What is low back pain pdf

Although recruitment targeted and z-values below 0 indicated a loss of function ie, reduced both primary care clinics and the community, the majority of LBP sensitivity compared with controls. All the analyses were performed using R statistical software. Demographic and clinical features at baseline are reported in Table 1. Results respectively. There were no statistically significant differences 3. Study participation between the LBP groups and the pain-free controls in de- mographic variables with the exception of body mass index, Figure 1 shows the flow chart of recruitment and screening of which was higher in the LBP groups P 5 0.

Among the LBP participants. A total of individuals were screened for the groups, those with persistent LBP had significantly higher pain study. Of 98 potentially eligible participants, 73 25 people with intensity NRS11 compared with the recovered LBP group, at LBP and 48 controls provided consent to participate and were baseline P 5 0. Medication enrolled in the study. Two people with LBP and 4 pain-free intake and treatments received during the 4-month period in both controls withdrew after the baseline assessment; 1 control did not LBP groups are reported in Table 2.

Clinical and psychological variables 3. Participants Longitudinal data for clinical and psychological variables are Twenty-two people with LBP completed the study and were reported in Table 3.

For disability levels measured by the RMDQ, therefore included in the analysis. Fifteen people were classified no significant interaction between time and group was found. This decreased over time P , 0. For the level of functional pain classification was consistent with a significantly higher level of interference measured by the FRI, a significant interaction functional pain interference assessed with the FRI reported in between time and group was observed P , 0.

Post hoc Figure 1. Screening and study participation flow diagram adapted from Consort Transparent Reporting of Trials. No differences in FRI scores were and the pain-free controls at baseline P , 0.

A significant interaction between time and group was 3. Quantitative sensory testing observed for all 3 psychological variables assessed P , Longitudinal data for QST variables at 3 time points and linear 0. Post hoc tests showed that pain self-efficacy and pain mixed-effect model analyses are reported in Table 4.

Thermal pain threshold improvement was shown from 2 to 4 months P 5 0. Post hoc tests showed of pain self-efficacy and higher levels of pain catastrophising that in the recovered LBP group, CPT at the hand significantly compared with the recovered LBP at all time points P , 0.

Depression, anxiety and stress DASS scores were by 4 months, as also illustrated in the z-score plot Fig. Post hoc tests whereas in the persistent LBP group and in the pain-free controls, showed that DASS scores significantly decreased in CPT at the hand remained unchanged over the 4 months. For Table 2 Use of medications and treatments in the 24 hours before QST assessment in people with low back pain at 3 time points.

For PPT at the back, between time and group were observed, and no significant main the persistent LBP group had significantly lower PPT compared effects for time and for group were observed after removing the with the recovered LBP group at 4 months P , 0. Wind-up ratio 3. Two-point discrimination threshold No significant interaction between time and group was found There was no significant interaction between time and group for for WUR at both sites P.

No significant main effects TPD P 5 0. A significant main effect for time was observed for time and for group were observed P. After adjusting for groups, removing the interaction term. The z-score plots Fig. Cold pressor test a further increase at 4 months, then reaching a difference of 2 SDs from controls. There was no significant interaction between time and group for the cold pressor test P 5 0.

No significant main effects for time and for group were observed P. Pressure pain threshold interaction term. There was a significant interaction between time and group for PPT at the hand P 5 0. Post hoc 3. Conditioned pain modulation tests showed a significant decrease in PPT at both sites in pain- free controls from baseline to 2 months P , 0. Figure 2. Significant difference between groups P , 0.

Discussion system sensitivity occurring in the subacute stage. Specifically, This exploratory study is the first to report the time course of an increase in pressure pain sensitivity was seen between 2 and 4 somatosensory function in an inception cohort of acute LBP followed months; and an earlier trend towards increased temporal up until 4 months. A comprehensive QST protocol encompassing summation was identified between baseline and 2 months, and static and dynamic tests was used, and longitudinal changes in pain- 2 to 4 months, at which point it exceeded 2 SDs beyond the pain- related psychological factors were concurrently evaluated.

In addition to the temporal changes in mechanical mechanical pain sensitivity was observed in the persistent LBP sensitivity in the persistent LBP group, a gain in cold pain group, suggesting potential underlying changes in the nervous sensation was observed in the recovered LBP group from Figure 3.

To the best of our knowledge, only one published study has reported on a range of QST variables in acute LBP 4 weeks from onset using a prospective study design48 with QST performed at baseline.

These authors reported that generalised hyposensitivity to thermal non-noxious stimuli, as well as enhanced temporal summation at the hand but not at the back measured in acute LBP, differentiated people who had not recovered at 6 months from those who had.

Unlike in the study by Starkweather et al. Two other cross-sectional studies have shown early enhancement of temporal summation in people with acute LBP ,4 weeks baseline to 2 months, which normalised from hypoesthetic to the duration compared with healthy controls,31,49 demonstrating pain-free values by 2 months. Pressure pain testing At baseline, pressure pain tests were similar between groups, 4.

Thermal pain testing which aligns with results from a previous prospective study in Among the thermal pain tests cold and heat including the cold acute LBP48 and other studies that reported no differences in PPT pressor test, only the CPT showed a differential change over time between acute LBP and healthy controls.

A similar increase in pressure pain sensitivity at the back has been reported in cross-sectional studies in subacute LBP. Tactile acuity pressure pain testing may reflect underlying sensitisation of primary afferent nociceptors through the release of neuro- This study provides the first data on tactile acuity in acute LBP as mediators such as neurotrophins and cytokines18 as well as the well as serial measures over time, until the onset of chronic LBP.

However, there was a small, but significant A significant decrease in PPT was also detected at the remote decrease in TPD threshold over time, indicating an improvement site at the hand in the persistent LBP group, although this was in tactile acuity, although these changes were within the within 1 SD of the healthy control values and the differences measurement error range. It is unclear, although a learning effect may have contributed.

A possible that widespread changes in pressure pain sensitivity previous systematic review has demonstrated a relatively con- become more evident in people with longer LBP duration1,5,15,16,37 sistent presence of altered tactile acuity in chronic LBP, whereby increases in central nervous system excitability are more particularly when measured at the area of greatest pain.

However, it has been recently included in the review investigated people with longstanding shown that generalised changes in pressure sensitivity do not chronic LBP eg, from 30 to months and may reflect occur uniformly in chronic LBP, but are selectively associated with functional changes that develop over longer periods, compared LBP subgroups14,43,53 which, interestingly, report more disturbed with the maximum 4-month duration of LBP in our study.

The lack clinical and psychological profiles. This phenomenon of a systematic maintain blinding of assessor. Conditioned pain modulation particularly between the first and the second measurements. Temporal summation effect from controls. The tion. In difference in CPM effect25,35,58 compared with controls. In other future studies of samples seeking care for LBP, psychological chronic pain conditions such a fibromyalgia or headache, CPM factors such as depression and anxiety which were not observed dysfunction has been more consistently documented.

Although changes in endogenous pain pain inhibition with LBP persistence, at least in the early months in modulation continue to be of great interest, efforts need to first this study sample. However, in light of the methodological focus on the standardisation of a CPM protocol to improve the variability of CPM testing,41 it is also not possible to exclude that reliability and interpretability of the test.

Disclosures 4. Psychological factors The authors have no conflict of interest to declare. Clinically significant lower self-efficacy scores Macquarie University. Quantitative sensory testing profiles in chronic back bles, particularly in the persistent LBP group align with the pain are distinct from those in fibromyalgia. Clin J Pain ;— Beyond the good prognosis: measured by RMDQ observed at all 3 time points assessed examination of an inception cohort of patients with chronic low back pain.

Table 3. This may reflect the fact that our sample was primarily Spine ; Is tactile community-based with relatively low initial levels of psychological acuity altered in people with chronic pain? Psychological factors: Mood and depression, stress, and psychological well-being also can influence the likelihood of experiencing back pain. A complete medical history and physical exam can usually identify any serious conditions that may be causing the pain.

Neurologic tests can help determine the cause of pain and appropriate treatment. Imaging tests are not needed in most cases but may be ordered to rule out specific causes of pain, including tumors and spinal stenosis. Occasionally the cause of chronic lower back pain is difficult to determine even after a thorough examination. Bone scans can detect and monitor an infection, fracture, or bone disorder. A small amount of radioactive material is injected into the bloodstream and collects in the bones, particularly in areas with some abnormality.

Scanner-generated images can identify specific areas of irregular bone metabolism or abnormal blood flow, as well as to measure levels of joint disease. Discography involves injecting a contrast dye into a spinal disc thought to be causing low back pain.

The dye helps to show the damaged areas on CT scans taken following the injection. Electrodiagnostics can identify problems related to the nerves in the back and legs. The procedures include:. Diagnostic imaging tests allow specialists to see into the body without having to perform exploratory surgery. Imaging includes:. Myelograms enhance the diagnostic imaging of x-rays and CT scans. In this procedure, a contrast dye is injected into the spinal canal, allowing spinal cord and nerve compression caused by herniated discs or fractures to be seen on an x-ray or CT scans.

Acute back pain usually gets better on its own. Acute back pain is usually treated with:. Exercising, bed rest, and surgery are typically not recommended for acute back pain. Chronic back pain is most often treated with a stepped care approach, moving from simple low-cost treatments to more aggressive approaches.

Specific treatments may depend on the identified cause of the back pain. Spinal injections include: Trigger point injections can relax knotted muscles trigger points that may contribute to back pain. An injection or series of injections of a local anesthetic and often a corticosteroid drug into the trigger point s can lessen or relieve pain.

Epidural steroid injections into the lumbar area of the back are given to treat low back pain and sciatica associated with inflammation.

Pain relief associated with the injections tends to be temporary and the injections are not advised for long-term use. Radiofrequency ablation involves inserting a fine needle into the area causing the pain through which an electrode is passed and heated to destroy nerve fibers that carry pain signals to the brain. Also called a rhizotomy, the procedure can relieve pain for several months.

Surgery When other therapies fail, surgery may be considered to relieve pain caused by worsening nerve damage, serious musculoskeletal injuries, or nerve compression. However, surgery is not always successful.

It may be months following surgery before the person is fully healed and there may be permanent loss of flexibility. Only a small proportion of people have a well understood pathological cause-eg, a vertebral fracture, malignancy, or infection.

People with physically demanding jobs, physical and mental comorbidities, smokers, and obese individuals are at greatest risk of reporting low back pain. Disabling low back pain is over-represented among people with low socioeconomic status. Most people with new episodes of low back pain recover quickly; however, recurrence is common and in a small proportion of people, low back pain becomes persistent and disabling. Initial high pain intensity, psychological distress, and accompanying pain at multiple body sites increases the risk of persistent disabling low back pain.