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Back to basis … confronting psychosocial issues in patients with low back pain
Journal of Manipulative and Physiological Therapeutics Volume 23 • Number 4 • May 2000
303
Journal Abstracts
to validate their efficacy. This study investigated the effectiveness of CV-4 and resting position techniques on TTH sufferers. Sixty adults between the ages of 21 and 65 (~=36, SD=I2) who were experiencing a TTH were randomly assigned to groups. Subjects in the first group received a 10minute session wherein multiple still points were induced using the CV-4 craniosacral technique. Subjects in the second group were placed supine in a resting position with the head and neck positioned for ten minutes in the most comfortable points in the ranges of protraction-retraction and flexion-extension. Subjects in the third group received no treatment; they lay quietly for 10 minutes. Pain intensity and the affective component of pain were measured before and after the treatments using visual analog scales. To determine if significant differences existed between the groups, a oneway multivariate analysis of covariance (MANCOVA) was used, followed by univariate tests and post-hoc tests. The MANCOVA was significant (F=3.59; df=4,108; p<0.05). Analyses of covariance for the variables of pain intensity and affect revealed significant differences among the groups (F=5.38; df=2,56; p<0.05 for intensity and F=4.45; df=2,56; p<0.05 for affect). Tukey tests revealed a significant improvement, in both intensity and affect scores, between the group receiving the CV-4 treatment and the no-treatment group and no significant difference between the group using only the resting position and the group receiving no treatment. The CV-4 technique is an effective technique for treating patients with TTH. Additional investigation is warranted to examine the duration of relief and to address the effectiveness of multiple treatment sessions utilizing the CV-4 and resting position techniques.
Hoffmann B. Back to b a s i c s . . , confronting psychosocial issues in patients with low back pain. Top Clin Chiropr 1999;6:1-7.
ABSTRACT: Purpose: This article provides an overview of the biopsychosocial model as it relates to low back pain. The significance of these factors in treatment outcomes and in the clinical assessment of patients with low back pain may be associated with the problems that become chronic. Specific methods of patient education and activation are discussed to help promote optimal outcomes with these patient populations. Method: Qualitative review of litera .t3are with synthesis by author for incorporation into chiropractic approaches with chronic low back pain. Summary: Identification of illness behavior through pain assessment instruments, nonorganic clinical findings, and progress monitoring should be incorporated. Any intervention should focus on specific goals aimed at reducing patient anxiety, promoting activity, and increasing patient's ability to be in control of activities of daily living. Reprinted with permission from Hoffmann B. Back to basics . . . confronting psychosocial issues in patients with low back pain. Top Clin Chiropr 1999;6:1-7. © 1999 Aspen Publishers, Inc.
Kjellman GV, Skargren El, Oberg BE. A critical analysisof randomizedclinical trials on neck pain and treatment efficacy. A review of the literature. Scand .I Rehab Med 1999;3 h 139-52.
ABSTRACT: The efficacy of physiotherapy or chiropractic treatment for patients with neck pain was analyzed by reviewing 27 randomized clinical trials published 1966-1995. Three different methods were employed: systematic analyses of; methodological quality; comparison of effect size; analysis of inclusion criteria, intervention and outcome according to The Disablement Process model. The quality of most of the studies was low; only one-third scored 50 or more of a possible 100 points. Positive outcomes were noted for 18 of the investigations, and the methodological quality was high in studies using electromagnetic therapy, manipulation, or active physiotherapy. High methodological quality was also noted in studies with traction and acupuncture, however, the interventions had either no effect or a negative effect on outcome. Pooling data and calculation of effect size showed that treatments used in the studies were effective for pain, range of motion, and activities of daily living. Inclusion criteria, intervention, and outcome were based on impairment in most of the analyzed investigations. Broader outcome assessments probably would have revealed relationships between treatment effect and impairment, functional limitation and disability.
Kuroki H,Tajima N, Hirakawa S, Kubo S,Tabe R, Kakitsubata Y.
Comparative study of MR myelography and conventional myelography in the diagnosis of lumbar spinal diseases. J Spinal Disord 1998;11:487-92.
ABSTRACT: Summary: The purpose of this study was to investigate the usefulness of magnetic resonance (MR) myelography by comparing it with conventional myelography. MR myelography was performed on 40 patients (24 men and 16 women; mean age, 44 years) with lumbar spinal diseases. MR myelography was imaged three-dimensionally by fast spin-echo technique with fat suppression and maximum intensity projection. We assessed both the ability to provide the images of nerve root sheaths and the similarity of the findings to conventional myelography. Satisfactory images of nerve root sheaths in the lumbar region were provided almost equally by MR and conventional myelography. The images obtained by MR myelography were similar in quality to those obtained by conventional myelography. When combined with some other conventional MR imaging techniques, this diagnostic technique of imaging lumbar spinal diseases is further enhanced.
Larsson R, Oberg A, Larsson S-E. Changesof trapezius muscle blood flow and electromyographyin chronicneck pain due to trapezius myalgia.Pain 1999;79:45-50.
ABSTRACT: Chronic neck pain may increase the transmitter activity of neuropeptides in the upper cervical medulla causing impair-
303
Journal Abstracts
to validate their efficacy. This study investigated the effectiveness of CV-4 and resting position techniques on TTH sufferers. Sixty adults between the ages of 21 and 65 (~=36, SD=I2) who were experiencing a TTH were randomly assigned to groups. Subjects in the first group received a 10minute session wherein multiple still points were induced using the CV-4 craniosacral technique. Subjects in the second group were placed supine in a resting position with the head and neck positioned for ten minutes in the most comfortable points in the ranges of protraction-retraction and flexion-extension. Subjects in the third group received no treatment; they lay quietly for 10 minutes. Pain intensity and the affective component of pain were measured before and after the treatments using visual analog scales. To determine if significant differences existed between the groups, a oneway multivariate analysis of covariance (MANCOVA) was used, followed by univariate tests and post-hoc tests. The MANCOVA was significant (F=3.59; df=4,108; p<0.05). Analyses of covariance for the variables of pain intensity and affect revealed significant differences among the groups (F=5.38; df=2,56; p<0.05 for intensity and F=4.45; df=2,56; p<0.05 for affect). Tukey tests revealed a significant improvement, in both intensity and affect scores, between the group receiving the CV-4 treatment and the no-treatment group and no significant difference between the group using only the resting position and the group receiving no treatment. The CV-4 technique is an effective technique for treating patients with TTH. Additional investigation is warranted to examine the duration of relief and to address the effectiveness of multiple treatment sessions utilizing the CV-4 and resting position techniques.
Hoffmann B. Back to b a s i c s . . , confronting psychosocial issues in patients with low back pain. Top Clin Chiropr 1999;6:1-7.
ABSTRACT: Purpose: This article provides an overview of the biopsychosocial model as it relates to low back pain. The significance of these factors in treatment outcomes and in the clinical assessment of patients with low back pain may be associated with the problems that become chronic. Specific methods of patient education and activation are discussed to help promote optimal outcomes with these patient populations. Method: Qualitative review of litera .t3are with synthesis by author for incorporation into chiropractic approaches with chronic low back pain. Summary: Identification of illness behavior through pain assessment instruments, nonorganic clinical findings, and progress monitoring should be incorporated. Any intervention should focus on specific goals aimed at reducing patient anxiety, promoting activity, and increasing patient's ability to be in control of activities of daily living. Reprinted with permission from Hoffmann B. Back to basics . . . confronting psychosocial issues in patients with low back pain. Top Clin Chiropr 1999;6:1-7. © 1999 Aspen Publishers, Inc.
Kjellman GV, Skargren El, Oberg BE. A critical analysisof randomizedclinical trials on neck pain and treatment efficacy. A review of the literature. Scand .I Rehab Med 1999;3 h 139-52.
ABSTRACT: The efficacy of physiotherapy or chiropractic treatment for patients with neck pain was analyzed by reviewing 27 randomized clinical trials published 1966-1995. Three different methods were employed: systematic analyses of; methodological quality; comparison of effect size; analysis of inclusion criteria, intervention and outcome according to The Disablement Process model. The quality of most of the studies was low; only one-third scored 50 or more of a possible 100 points. Positive outcomes were noted for 18 of the investigations, and the methodological quality was high in studies using electromagnetic therapy, manipulation, or active physiotherapy. High methodological quality was also noted in studies with traction and acupuncture, however, the interventions had either no effect or a negative effect on outcome. Pooling data and calculation of effect size showed that treatments used in the studies were effective for pain, range of motion, and activities of daily living. Inclusion criteria, intervention, and outcome were based on impairment in most of the analyzed investigations. Broader outcome assessments probably would have revealed relationships between treatment effect and impairment, functional limitation and disability.
Kuroki H,Tajima N, Hirakawa S, Kubo S,Tabe R, Kakitsubata Y.
Comparative study of MR myelography and conventional myelography in the diagnosis of lumbar spinal diseases. J Spinal Disord 1998;11:487-92.
ABSTRACT: Summary: The purpose of this study was to investigate the usefulness of magnetic resonance (MR) myelography by comparing it with conventional myelography. MR myelography was performed on 40 patients (24 men and 16 women; mean age, 44 years) with lumbar spinal diseases. MR myelography was imaged three-dimensionally by fast spin-echo technique with fat suppression and maximum intensity projection. We assessed both the ability to provide the images of nerve root sheaths and the similarity of the findings to conventional myelography. Satisfactory images of nerve root sheaths in the lumbar region were provided almost equally by MR and conventional myelography. The images obtained by MR myelography were similar in quality to those obtained by conventional myelography. When combined with some other conventional MR imaging techniques, this diagnostic technique of imaging lumbar spinal diseases is further enhanced.
Larsson R, Oberg A, Larsson S-E. Changesof trapezius muscle blood flow and electromyographyin chronicneck pain due to trapezius myalgia.Pain 1999;79:45-50.
ABSTRACT: Chronic neck pain may increase the transmitter activity of neuropeptides in the upper cervical medulla causing impair-