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Backwatch : What's new in back care?
 

1. Scott et al, in Spine  1999, learned "that smokers have more frequent episodes of back pain may imply that smoking exacerbates back pain, and the observation that stronger associations between back pain and smoking were found in the scoliosis cohort suggests that smoking may have a greater impact on persons with damaged spines."

2. Shah reports, in Spine ,Feb 2002, that sacral stress fractures in athletes, can be a cause of low back pain, and this is usually not considered in the diagnostic workup.  He reports a 16 year old who suffered a sacral stress fracture playing volleyball, and was successfully treated with non steroidal antiinflammatory medications.

3. Lang , in Schmerz (Feb 2002) found that a multimodal treatment of low back pain, 4 hours per day for 20 days, consisting of medical training therapy, cognitive behavioral therapy, physiotherapy and patient education, organized in a private health oriented sports center with three physiotherapists, a psychologist and a pain specialist, improved outcomes. 

4. Cohen, in Sports Medicine (2002 ;32(1)) evaluated agressive exercise as a treatment for chronic low back pain.  He found that "by eliminating impairments in back function, altering fears and beliefs about pain, and reducing disability, patients with chronic low back pain can achieve meaningful improvements in their quality of life."

5. Gatterman, in the Journal of Manipulative Physiol Ther, Sept 2001, wrote "The four conditions rated most amenable to chiropractic treatment were noncomplicated low back pain, sacroiliac joint dysfunction, posterior joint/subluxation, and low back pain with buttock or leg pain."  He concluded " the ratings for the effectiveness of chiropractic technique procedures for the treatment of common low back conditions are not equal. Those procedures rated highest are supported by the highest quality of literature. Much more evidence is necessary for chiropractors to understand which procedures maximally benefit patients for which conditions."

6. Han, in Int J Obes Relat Metab Disord (Jul 1997) found: "Women who are overweight or with a large waist have a significantly increased likelihood of low back pain. There are no significant interactions between waist and height, or waist to hip ratio and body mass index on low back pain symptoms."

7. Strauss, in Geriatrics (Nov 1997) reported: "Common orthopedic problems in sedentary midlife patients are shoulder impingement, low back pain, and plantar fasciitis. Although the responsibility for maintaining an exercise program rests with the individual, the primary care physician can play an important role as coach, cheerleader, and respected advisor. The key is to encourage patients to initiate a program of regular, moderate exercise 30 minutes a day, three times a week, and to eat a balanced, nutritious diet."

8. Mauro, in Eur Rev Med Pharmacol Sci  (May-June 2000) eveluated 60 patients between 18 and 65 years, with lumbago or sciatic neuritis of mechanical origin, without the need for surgery.  Back pain had been present from 6 mos to 5 years.  He concluded "The efficacy and safety of parenteral Vitamin B12 in alleviating low back pain and related disability and in decreasing the consumption of paracetamol was confirmed in patients with no signs of nutritional deficiency."

9. Paajanen, in Arch Orthop Trauma Surg (1997), studied lumbar disc degeneration in subjects suffering from low back pain.  He concluded that "The percentage of subjects with degenerated discs increased with age; starting from the age of 15 years, this increase was more rapid in subjects with low-back pain. Concurrently, the number of degenerated discs was higher in the pain group than in controls. Lumbar disc degeneration manifests earlier and in a greater percentage of subjects with low-back pain than in asymptomatic controls."

10. In my practice, I find that the radiologists will very often discover many levels of degenerative changes in the spines of my patients.  This a cause of great consternation for many.  We all would like to think our spines are healthy, and this causes worry for many.  I am pleased with the findings of Kikuchi, from the Dept of Orthopedic Surgery in the Fukushima Medical School, Japan. In Semin Musculoskelet Radiol (Jun 2001) he wrote " MR imaging has a significant diagnostic value, but abnormal findings revealed by MR imaging do not always cause symptoms. MR imaging findings should be confirmed by subjective symptoms, objective findings, and functional diagnostic procedures."

11. For a surgical perspective, Leufven, from Gothenburg, Sweden, wrote in Spine (Oct 1999).  He studied 29 patients who had low back pain, chronic and disabling, and suffering for over 2 years.  After appropriate testing and selection of surgical candidates, he performed a a posterior lumbar interbody fusion, posterolateral fusion, and pedicle screw instrumentation.  He found : "There was a highly significant reduction in back and leg pain measurements. Of the 29 patients, the results were excellent in 9 patients (31%), good in 6 patients (21%), fair in 6 patients (21%), and poor in 8 patients (27%). A total of 18 patients (62%) had returned to work. CONCLUSION: The authors consider posterior lumbar interbody fusion with concurrent posterolateral fusion and pedicle screw instrumentation a possible method for managing chronic disabling low back pain."

12. There is a group of patients who have had long term chronic low back and lower extremity pain.  Dorsal column stimulation, that is electrical stimulation of the lower portion of the spinal cord, has been shown to be effective.  Villavicencio, from the Division of Neurosurgery at Duke University (Neurosurgery  Feb 2000) concluded " Spinal cord stimulation is an effective treatment for chronic pain in the lower back and lower extremities that is refractory to conservative therapy. Electrodes placed via laminectomy in the thoracic region appear to be associated with significantly better long-term effectiveness than are electrodes placed percutaneously."

13. Accupuncture is one of the alternative forms of treatment of low back pain.  In Spine (1999, Jun), van Tulder,  from the Institute for Research in Extramural Medicine, Amsterdam, The Netherlands, reported on eleven randomized controlled trials.  His conclusions were "Because this systematic review did not clearly indicate that acupuncture is effective in the management of back pain, the authors would not recommend acupuncture as a regular treatment for patients with low back pain. There clearly is a need for more high-quality randomized controlled trials."