of lower back pain published in domestic and foreign nursing and medical magazines in these 10 years is as follows ; 1. General characteristic of lower back pain ; 1) In sex distribution, there were more men than women in 5 papers and more women than men in 4 papers among 9 papers surveryed. 2) In age distribution, thirties to forties of patients had more lower back pain as surveyed by general hospitals and fifties to sixties of patients had more lower back pain as surveyed by oriental medical hospitals. 3) In cause factor, there were 50 to 65% of sprain, 32 to 44% of herniated intervertebral disc and 13 to 29% of degenerative changes. 4) In symtom distribution, there were 26 to 57% of lower back pain, 42 to 65% of lower back pain with radiating pain and 34 to 99% of paravertevral muscle spasm. 5) In period of pain management distribution, 18 to 40% of patients experienced pain for less than 6 months and 59 to 82% of them experienced pain for more than 6 months in 3 papers among 4 papers. 6) In surveying the treatment, 66 to 88% of patients had conservative treatment and there were treatments of general hospital, oriental medicine, self remedy and traditional practice in conservative treatment. 7) In job distribution, 12 to 50% of them were housekeepers, 23 to 31% office workers, 4.6 to 36% blue color workers and 11 to 15% students. 2. As psychological character lower back pain paients had anxiety, depression, anger-hostility, phobic anxiety, neurasthenia, hypochondriasis, and interpersonal sensitivity. 3. To distinguish the cause of lower back pain, plain lumbar roentgenogram, straight leg rasing test, eletromyelogic findings, somatosensory evoked potentials CT and MRI were performed. 4. To relieve lower back pain. epidural adhesiolysis, epidulal injection of local anesthetic in mixture with steroid, lumbar spinal root block, low level laser therapy, acupuncture like transcutaneous nerve stimulation(AL TENS), topical capsaicin and lumbar orthotics were used in medical field, and relaxation technique was used in nursing field. 5. Mckenzie's extension exercise and William's flexsion exercise for lower back pain were used in medical field and Yoga exercise was applied in nursing field. 6. The more school education and self efficacy were high, the better they had active coping lower back pain positively and the less self efficacy was the more they had serious pain. As a result of studying the paper there have been very little research for lower back pain in nursing fields of Korea and foreign countries. Because 60 to 80% of population expeience lower back pain at least more than once, it is necessary to develop the study and clinical practice for management of lower back pain.
Low back pain is a common clinical condition with heterogeneous causes and challenges to manage. High prevalence and numerous assessments result in an enormous socioeconomic burden. Clinician must conduct efficient and stepwise evaluation process to rule out serious spinal pathology, neurologic involvement, and identify risk factors for chronicity. The process can be achieved through the focused history taking and physical examination. Certain factors related to serious spinal pathology include age (>50 years), trauma, unexplained fever, recent urinary or skin infection, unrelenting night or rest pain, unexplained weight loss, osteoporosis, immunosuppression, steroid use, and widespread neurological symptoms. In non-specific low back pain, diagnostic imaging and laboratory studies are often unnecessary and can disturb an appropriate management. For the management of acute low back pain, patient education and medication such as acetaminophen, non-steroidal anti-inflammatory drugs, and muscle relaxants are recommended. For chronic low back pain, behavior therapy, back exercise, and spinal manipulation are beneficial. The evidence based approach could improve success rate of management, result in prevention of acute low back pain from being chronic intractable pain.
Epidural steroid therapy has been well-established for the treatment of sciatica and low back pain. Disappointing results following surgical decompression or discectomy pain owing for to nerve root compression have led to trials of corticosteroids injected either systemically or into the intrathecal or epidural space to treat intervertebral disc. Epidural steroid is less effective in the patients with low back pain who have a history of surgical operation, so that the use of epidural morphine and methylprednisolone has been advocated for the amelioration of chronic low back pain in the post-laminectomy pain("failed back") syndrome over the past several years. We treated 47 patients with low back pain who had a history of one or two surgical procedures. We concluded that epidural steroid therapy is less effective in the patients with "failed back" syndrome than in the virgin back furthermore, there is a greater risk of complication such as inadvertent dural puncture and corresponding motor paralysis and headache.
The purpose of this study were to determine causes of low back pain in bus drivers who usually work in prolonged sitting position and to find the relationship of back pain with general characteristics and work environmental characteristics, stress symptoms, to com맹re lordosis angle of habitual driving posture and resting posture in low back pain group and non-low back pain group, and to use this result as a basis for improvement of work environment and comprehensive rehabilitative management of low back pain. Ninety-eight bus drivers were selected from the membership of an urban transit union in Seoul. These informations were collected from May 1, 1997 to May 25, 1997 by means of structured questionnaires and X-ray findings. These data were analyzed by $x^2$ test, t-test, logistic regression using SAS. The major results were as follows: 1. Of the respondents, 66.3% of bus drivers were found to be experiencing back pain. 2. Of the respondents of low back pain groups, 78.5% reported that major cause of low back pain was due to prolonged sitting. 3. The group with experiences of frequent or continuous vibration had more low back pain (p<0.05). There were no significant differences among other work environmental factors. 4. Average stress score was significantly higher in the group with low back pain than in the group without low back pain (p<0.05). 5. The results of the logistic regression analyses were statistically significant vibration from seat and stress score among the risk factors (p<0.05). 6. Averaged lordosis angle of habitual driving posture was $7.6{\pm}14.9$ degrees in low back pain group, $16.5{\pm}8.7$ degrees in non-low back pain and averaged lordosis angle of resting sitting posture was $10.8{\pm}13.7$ degrees in low back pain, $18.9{\pm}9.6$ degrees in non-low back pain group but the difference in mean lordosis angles of two groups was not statistically significant. The results of this study indicate that professional drivers developed chronicity of low back pain due to unfit seat, poor habitual posture and stress from vibration or other risk factors. Therefore, there is need to improve work environment, i.e. enough resting, to set a seat to support lumbar spine properly and to provide comprehensive rehabilitation program including early diagnosis, proper treatment and education for self help management.
This study was undertaken to investigate the severity of depression and to analyze various factors related to depression in chronic back pain patients in urban-rural areas. In this study, 30 patients who suffered from back pain more than 6 months, and 30 normal subjects who had similar demographic characteristics as the patient group were evaluated using the Back Depression Inventory(BDI). Various factors such as age, sex, causes of back pain, vocational history, pain continuity, visual analogue scale(VAS), duration of pain, type of management, and urban or rural residence were recorded for the study group. The results are 1) The study group revealed higher BDI scores than the control group(p<0.05). 2) The patients who were older and had higher VAS, longer duration of pain, or previous history of surgical management for back pain, and an urban 033residence revealed higher BDI scores(p<0.05). 3) The BDI scores were not significantly influenced by the subjects' sex, causes of back pain, pain continuity, and vocational history in the study group(p>0.05). From this study, we concluded that a Psychosocial approach is required for the management of chronic back pain patients. Also, it is necessary to assess the factors, which are making depression worse in other chronic diseases for comprehensive rehabilitation.
Background: This study investigated the effects of sustained natural apophyseal glides (SNAGS) technique on lower back pain and pain disability among university students with lower back pain. Methods: A total thirty 20~30 year old university students with lower back pain were divided into two groups. A lumbar flexibility exercise was applied to the control group (n=15). The SNAGS technique group (n=15) received L1~L4 segment mobilization using SNAGS technique. Intervention was implemented for 20 minutes, 3 times a week for 3 weeks. The SNAGS were performed using belt with flexion and extension, whereas lumbar flexibility exercise included lumbar flexion and extension. Lower back disability was measured using the Korean Oswestry disability index (KODI), and pain sensitivity was measured by pain pressure threshold (PPT). The groups were assessed for lower back pain disability and pain, before and after the intervention. Results: There were significant improvements in both the KODI and PPT of the SNAGS technique group (p<.05), while the lumbar flexibility exercise group showed no significant change (p>.05). In addition, the SNAGS technique group had a statistically significant difference in KODI and PPT compared to the lumbar flexibility exercise group (p<.05). Conclusion: SNAGS technique is more effective than lumbar spine joint flexibility exercise in the improvement of lower back pain disability and pain among university students with lower back pain.
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