Back Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AMES N. P ARKER , ...

Author: Health Publica Icon Health Publications

20 downloads 1405 Views 5MB Size Report

This content was uploaded by our users and we assume good faith they have the permission to share this book. If you own the copyright to this book and it is wrongfully on our website, we offer a simple DMCA procedure to remove your content from our site. Start by pressing the button below!
Report copyright / DMCA form

DOWNLOAD PDF

A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

ii

ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2003 by ICON Group International, Inc. Copyright 2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Back Pain: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83758-9 1. Back Pain-Popular works. I. Title.

iii

Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

iv

Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on back pain. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

v

About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

vi

About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

vii

Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON BACK PAIN ................................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Back Pain ...................................................................................... 9 E-Journals: PubMed Central ....................................................................................................... 64 The National Library of Medicine: PubMed ................................................................................ 66 CHAPTER 2. NUTRITION AND BACK PAIN .................................................................................... 103 Overview.................................................................................................................................... 103 Finding Nutrition Studies on Back Pain ................................................................................... 103 Federal Resources on Nutrition ................................................................................................. 107 Additional Web Resources ......................................................................................................... 107 CHAPTER 3. ALTERNATIVE MEDICINE AND BACK PAIN.............................................................. 109 Overview.................................................................................................................................... 109 The Combined Health Information Database............................................................................. 109 National Center for Complementary and Alternative Medicine................................................ 110 Additional Web Resources ......................................................................................................... 137 General References ..................................................................................................................... 143 CHAPTER 4. DISSERTATIONS ON BACK PAIN................................................................................ 145 Overview.................................................................................................................................... 145 Dissertations on Back Pain ........................................................................................................ 145 Keeping Current ........................................................................................................................ 150 CHAPTER 5. CLINICAL TRIALS AND BACK PAIN .......................................................................... 151 Overview.................................................................................................................................... 151 Recent Trials on Back Pain ........................................................................................................ 151 Keeping Current on Clinical Trials ........................................................................................... 159 CHAPTER 6. PATENTS ON BACK PAIN .......................................................................................... 161 Overview.................................................................................................................................... 161 Patents on Back Pain ................................................................................................................. 161 Patent Applications on Back Pain.............................................................................................. 195 Keeping Current ........................................................................................................................ 210 CHAPTER 7. BOOKS ON BACK PAIN .............................................................................................. 211 Overview.................................................................................................................................... 211 Book Summaries: Federal Agencies............................................................................................ 211 Book Summaries: Online Booksellers......................................................................................... 212 The National Library of Medicine Book Index ........................................................................... 218 Chapters on Back Pain ............................................................................................................... 219 Directories.................................................................................................................................. 222 CHAPTER 8. MULTIMEDIA ON BACK PAIN ................................................................................... 225 Overview.................................................................................................................................... 225 Video Recordings ....................................................................................................................... 225 Bibliography: Multimedia on Back Pain .................................................................................... 226 CHAPTER 9. PERIODICALS AND NEWS ON BACK PAIN ................................................................ 229 Overview.................................................................................................................................... 229 News Services and Press Releases.............................................................................................. 229 Newsletter Articles .................................................................................................................... 233 Academic Periodicals covering Back Pain.................................................................................. 235 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 239 Overview.................................................................................................................................... 239 NIH Guidelines.......................................................................................................................... 239 NIH Databases........................................................................................................................... 241

viii Contents

Other Commercial Databases..................................................................................................... 243 APPENDIX B. PATIENT RESOURCES ............................................................................................... 245 Overview.................................................................................................................................... 245 Patient Guideline Sources.......................................................................................................... 245 Associations and Back Pain ....................................................................................................... 258 Finding Associations.................................................................................................................. 259 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 261 Overview.................................................................................................................................... 261 Preparation................................................................................................................................. 261 Finding a Local Medical Library................................................................................................ 261 Medical Libraries in the U.S. and Canada ................................................................................. 261 ONLINE GLOSSARIES................................................................................................................ 267 Online Dictionary Directories ................................................................................................... 269 BACK PAIN DICTIONARY ........................................................................................................ 271 INDEX .............................................................................................................................................. 335

1

FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with back pain is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about back pain, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to back pain, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on back pain. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to back pain, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on back pain. The Editors

1

From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

3

CHAPTER 1. STUDIES ON BACK PAIN Overview In this chapter, we will show you how to locate peer-reviewed references and studies on back pain.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and back pain, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “back pain” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Physical Examination of the Patient with Low Back Pain Source: Hospital Medicine. p. 37; May 1996. Summary: This journal article describes low back pain in the following areas: musculoskeletal pain, referred pain, managing acute pain, and managing chronic pain. The author states that referred pain, occurring only in 1 percent to 2 percent of the cases, requires intensive medical evaluation due to its unrelenting nature and serious etiology. However, most acute low back pain, found in 90 percent of the cases, resolves itself spontaneously within 3 months and can be managed with conservative measures. Physical examination procedures for low back pain are illustrated and include observation and inspection, palpation, and diagnostic maneuvers.

4

Back Pain

•

Neuroimaging in Low Back Pain Source: American Family Physician. 65(11): 2299-2306. June 1, 2002. Summary: This journal article for family physicians outlines imaging techniques used to diagnose low back pain. Patients commonly present to family physicians with low back pain. Because the majority of patients fully or partially recover within six weeks, imaging studies are not recommended in the first month of low back pain. Exceptions include patients with suspected cauda equina syndrome, infection, tumor, fracture or progressive neurologic deficit. Patients who do not improve within one month should obtain magnetic resonance imaging if a herniated disc is suspected. Computed tomographic scanning is useful in demonstrating osseous structures and their relations to the neural canal, and for assessment of fractures. Bone scans can be used to determine the extent of metastic disease through the skeletal system. All imaging results should be correlated with the patient's signs and symptoms because of the high rate of positive imaging findings in asymptomatic persons. 7 figures, 1 table, and 28 references. (AA).

•

Clinical Assessment of Back Pain in Children Source: Journal of Musculoskeletal Medicine. 15(4):31-37; April 1998. Summary: This journal article for health professionals, the third in a special series of articles on the diagnosis and management of back pain, focuses on the clinical assessment of back pain in children. It reviews current prevalence data on back pain, identifies the major causes of back pain in children, and presents each step of the clinical assessment. When a child presents with back pain, a comprehensive clinical assessment is essential. Initial onset and duration of symptoms, history of trauma or infection, pain location, and frequency and intensities of discomfort are major diagnostic clues. Head, neck, extremities, and the spine, are examined. Changes in neurologic function and general health are noted. No further work-up is necessary if the mechanism is known, symptoms are localized, and pain is of short duration. Persistent pain or evidence of systemic involvement requires further evaluation. Roentgenography is the best initial imaging study. A bone scan or magnetic resonance imaging (MRI) may be helpful under certain circumstances. Referral is appropriate if x-ray studies are normal but pain persists; if there is roentgenographic evidence of an abnormality; or if expensive studies, such as MRI and computed tomography, are being considered. 6 references, 6 figures, and 1 table. (AA-M).

•

Taking the Mystery Out of Back Pain Source: American Family Physician. 53(2):683-684. February 1, 1996. Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. E-mail: [email protected]. Website: www.aafp.org. Summary: This journal article for individuals with back pain uses a question-andanswer format to provide an overview of back pain. Questions deal with the causes of acute back pain, the ineffectiveness of X-rays in diagnosing the cause of back pain, drugs that will relieve back pain, and other approaches to easing back pain. In addition, a list of suggestions for minimizing back pain is presented.

•

Fighting Back Pain: A Step-by-step Approach That Works Source: Hippocrates. 10(8): 46-47. September 1996.

Studies

5

Summary: This journal article for physicians treating patients with back pain provides answers to some of the most common questions concerning diagnosis and treatment. It reveals that most diagnostic tests are generally useless for back pain. Treatment options include the application of ice and taking aspirin or Ibuprofen with the inclusion of moderate exercise. A physician should be consulted for persistent pain. Diagnostic tests should be reserved for confirming serious suspicions, not used merely to define a problem, since back pain will nearly always resolve on its own. Rapid loss of weight or fever accompanying the back pain should be investigated for infection or presence of a tumor. Long lasting or frequently reoccurring back pain could reveal emotional turmoil because stress triggers muscle tension that in turn can exacerbate pain. Patients need to be coached into recognizing stressful situations, and they need to be reassured that returning to normal activities will not harm them. Controlling back pain may require a program of exercises to increase flexibility, endurance, and strength. •

Easing Low Back Pain Source: Postgraduate Medicine. 100(6):192; December 1996. Summary: This journal article for the general public offers suggestions for easing low back pain. Symptoms that require medical attention are identified. Steps that individuals can take to treat low back pain include stopping the activity that is causing the pain and lying down as soon as possible, holding ice on the sore area for 20 to 30 minutes, taking an analgesic or nonsteroidal anti-inflammatory drug, applying heat, resuming normal activities as soon as possible, getting some moderate exercise, losing extra weight, and sleeping in the lateral position. 2 illustrations.

•

Massage Therapy for Low Back Pain: A Systematic Review Source: Journal of Pain and Symptom Management. 17(1): 65-69. January 1999. Summary: This journal article presents a systematic review of the literature on massage therapy for low back pain (LBP). The purpose was to examine the evidence for or against the efficacy of massage therapy for this indication. Only four randomized clinical trials were found in which massage was tested as a monotherapy for LBP. According to the author, all four trials had major methodological flaws. One of the studies suggests that massage is superior to no treatment. Two studies report that it is equally effective as spinal manipulation and transcutaneous electrical stimulation. One study suggests that massage is less effective than spinal manipulation. The author concludes that massage therapy may have some potential as a treatment for LBP, but too few trials of massage therapy exist for a reliable evaluation of its efficacy. The article has 1 table and 26 references. (AA-M).

•

Low Back Pain: Exercises To Prevent Recurrence Source: Consultant. 42(3): 357-358,361. March 2002. Summary: This journal article provides health professionals with information on a long term exercise program that they can prescribe for their patients who experience recurrent low back pain. Recurrences of such pain are common, so a long term exercise program that includes stretching, strengthening, and cardiovascular activities can minimize the frequency and pain of recurrences. Increasing flexibility plays an important role in recovery from low back pain and in prevention of future incidents. Exercises that stretch the muscles of the lower extremities and the hip are especially important. Exercises to strength the trunk, abdomen, and lower extremities also play an important role in both recuperation from and prevention of lower back injuries. Most

6

Back Pain

exercises that build endurance and strength are based on either concentric contractions or eccentric contractions. Strengthening exercises need to incorporate multifidi, paravertebral, and abdominal muscles. If a patient with low back pain could participate in only one type of exercise, cardiovascular exercise would be the best choice. More muscles are used in cardiovascular activities than in any other type of exercise. In addition, 30 minutes of aerobic activity three to four times a week increases endorphin levels and improves blood flow and cardiopulmonary status. This, in turn, leads to an increased sense of well being, pain reduction, and improved ability of the muscles to relax. Walking is an excellent aerobic exercise for patients with low back pain, but many other exercises are also appropriate, including jogging on a treadmill, swimming, and biking. 5 figures and 6 references. (AA-M). •

Rational Approach to Low Back Pain, A Source: Patient Care. 34(6): 23-24,27-30,40,42-44,47-48. March 30, 2000. Summary: This journal article provides primary care physicians with information on the diagnosis, treatment, and psychosocial aspects of low back pain (LBP). The diagnosis first involves ascertaining whether the patient's condition falls in the category of common LBP or is due to a more serious problem. Common LBP usually consists of a combination of strain and sprain of the muscles, joints, and related structures. Serious conditions that may cause LBP include herniated nucleus pulposus, spinal stenosis, fracture, malignancies, infections, and various systemic diseases. The Agency for Health Care Policy and Research guidelines for acute low back problems are the standard of care for both the diagnosis and treatment of back pain of less than 3 months' duration. The guidelines include warning signs for serious causes of LBP. The article provides guidelines on ruling out and diagnosing serious causes of LBP, and referring a patient to a surgeon for evaluation. In addition, the article presents the information physicians need to give patients following the diagnostic process and describes modalities for treating LBP. Conservative therapy for common LBP includes nonsteroidal antiinflammatory drugs, heat, and ice. Ever increasing physical activity should be undertaken after the first day or two. The article concludes with a discussion of the psychosocial aspects of LBP, focusing on the identification and treatment of psychosocial issues. 4 figures, 2 tables, and 2 references.

•

15-Minute Visit: Low Back Pain Source: Patient Care. 35(9): 16,19. May 15, 2001. Summary: This journal article uses a case report to provide health professionals with information on an approach to treating patients with low back pain. This approach involves taking a medical history, conducting a physical examination, and obtaining imaging studies. The patient should be advised to use nonsteroidal antiinflammatory drugs, avoid more than 1 to 2 days of bed rest, refrain from exercising, and return to accustomed activities as soon as possible. Some patients may benefit from spinal manipulation, massage, or acupuncture. Weight loss and exercises to strengthen muscles in the back and legs may prevent or ameliorate recurrences. The article also asks readers questions that present different patient situations.

•

Primary Care Approach to Low Back Pain: The Good, the Bad, and the Ugly Source: Physician Assistant. 24(11): 31-42. November 2000. Summary: This journal article, part of the 'Physician Assistant' recertification series, provides health professionals with information on the differential diagnosis, risk factors,

Studies

7

evaluation, and management of low back pain in adults. Acute low back pain is among the most common complaints presented to primary care practitioners; however, the etiologic pathology is often elusive. Etiologies of low back pain range from muscle strain to metastatic cancer. Clinically, low back pain can be divided into mechanical and nonmechanical pain. Mechanical low back pain is aggravated by activity and relieved by rest, whereas nonmechanical back pain is constant and persistent. The differential diagnosis of low back pain is extensive, and, although the vast majority of back pain is benign, primary care clinicians should not treat all back pain in the same way. The serious pathology in the differential diagnosis, if missed, can cause permanent neurologic deficit or death. Clinicians should triage for neurologic compromise, especially progression deficit, and the red flags that suggest serious pathology. Once these have been ruled out, initial treatment can be prescribed with relative confidence. Nonsteroidal antiinflammatory drugs are the first line of medical treatment for simple backache. There is no general consensus on the use of muscle relaxants for treating simple backache. Physical therapy is an important treatment option. During the acute phase, chiropractic manipulation can accelerate pain relief and return some patients to normal activity levels. Surgery may be required for more serious causes of backache such as ruptured disks, spinal stenosis, and cauda equina syndrome. For the majority of patients presenting with low back pain, pain is a symptom, not a disease, and the primary goal is to reduce pain and restore function. A continuing medical education test follows the article. 6 figures, 5 tables, and 17 references. (AA-M). •

Taking the Mystery Out of Low Back Pain Source: Journal of Musculoskeletal Medicine. 17(8): 450-452,461-462, 464-466. August 2000. Summary: This journal article, the first article in a special series of articles on the evaluation and management of back pain, provides health professionals with information on a strategy for categorizing commonly seen low back problems. Low back pain (LBP) is a significant public health problem that frequently restricts patient activity and boosts health care costs. LBP is also a vexing clinical problem. Although it is usually associated with specific work and social factors, in most cases the precise cause of pain cannot be determined. As a result, approaches to diagnosis and treatment are often ill defined and inconsistent. A clear strategy for diagnosis of commonly seen LBP problems can lead to more effective initial treatment and referrals. This strategy places LBP problems in one of four general diagnostic categories: disk herniations, spinal canal stenosis, diskogenic LBP, or severe nonmechanical LBP. Disk herniations are protrusions or extrusions of nuclear material beyond the normal posterior margins of the vertebral bodies. Spinal canal stenosis is a narrowing of the neural canal within the lumbar spine. Diskogenic LBP occurs when a disk degenerates. Severe and nonmechanical LBP involves pain that is of much greater proportion than that commonly seen with degenerative disk disease and often has infection. The article makes specific diagnostic, initial treatment, and referral recommendations for each category. 3 figures, 2 tables, and 11 references. (AA-M).

•

Chronic Low Back Pain: New Perspectives and Treatment Guidelines for Primary Care: Part 1 Source: Managed Care Interface. 11(2): 72-77,78. 1998. Summary: This journal article, the first of two parts, provides health professionals with an overview of chronic low back pain. Low back pain is a major factor in work-related disability and has important socioeconomic repercussions. Although little evidence

8

Back Pain

exists regarding the best treatment for chronic low back pain, it is possible to set treatment goals. The article discusses the epidemiology of low back pain and presents various methods of classification. This is followed by guidelines for diagnosing low back pain from the patient's medical history, physical examination, and diagnostic testing. The article then presents the goals of low back pain management. Primary care providers should focus on managing pain, improving activity and functional level, and fostering a greater understanding of the condition. The article also describes nonpharmacologic methods of treating low back pain, including physical activity and exercise, patient education, acupuncture, massage therapy, psychological interventions, and surgery. 1 figure, 3 tables, and 35 references. (AA-M). •

How To Manage Low Back Pain: Physical Therapy or Physical Training? Source: Journal of Musculoskeletal Medicine. 18(4): 182-184,187-189. April 2001. Summary: This journal article, the fourth in a special series on evaluation and management of back pain, provides health professionals with an overview of low back pain (LBP) and examines the debate over the effectiveness of physical therapy and physical training in managing it. The causes of LBP often cannot be specifically determined, so current treatment guidelines recommend taking minimal action. In many cases, clinicians suggest simple measures that patients can implement on their own. Which therapeutic approach to take is the subject of debate. One method, physical therapy, includes passive measures and active exercises for controlling pain. Physical training incorporates more specific, self-directed exercises geared to restoring fitness and preventing future symptoms. The lack of a clear distinction between approaches and the lack of well defined goals may lead to ill advised hybrid treatment. Proponents of both treatment methods should recognize the importance of patient response. People who suffer from back pain may benefit from a combination of passive and active modes of treatment. 1 table and 18 references. (AA-M).

•

Chronic Low Back Pain: New Perspectives and Treatment Guidelines for Primary Care: Part II Source: Managed Care Interface. 11(3): 71-75. 1998. Summary: This journal article, the second of two parts, provides health professionals with treatment guidelines for chronic low back pain. Low back pain is a major factor in work-related disability and has important socioeconomic repercussions. Although little evidence exists regarding the best treatment for chronic low back pain, it is possible to set treatment goals. These goals are: achieving rapid pain control, restoring function quickly, and minimizing adverse drug reactions. The goals can be met through nonpharmacologic and pharmacologic measures. The article discusses the efficacy and side effects of various pharmacologic interventions for managing low back pain; these are acetaminophen, aspirin and nonsteroidal anti-inflammatory drugs, tramadol, opioid analgesics, muscle relaxants, tricyclic antidepressants, anticonvulsants, and corticosteroid injections. Guidelines are offered for selecting drug therapy in the elderly, in people who have upper gastrointestinal disease or cardiovascular disease, and in people who are taking other medications. Indications for referral to another health care provider are also discussed. 1 figure, 1 table, and 18 references. (AA-M).

•

Low Back Pain During Pregnancy: Helping Patients Take Control Source: Journal of Musculoskeletal Medicine. 17(4): 223-226,229-232. April 2000.

Studies

9

Summary: This journal article, the third in a special series on orthopedic and musculoskeletal problems in women, introduces health professionals to a system of physical therapy assessment and treatment of low back pain (LBP) during pregnancy. This approach allows the patient to self manage LBP up to and after delivery. Theories about the causes of LBP during pregnancy focus on hormonal changes, vascular changes, and anatomic and biomechanical alterations caused by the enlarging fetus or the loosening of ligaments that occurs pursuant to hormonal changes. LBP that occurs during pregnancy is not always temporary and can recur; therefore, effective treatment is not palliative but requires close cooperation between the patient and her health care providers. Back pain can be mechanical or nonmechanical. Mechanical pain occurs in a pattern, becoming better or worse with certain positions, movements, and activities. Patient management begins with a history, physical examination, and specific mechanical testing procedures. Issues that need to be considered when obtaining a patient history include determining how and when the symptoms began, where the symptoms occurred at onset, where current symptoms are located, whether the symptoms are constant or intermittent, and how daily activities affect symptoms. The physical examination involves determining lumbar position through visual inspection and manual palpation; observing how well the lumbar spine moves into flexion, extension, and lateral flexion; determining which positions or movements intensify or alleviate symptoms; and conducting a neurologic screening and other standard physical examination procedures. The results of these assessments form the basis for an exercise and activity modification program that the patient can practice at home or work. Most pregnant women with LBP find that extension activities, such as walking or bending backward, provide more relief than flexion based maneuvers. 4 figures, 1 table, and 24 references. (AA-M).

Federally Funded Research on Back Pain The U.S. Government supports a variety of research studies relating to back pain. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to back pain. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore back pain. The following is typical of the type of information found when searching the CRISP database for back pain: •

Project Title: 3-D DYNAMIC MOTION SEGMENT BEHAVIOR Principal Investigator & Institution: Krag, Martin H.; Orthopedics and Rehabilitation; University of Vermont & St Agric College 340 Waterman Building Burlington, Vt 05405

2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

10

Back Pain

Timing: Fiscal Year 2001; Project Start 22-SEP-2000; Project End 31-AUG-2005 Summary: (adapted from Investigator's abstract) Mechanical dysfunction of the low back is widely considered to be an important component of the large problem of idiopathic low back pain (LBP) and to involve abnormalities of vertebral motion (motion segment kinematics) and vertebral muscle use and/or morphology. Much has been learned concerning the end-points of the range of spinal motion but there is still limited understanding and treatment of these kinematic and muscle abnormalities. Recent investigations of these topics by the applicants and others have shown that: (1) the details of the motion between pairs of vertebrae are very finely controlled and repeatable in normal subjects (2) the expected linkage between abnormal motion and abnormal local muscle activity appears to be present, and (3) localized muscle morphometric changes occur in a number of cases of idiopathic LBP. Building on these studies, the proposed work has as its specific aims: 1) for each of the lumbar motion segments, to measure kinematic, EMG, and muscle size parameters during various range of motion and lifting tasks in normal subjects and in idiopathic LBP subjects that are considered likely to have abnormalities detectable by these measurements; 2) to test for correlation of these measurements with those of clinically available parameters; and 3) to test whether subjects can voluntarily alter their motion segment kinematic or EMG behaviors during task performance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: A PILOT TRIAL OF IV PAMIDRONATE FOR LOW BACK PAIN Principal Investigator & Institution: Pappagallo, Marco; Beth Israel Medical Ctr (New York) 1St Ave at 16Th St New York, Ny 10003 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-JUL-2006 Summary: (provided by the applicant): We have been motivated to propose an openlabel, dose-escalation, clinical pilot trial of Pamidronate infusions for the relief of chronic low-back pain by: (1) human studies that have demonstrated the analgesic effect of Pamidronate for cancer and non-cancer bone pain; (2) animal studies that have demonstrated the analgesic effect of this drug for pain unrelated to bone pathology; and (3) the impressive relief of non-malignant, chronic low-back pain among our patients treated with Pamidronate. Chronic low-back pain affects large segments of populations throughout the world, and is responsible for large costs in the form of suffering, lost workdays, and medical treatment. While Pamidronate infusions relieve bone pain related to Metastatic cancer, Paget's Disease, Ankylosing Spondylitis, and inflammatory bone and articular conditions, there have been no clinical trials of Pamidronate for chronic, mechanical low-back pain. The study participants will be 40 patients who have not had back surgery, and who have chronic, mechanical low-back pain associated with disc degeneration. Consistent with the success we have observed in patients with and without Osteoporosis, study participants will include individuals with and without Osteoporosis. They will be equally divided among five treatment groups (N=8 per group), who will receive between one and five 90 mg. Pamidronate infusions, respectively. There will be a one-month interval between infusions, and a 24-week follow-up period after the last infusion. Nightly, participants will electronically complete the Brief Pain Inventory (BPI). In addition, the research coordinator will administer the BPI, weekly, via telephone. The primary objective of the pilot is to determine the optimal dose of Pamidronate for a Phase III trial by comparing the different doses with respect to their tolerability and safety profiles, including their effect on bone remodeling. Very little is known about the effects of Pamidronate in individuals with normal bone turnover. Secondary aims include the determination of the duration

Studies

11

of follow-up for the Phase 111 trial, and the assessment of the relationships of (1) pain intensity changes to baseline bone scan results, (2) changes in performance on the Simmonds Physical Performance Battery for Patients with Low-Back Pain, to the number of Pamidronate infusions and to changes in pain intensity scores, and (3) patient satisfaction to treatment regimens. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ACADEMIC CAREER DEVELOPMET AWARD IN CAM Principal Investigator & Institution: Gay, Ralph E.; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2006 Summary: The purpose of this Academic Career Development Award is to enable the candidate, Ralph Edward Gay, MD, DC, an Instructor in Physical Medicine and Rehabilitation, to pursue formal, supervised training and skill development in clinical research, curriculum development, teaching and leadership. These skills are necessary for the candidate to become an effective teacher, researcher and leader with special expertise in the treatment of musculoskeletal disorders with complementary and alternative medicine (CAM) treatments. The candidate has a unique background as both a chiropractor and a board certified physiatrist , which enhances his ability to pursue these career goals. His Academic Career Plan will be implemented with guidance and counsel from a structured, three-member mentoring committee composed of accomplished academic researchers and educators. The Academic Career Award will provide 5 years of supervised training experience with the following specific aims: 1) Completion of the Mayo K30 NIH- supported Clinical Research Training Program leading to a Masters of Biomedical Science in Clinical Research, 2) Application of learned research competencies to complete a feasibility study of Flexion- Distraction manipulation treatment of low back pain, 3) Acquisition of grant writing and submission of grant applications for future studies in manual medicine, 4) Acquisition of teaching and curriculum development skills, 5) Development of two graduate level courses in CAM available at no cost to the approximately 4000 students, trainees, practitioners, physicians and researchers of the Mayo Clinic system, 6) Development of leadership competencies to aid in the achievement of short and long-term professional goals, including academic advancement, networking, and the formation of a Mayo CAM research. This Academic Career Award will provide Dr. Gray with the opportunities and resources necessary to achieve his goal of becoming a respected and recognized expert in CAM treatment of musculoskeletal disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: ANGER, SYMPTOM SPECIFIC REACTIVITY AND CHRONIC PAIN Principal Investigator & Institution: Burns, John; Psychology; Finch Univ of Hlth Sci/Chicago Med Sch North Chicago, Il 60064 Timing: Fiscal Year 2001; Project Start 01-SEP-1998; Project End 30-JUN-2003 Summary: Anger and anger management style (the tendency to suppress or express anger) are important emotional factors which contribute to the aggravation of chronic pain. Few mechanisms, however, have be examined which explain how anger variables affect chronic pain. A "symptom-specificity model" is advanced in which chronic low back pain (CLBP) patients can be distinguished from patients with chronic nonback pain and from normals on the basis of anger-induced tension in the musculature at the site of pain (lower paraspinals). The investigator proposes that exaggerated lower

12

Back Pain

paraspinal (LP) reactivity during anger constitutes a physiological mechanism by which anger and anger management style affect CLBP. Three aims will be pursued. First, it will be determined whether anger provocation has unique effects on LP reactivity among CLBP patients. Study 1 will examine whether CLBP patients show: greater overall LP reactivity than nonback pain patients and normals; greater LP reactivity during angerinduction versus anxiety-induction; trapezius, bicep and cardiovascular reactivity equivalent to the other groups. Second, it will be determined whether anger expression or suppression have effects on LP reactivity. Study 2 will examine whether self-reported anger management style predicts the degree to which anger is expressed during provocation, which in turn predicts LP reactivity, but not trapezius nor bicep reactivity, only among CLBP patients. Third, it will be determined whether anger arousal can influence variables reflecting CLBP aggravation via LP reactivity. Study 3 will test whether anger-induced LP reactivity, but not trapezius nor bicep reactivity, is related to pain report and pain behavior among CLBP patients during a subsequent paininduction task. Findings will show whether LP reactivity constitutes a unique pathway by which anger, distinct from other emotions, exacerbates CLBP. Documenting a link between anger and LP reactivity will give empirical justification for targeting problematic anger among CLPB patients, and will provide principles on which to found new intervention strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: APPLICATION OF CONJOINT ANALYSIS TO PREFERENCES OF LOW * Principal Investigator & Institution: Meenan, Richard T.; Kaiser Foundation Research Institute 1800 Harrison St, 16Th Fl Oakland, Ca 94612 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-MAR-2003 Summary: The proposed study uses conjoint analysis (CA) to elicit preferences of a sample of HMO low back pain patients for chiropractic and primary care visits that vary by attributes of process and health outcomes. Study subjects identified through administrative data will receive a mail questionnaire, the core of which is a set of 10- 12 hypothetical choices between visits that vary by specified attributes of outcome and process, including cost. Responses will be analyzed using probit regression based on random utility theory. Reliable and generalizable economic evaluations of therapies in complementary and alternative medicine (CAM) such as chiropractic are needed to inform resource allocation decisions of health insurers and payers. Since most benefits from CAM are quality of life improvements rather than life extension, appropriate utility estimates will be crucial. We hypothesize that assessments of "process"? utility will be especially important in the CAM context, based on considerable research suggesting that therapeutic benefits from CAM (e.g., reassurance, information) beyond direct health outcomes. CA may be potentially quite valuable in economic evaluations of CAM because in theory it can produce both utility and willingness to pay (WTP) estimates that incorporate process as well as final outcome. The specific aims of this study are to (1) conduct a feasibility study of conjoint analysis as a method of eliciting preferences over chiropractic and conventional treatment of acute low back pain among a population of approximately 400 adult members of Kaiser Permanente Northwest diagnosed with acute low back pain, focusing on assessments of validity and reliability, including respondent burden and internal consistency; (2) produce preliminary utility estimates that incorporate both process and outcome attributes, for eventual use in costutility analyses of low back pain treatment within the HMO context; and (3) produce preliminary WTP estimates for process attributes of low back pain treatment for

Studies

13

eventual use in cost-benefit analyses within the HMO context. This study will generate useful preliminary data that informs the future development of benefit assessment methods that are appropriate for economic evaluations of chiropractic and that are sensitive to both process and outcome. We expect that lessons from this study will readily generalize to future economic evaluations of other therapies in CAM as well as in conventional medicine, especially those delivered in the managed care context. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ASSESS & IMPROVE THE QUALITY OF CARE FOR LOW BACK PAIN Principal Investigator & Institution: Birkmeyer, Nancy J.; Community and Family Medicine; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, Nh 03755 Timing: Fiscal Year 2001; Project Start 15-SEP-2000; Project End 31-AUG-2005 Summary: As reflected in the-topic of this proposal, the applicant has two main career goals: (I) to evaluate the quality of surgical and non-surgical treatment for low back pain; and (2). to reduce variation in treatment practices and improve the outcomes of treatment for these conditions. This five-year project combines the use of outcomes research and continuous quality improvement techniques to close the gap between knowledge gained through outcomes research and clinical practices to improve outcomes for patients with low back pain. Despite its frequency and related costs, little is known about the quality of care for spinal disorders. The data and infrastructure provided by the recently initiated Spine Patient Outcomes Research Trials (SPORT) presents a unique opportunity to study, compare, and improve outcomes for patients undergoing treatment for three surgically treatable spine conditions: herniated disc, spinal stenosis, and degenerative spondylolisthesis. SPORT is a set of clinical trials to compare the effectiveness of surgical and non-surgical approaches to the treatment of these conditions that is being conducted at II U.S. medical centers and expects to enroll approximately 3000 patients. The overall goals of this proposal are to evaluate and improve the quality of care for low back pain through a comparative study of the structure, process, and outcomes of care at medical centers participating in SPORT. Specifically, this proposal has three research objectives: 1. To characterize clinical practices. We plan a detailed study of variability in structures and processes of care for patients with low back pain at the sites participating in SPORT. 2. To assess outcomes of care. After developing and validating methods for risk-adjustment, we will evaluate and compare quality of care for low back pain across the II sites participating in SPORT. Outcomes, to be assessed in both surgically and non-surgically treated patients, will include functional health status, clinical outcomes, patient satisfaction, and cost. 3. To link clinical practices and outcomes. Using statistical models to account for random variation in the setting of hierarchical data structures, we will examine associations between clinical structure, process, and outcomes to identify high-leverage areas for improvement. Improving clinical care can not occur in the vacuum of a research laboratory. At each step of this project, we will feedback data to clinicians at the participating medical centers and work with them to develop a focused quality improvement agenda that is designed to improve patient outcomes by reducing variability in clinical practices. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: AXONAL TRANSPORT AND PERIPHERAL NERVE FUNCTION Principal Investigator & Institution: Topp, Kimberly S.; Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122

14

Back Pain

Timing: Fiscal Year 2001; Project Start 01-FEB-1997; Project End 31-JAN-2003 Summary: (Adapted from the Applicant's Description): Over the course of a lifetime, a significant percentage of the population needs medical attention for some form of neuropathy, such as low back pain, diabetic neuropathy or carpal tunnel syndrome. Due to their prevalence and complexity of treatment, neuropathies have a major financial impact in health care. Compromise of axonal transport may contribute to the pathophysiology of several clinical neuropathies. The goal of the candidate's proposed research is to understand the role of axonal transport in peripheral nerve function. Axons are dependent on continuous replenishment of membrane proteins and on the feedback provided by materials taken up at nerve terminals. The length of the nerve dictates that bi-directional transport be tightly regulated. Interruption of axonal transport leads to Wallerian degeneration of axons distal to the site of impairment. Therefore, several neuropathies are thought to have impaired axonal transport. However, there have been few controlled investigations of the functional consequences of impaired axonal transport or of the aspects of transport that may contribute to peripheral neuropathy. The proposed specific aims address these two issues, and seek to identify physical interventions that may alter function in neuropathic nerves. The first aim is to determine how the function of peripheral nerves is impaired by disruption of axonal transport. To accomplish this aim, peripher-al nerves in which axonal transport has been experimentally impaired will be tested for their ability to respond to sensory stimuli, using behavioral tests and electrophysiological techniques. The second aim is to determine what aspects of axonal transport are disrupted in peripheral neuropathies. To address this aim, peripheral poly- or mononeuropathy will be experimentally induced, and anterograde or retrograde axonal transport will be tested for impairment, using biochemical and morphological techniques. Additional observations will be made of the components required for axonal transport, specifically, energy stores, divalent cations and cytoskeletal structural framework. The third aim is to identify physical interventions that improve or impair axonal transport and nerve function in peripheral neuropathies. To accomplish this aim, neuropathic nerves with demonstrated alterations in axonal transport will be further exposed to nerve compression, extremity mobilization or immobilization. Nerve function will be assessed using behavioral tests and electrophysiological techniques. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BACK PAIN & WORK DISABILITY IN HEALTH CARE WORKERS Principal Investigator & Institution: Pompeii, Lisa A.; Community and Family Medicine; Duke University Durham, Nc 27706 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 29-SEP-2006 Summary: (provided by applicant): The purpose of the proposed study is to examine risk factors for occupational back pain (OBP), and to examine the impact of work disability on workers and their co-workers in a large population population (n = 12,500) of health care workers at Duke University Medical Center (DUMC). This study aims to examine organizational factors, such as downsizing efforts while considering other known and suspected risk factors of OBP, as possible predictors for back injury and disability in health care workers that have not been adequately addressed in prior studies. In addition, risk factors for back injury specific to nursing personnel whose jobs involve patient handling will be examined. Detailed analyses will be conducted to explore differences in back injuries that result in restricted and lost workdays across variable demographic, psychosocial, and occupational characteristics for the entire cohort of health care workers. Factors influencing the feasibility and effectiveness of

Studies

15

modified work assignments specific to nursing units will also be addressed. The number of lost and restricted workdays, physical impairment, psychosocial demands, and the injured worker's perception of workplace accommodations will be considered in determining the overall effectiveness of modified work assignments. The feasibility of modified work assignments in nursing units will be examined by considering feedback from nurse managers, nursing personnel, occupational physicians, occupational health nurses, and workers' compensation administrators and case-managers who are integrally involved with implementing these workplace strategies. Data previously collected at DUMC will be used, as well as additional prospective surveillance data, and focus group information. This mix of quantitative and qualitative techniques will be utilized to address the National Occupational Research Agenda's Priority Research Area of low back disorders, in addition to addressing issues related to special populations at risk, surveillance efforts, and occupational health services research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BIOELASTIC MATERIAL TO PREVENT POST-LAMINECTOMY ADHESION Principal Investigator & Institution: Xu, Jie; Bioelastics Research, Ltd. 2800 Milan Ct, Ste 386 Birmingham, Al 35211 Timing: Fiscal Year 2001; Project Start 01-MAR-1997; Project End 30-JUN-2003 Summary: Using two biocompatible elastic protein-based polymers (in viscolelastic gel and elastic sheet forms), the Phase I study demonstrated both materials to be highly effective in preventing adhesions to the spinal dura in the rabbit laminectomy model. The specific aims of Phase II are: 1) to identify the preferred membrane and/or gel configuration(s) of two biocompatible and resorbable polymer compositions for prevention of adhesions in a large animal laminectomy model, 2) to develop sensitive double radio-label standards for purification and a quality control protocol, 3) to utilize an adult sheep lumbar spine model with laminectomies performed at two noncontiguous levels (L3-L4 and L5-L6) allowing for a randomization of the polymer placement to surgical site, 4) to develop a mechanical test method for assessing the interface between the dura mater and the tested polymer and the epidural fibrotic tissue at the control site, and 5) to complete biocompatibility testing and prepare an IDE application for the preferred polymer(s) and state(s). The physical disability resulting from intervertebral disc herniation constitutes the third most common condition for worker disability in the U.S. An improved outcome of intervertebral disc laminectomy would improve the quality of life and restore function for many millions of disabled Americans. PROPOSED COMMERCIAL APPLICATION: Low back pain, for which intervertebral disc pathology is the major cause, is second only to the common cold for work absenteeism in the United States; it is reported to result in more productivity loss than any other medical condition and in an annual health care cost of $33 billion. Over four million cases of prolapsed intervertebral discs are reported annually in the U.S. Development of materials that would improve the outcome of intervertebral disc laminectomy would clearly be of commercial significance while impacting favorably on medical care costs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: CHRONIC LOW BACK PAIN AS A MODEL OF FIBROMYALGIA Principal Investigator & Institution: Clauw, Daniel J.; Associate Professor; Medicine; Georgetown University Washington, Dc 20057

16

Back Pain

Timing: Fiscal Year 2001; Project Start 15-JUN-1999; Project End 31-MAY-2003 Summary: Fibromyalgia (FM) is defined by a history of widespread pain, and the finding of tender points on examination. Arguably the two most discriminating features of FM are: 1) a generalized disturbance in pain perception, and 2) elevated levels of pronociceptive neuropeptides in the cerebrospinal fluid. The first feature, pain induced by a normally non-painful stimuli, is not surprising since this is a defining feature of FM. But it is not certain how tenderness relates to pain, since population based studies have demonstrated that not all persons who are tender have pain, and vice versa. And it has recently become clear that tender points are a poor measure of a person's inherent tenderness. The meaning of these elevated levels of CSF neuropeptides is likewise unclear. These findings may not be specific for FM, and may be the cause of pain and/or tenderness, or may be the result of pain, tenderness, or some other process. Chronic lower back pain (CLBP) is among the most common medical problems in industrial societies. Despite this, little is actually known about the precise cause for most cases of CLBP. Anatomic and psychosocial factors have been demonstrated to predict only a small portion of the variance in the degree of pain or disability in CLBP. In preliminary studies in CLBP, we have demonstrated that tenderness predicts a significant percentage of the variance in both functional status and pain, more than either the severity of path-anatomical abnormality (i.e., X-ray/MRI),or by psychosocial factors. In a small pilot study of a subset of these patients tenderness was correlated with CSF levels of pro-nociceptive neuropeptides. There are 3 specific aims in the proposed study: 1) To confirm in a cross-sectional study of 200 CLBP patients that pain sensitivity predicts more variance in clinical outcome (e.g. functional status, pain level, Roland index) than either anatomic or psychological factors. Furthermore, we will demonstrate that pain sensitivity is an independent trait, and not a surrogate for psychological factors such as depression, anxiety, or work-related stressors. 2) To demonstrate that an individual's global pain sensitivity is determined primarily by physiologic factors (e.g. neurotransmitters in cerebrospinal fluid) and modified by psychosocial factors (e.g. cognitive and behavior influences on pain perception). We will measure the CSF concentrations of pro-nociceptive peptides such as Substance P and Nerve Growth Factor, and hypothesize that the levels of these substances largely determine an individual's global pain sensitivity. This testing will be done in patients with CLBP and FM, as well as sedentary and non-healthcare-seeking controls. 3) To use alternative methods of pain assessment that are much less influenced by psychological factors (e.g., scaling methods, Multiple Random Staircase), using both pressure and thermal stimuli, to examine the true meaning of tender points, and the relationship between these results, and the results of the above noted physiologic and psychologic parameters in individuals with FM and CLBP. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHRONIC PAIN IN THE 65+: EVALUATING FUNCTIONAL IMPACTS Principal Investigator & Institution: Rudy, Thomas E.; Professor and Director; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001; Project Start 15-SEP-2001; Project End 31-AUG-2006 Summary: Chronic pain plagues approximately 50 percent of community dwelling older adults, and may cause significant disruption of physical, psychosocial, and cognitive function. Despite the prevalence of this potentially devastating problem, well-controlled studies of chronic pain in older adults that use a comprehensive multidimensional

Studies

17

model are lacking. Chronic low back pain (CLBP) is among the most common chronic pain conditions of older adults, affecting approximately 6 million individuals in the United States who are greater than or equal to age 65. CLBP offers a robust model with which to study the comprehensive functional effects of chronic pain in the older adult because of the reliable and valid measures of observed physical capacity, self-reported disability and pathology that have been developed specifically for patients with low back pain. The purpose of this investigation is to broaden our understanding of disability in the older adult with chronic pain. Specifically, we will explore (1) the magnitude of the effect of CLBP on physical, psychosocial, and cognitive functioning in 200 community dwelling older adults greater than or equal to age 65 as compared with 200 pain-free control subjects, (2) the impact of CLBP associated psychosocial and neuropsychological dysfunction on physical function, and (3) whether older adults with chronic pain can be classified using a multiaxial taxonomy that has been demonstrated in younger chronic pain patients. The laboratory-based physical capacities testing protocol is designed to assess body mechanics, endurance and coordination using ergonomically relevant tasks (e.g., lifting, reaching). Other comprehensive multidimensional assessment measures will include those that have particular relevance to older adults, such as pain intensity, clinical measures of physical performance, disability, sleep, mood, self- efficacy, detailed measures of neuropsychological function, and self perceptions of health and well-being. This study represents the first wellcontrolled, comprehensive examination of the effects of chronic pain on individuals who may be most threatened by the risk of functional decline, that is, community dwelling older adults. Once the effects of chronic pain have been comprehensively described, only then can effective treatment programs be developed to help ameliorate the suffering of these older Americans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHRONIC PAIN MANAGEMENT IN PRIMARY CARE Principal Investigator & Institution: Von Korff, Michael R.; Senior Investigator; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 01-JAN-1989; Project End 31-AUG-2004 Summary: This research seeks a more effective and cost-effective integration of medical care and self-care for chronic and recurrent pain in pr5imary care settings. Aim 1: Identify improved methods for analysis of automated health care and medicine use data for TMD pain, headache and back pain patients. Identify potentially modifiable determinants of long-term frequent use of health care and pain medications for these conditions. Study One: We will study determinants of health care and prescription medicine use for pain over a five-year time span. {{Methods for analysis of automated health care and medicine use data will be assessed to test more powerful and informative approaches. Using improved analytic methods,}} we will assess the ability of patient variables to predict and explain frequent use of health care, opioid medications and sedative- hypnotic medications for patients with TMD (n=391), back pain (n=833) and headache (n=869) over a five year time-span. Aim 2: Evaluate the effectiveness of Self-Care Group interventions guided by a stepped care model. Study Two: Data from two randomized controlled trials of Self- Care Groups (SCG) initiated in 1996-98) as part of the current Program Project will be used to identify factors influencing the long-term effectiveness of SCG (participation, baseline severity, self-care orientation, prognostic variables). Study Three: A new randomized controlled trial will evaluate Self-Care Groups fully integrated into primary care. This trial will evaluate the initial benefits and the long-term effectiveness of Self-Care Groups among actively

18

Back Pain

recruited back pain patients (n=250). The intervention will target patients with enduring activity limitations and higher use of health care for back pain {{Patients with continuing activity limitations will receive more intensive intervention according to a stepped care protocol.}} Patients will be followed-up 2, 6, 12 and {{24}} months after randomization. The primary outcome will be activity limitations (Roland Disability Score with added items concerning occupational role disability). Aim 3: Assess the impact of Self-Care Groups (SCG) on long-term health care and prescription medication use. Determine the effect of SCG on health care costs. Study Four: Using automated health care and medicine use data and improved analytic methods, we will investigate the long-term effects of SCG on: (1) use of health care; (2) use of prescription pain medications; and (3) health care costs for back pain (total n from three SCG trials=731). Since the SCG interventions have been shown to reduce worry, enhance confidence in self-care, and reduce activity limitations, this research will provide an experimental test of whether modifying these factors reduces subsequent use of health care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLINICAL DECISION MAKING IN LOW BACK PAIN Principal Investigator & Institution: Lurie, Jon D.; Medicine; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, Nh 03755 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): The applicant has the broad career goal of improving the diagnostic evaluation, treatment recommendations, and health outcomes for patients with low back pain. In this project he proposes to extend his prior training in outcomes research, technology assessment, medical decision-making, and biostatistics. These advanced quantitative skills will be used to identify optimal treatment strategies for subgroups of low back pain patients defined on the basis of clinical and radiologic features. Low back pain is one of the most prevalent and costly health problems in the industrial world. Back surgery is nearly always elective, yet the rates of spine surgery in the US have increased dramatically in the past 10 years and show marked geographic variation. Both the First and Second International Forums for Primary Care Research on Low Back Pain chose the identification of important clinical subgroups of low back pain patients based on characteristics, imaging studies and other factors as their number one research priority. The data and infrastructure provided by the recently initiated Spine Patient Outcomes Research Trial (SPORT) presents a unique opportunity to study the predictors of outcome for patients with herniated discs, spinal stenosis, and degenerative spondylolisthesis. SPORT is a set of clinical trials designed to compare the effectiveness of surgical and non-surgical approaches to the treatment of these conditions; it is being conducted at I I U.S. medical centers and expects to enroll approximately 3000 patients. Extensive clinical, functional status, quality of life, and imaging data will allow for an unprecedented ability to identify optimal treatment approaches for these patients. This five-year project combines the use of outcomes research and decision analytic techniques to better understand the predictors of outcome with surgery and non-surgical treatment. After a period of additional training in decision in mdeling and biostatistics, the applicant will work closely with the Principal Investigator and Co-Principal vestigators of SPORT to accomplish two specific research objectives: To identify patient subgroups, defined by clinical and radiographic features at baseline, that are predictive of good/bad outcome with surgical/nonsurgical treatment among patients with intervertebral disc herniation, spinal stenosis, or degenerative spondylolisthesis with associated stenosis. To develop decision analytic models for specific patient subgroups, which also accommodate individual patient

Studies

19

preference and quality of life data, for the purpose of identifying optimal treatment strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COHORT STUDY OF TREATMENT FOR DISCOGENIC BACK PAIN Principal Investigator & Institution: Deyo, Richard A.; Professor; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2002; Project Start 15-FEB-2002; Project End 31-DEC-2006 Summary: (provided by applicant): Discogenic pain is low back pain attributed to mechanical and chemical disruption of an intervertebral disc. When this diagnosis is made, it often leads to lumbar spine fusion, and this form of invasive treatment is rapidly increasing in the United States. However, the diagnosis itself remains controversial, as do diagnostic criteria. The efficacy of various treatment options has not been established in controlled trials. Our goal is to better define the outcomes of lumbar fusion for discogenic back pain and compare them to the outcomes of non-surgical care for patients with clinically similar disc degeneration. In addition, we seek to identify baseline characteristics that distinguish patients who choose surgery from those who do not; determine the frequency and consequences of common complications of spinal fusion; identify patient characteristics that may predict a good response to surgical therapy but not to others; and examine the characteristics and outcomes of patients who undergo repeat back surgery for this condition. This will be a prospective cohort study, because we do not believe a randomized trial for this condition is feasible at this time. Patients with chronic back pain, one- or two-level disc degeneration, and normal neurologic examination will be recruited at three Hospitals in the University of Washington system. Consenting eligible subjects will provide baseline measures of symptoms, physical function, psychological distress, and work status, Treatment decisions will not be dictated by the study, but will be those naturally occurring based on patient and physician preferences. The treatment selected, relevant treatment details, and complications will be recorded for all patients. Follow-up will be obtained at 6 months, one year and two years following initial enrollment, and we will repeat measures of symptoms, physical function, psychological distress, work status, and health care utilization. Accumulating data will be stored in a central database maintained by the core methodology team. The analysis will use appropriate univariate and multivariate techniques to address the study questions, and complication rates will be determined by a uniform prospective data collection process. This study will provide new data on the relative benefits and risks of fusion surgery and non-surgical care for discogenic pain, and help to identify patient characteristics for optimal selection of treatment modalities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: COLLAGENS OF CARTILAGE AND THE INTERVERTEBRAL DISC Principal Investigator & Institution: Eyre, David R.; Professor; Orthopaedics/Sports Medicine; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 01-JAN-1986; Project End 31-DEC-2003 Summary: This project is using advanced methods in protein chemistry to understand the polymeric architecture and interactions of the various molecular types of collagen that form the framework of cartilage and intervertebral disc tissue. The long-term objective is to define how the various kinds of collagenous protein are organized in the matrix, to what degree they are designed to self-assemble and interact with each other

20

Back Pain

and with other matrix macromolecules in order to form the heteropolymeric fibrillar network. The need for molecular differences in the matrix architecture of different forms of cartilage and between regions within a single tissue, including junction domains with adjacent non-cartilaginous tissues, and the role of different collagen chemistries and modifying molecules are of particular interest. Two tissues, articular cartilage and intervertebral disc, will be studied in greatest detail using bovine and human sources. A focal topic is the manner of covalent intermolecular cross-linking and the scope of heterotypic polymerization in and between the collagen sub-families of molecules. Specific aims include defining precisely the molecular sites and chemistry of covalent interaction between types IX and II collagens, studying the incidence of cross- linking between types I and II collagens, defining the cross-linking mechanisms among the chain isotypes of the collagen V/XI sub-family of gene products, understanding the action of stromelysin and other extracellular proteases in degrading the cartilage collagen network and discovering the mechanism of cross-linking in type X collagen. The latest techniques in protein chemistry will be the primary approach, including HPLC peptide separations, gas-phase automated amino acid sequencing, specialized methods to detect and quantify the unique collagen cross- linking amino acids, and use of specific antibodies. The clinical significance of this work is in providing a molecular basis for understanding the processes whereby articular cartilage is degraded in osteoarthritic joints (osteoarthritis) and intervertebral discs break down with increasing adult age and contribute to common spinal disorders (low back pain). In both tissues a failure of the collagen framework is a central irreversible feature of the cartilage tissue degeneration. There is reason to believe that there may be common mechanisms of tissue destruction in joint cartilages and discs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CORTICAL PATHOPHYSIOLOGY OF PAIN Principal Investigator & Institution: Apkarian, Apkar Vania.; Associate Professor; Physiology; Northwestern University Office of Sponsored Programs Chicago, Il 60611 Timing: Fiscal Year 2001; Project Start 01-MAY-1996; Project End 31-DEC-2002 Summary: (Adapted from the Investigator's Abstract) This proposal is in response to the BIOBEHAVIORAL PAIN RESEARCH RFA PA-99-021. It is a COMPETING CONTINUATION application for grant NS 35115 funded from 5-1-96 to 4-30-99. In the last funding period we developed a new functional brain imaging paradigm, using functional magnetic resonance imaging (fMRI), that enables us to parcel cortical activity associated with painful stimuli along a stimulus-suffering from chronic Reflex Sympathetic Dystrophy (RSD) pain show prefrontal hyperactivity. These abnormal activations are reversed to that seen in normal subjects after a sympathetic block. Given the new paradigm and our observations in chronic pain patients and normal volunteers we propose to extend the studies to extend the studies of the pathophysiology of chronic pain by testing specific hypotheses, designed to distinguish between two chronic pain states: Specific Aim 1 tests the hypothesis that chronic low back pain with radicular involvement can be differentiated from acute low back pain, and from normal subjects by functional brain imaging studies. These studies are designed to image brain activity directly related to the pain from which the patients suffer. The acute back pain patients are studied before and three months after spinal cord surgery. Specific Aim 2 tests the hypothesis that chronic RSD pain with allodynia is distinct from chronic RSD pain with only hyperalgesia, and that chronic RSD pain is distinguishable from chronic low back pain. The studies are done using fMRI and again are designed to directly study the pain from which the patients suffer. Specific Aim 3 tests the hypothesis that chronic pain

Studies

21

states are associated with brain biochemistry abnormalities, and that different chronic pains may be differentiated by brain biochemistry. Hydrogen-Magnetic Resonance Spectroscopy (MRS) will be used to examine different brain regions and chemicals in RSD and low back pain patients and compared to normal subjects. Specific Aim 4 tests the hypothesis that chronic pain is correlated with cognitive abnormalities. RSD and back pain patients will be tested on a battery of cognitive tests: Stroop, WCST, and Bechara's Gambling test. The chosen tests examine different frontal abilities and may differentiate between types of chronic pain. Overall the studies are designed to examine chronic pain by functional imaging, brain biochemistry, and cognitive abilities. The results, if successful, have the potential of being used in the clinic as diagnostic or prognostic tools. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROSTHESIS

DEVELOPMENT

OF

A

SPINAL

INTERVERTEBRAL

DISC

Principal Investigator & Institution: Buttermann, Glenn R.; Dynamic Spine, Llc 1725 Park Ave Mahtomedi, Mn 55115 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 31-DEC-2003 Summary: (provided by applicant): Chronic back pain is a common disability in which spinal fusion surgery is sometimes beneficial. Far more functional outcomes would be obtained with a successful intervertebral disc prosthesis If commercialized world-wide, it has been estimated that disc prostheses would be implanted at a rate of one million per year, after five years of marketing with potential sales of two billion dollars. This SBIR Phase I project will perform research to develop a spinal device that will restore function of the spine and relieve back pain for patients with intervertebral disc degeneration. Dynamic Spine is pursuing the development of an intervertebral disc replacement. Historically, severe knee and hip degeneration were treated with fusion of the joint which decreased pain but eliminated motion. Currently, hip and knee fusion have almost been entirely eliminated due to the enormous success of prosthetic hip and knee replacements. For back pain due to disc degeneration that has not responded to nonoperative treatment, spinal fusion is recommended. Spinal fusion improves pain but limits motion and hence function, and also increases stress on neighboring discs which over time predisposes to additional disc degeneration. A successful disc replacement is not yet available. Dynamic Spine is developing a prototype disc replacement which is unique from others currently in development and has characteristics which should overcome deficiencies of other disc prototypes. A US patent has been obtained and international patents are pending. The objective of Phase I is to demonstrate that the device restores normal spine biomechanics (range of motion and stiffness) and is durable in fatigue testing. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECTS OF BINAURAL BEATS ON PAIN, MOOD AND EEG IN LOW BACK PAIN PATIENTS Principal Investigator & Institution: Taylor, Ann G.; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2001 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

22

Back Pain

•

Project Title: EFFICACY OF ACUPUNCTURE FOR CHRONIC LOW BACK PAIN Principal Investigator & Institution: Cherkin, Daniel C.; Center for Health Studies Seattle, Wa 98101 Timing: Fiscal Year 2003; Project Start 15-MAY-2003; Project End 31-JAN-2008 Summary: (provided by applicant): A 5-arm multi-site randomized controlled trial is proposed to clarify the extent to which acupuncture needling can diminish the effect of chronic low back pain on patient functioning and symptoms. Reviews have noted the poor quality of research in this area and urged that scientifically rigorous studies be conducted. Recent higher quality trials suggest acupuncture is a promising treatment for back pain. This study directly addresses methodological shortcomings that have plagued previous studies. Specific aims are to determine, for chronic low back pain, if: 1) acupuncture is more effective than placebo acupuncture, 2) individualized acupuncture is more effective than standardized acupuncture, 3) acupuncture is more effective when needles are inserted in acupuncture points believed effective for chronic low back pain than when needles are inserted in points considered ineffective for chronic low back pain, 4) acupuncture is more effective than usual medical care alone. A total of 1100 subjects (220 per arm) with low back pain lasting at least 3 months will be recruited from group model HMOs in Seattle, Oakland, and Honolulu. They will be randomized to one of two forms of Traditional Chinese Medical acupuncture needling (individualized or standardized), one of two "control" groups (simulated acupuncture or needling of ineffective points), or to continued usual medical care. Ten treatments will be provided over 7 weeks. The primary outcomes, dysfunction and bothersomeness of low back pain, will be measured at baseline, and after 3, 8, 26 and 52 weeks by telephone interviewers masked to treatment. Analysis of covariance within an intentionto-treat context will be used to analyze the data. Because chronic back pain is a major public health problem and the top reason patients seek acupuncture treatment, a clear, unambiguous assessment is critical for making informed decisions about whether acupuncture should be included as part of conventional care for back pain or covered by insurance. Results of this study will provide the clearest evidence to date about the value of acupuncture needling as a treatment for chronic low back pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: EFFICACY OF ANTIDEPRESSANTS IN CHRONIC BACK PAIN Principal Investigator & Institution: Atkinson, J Hampton.; University of California San Diego 9500 Gilman Dr, Dept. 0934 La Jolla, Ca 92093 Timing: Fiscal Year 2001 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: ELECTROMECHANICAL PROPERTIES OF INTERVERTEBRAL DISC Principal Investigator & Institution: Gu, Weiyong; Biomedical Engineering; University of Miami Coral Gables University Sta Coral Gables, Fl 33124 Timing: Fiscal Year 2001; Project Start 01-JUN-2000; Project End 31-MAY-2003 Summary: Low-back pain is a major socio-economic concern in this country. Although the exact cause for low back pain is unclear, the degenerative changes of the intervertebral disc (IVD), a crucial component of the human spine, have been implicated as a possible primary etiologic factor. The long-term objectives of this project are: (1) to better understand the biomechanics of the IVD, (2) to delineate the biomechanical

Studies

23

etiology of disc failure, (3) to elucidate the pathophysiology of low-back pain, and (4) to develop new, minimally invasive diagnostic tools for disc degeneration. The purpose of this pilot research is to develop new techniques and experimental protocols for the investigation of relations of material properties to tissue composition and structure. The specific aims are to (1) investigate effects of proteoglycan (PG) content and collagen matrix density on tissue hydration, (2) investigate electrical properties of normal and PG-extracted IVD tissues, and (3) investigate dynamic compressive behavior of normal and PG-extracted IVD tissues. Three experimental studies will be developed and performed in this project. They are: (1) measurements of water content and true density of solid matrix, (2) measurement of electrical conductivity, and (3) dynamic compression testing of normal and PG-extracted animal IVD tissues. The experimental data will also be analyzed using a mechano-electrochemical theory to elucidate the relations of material properties to tissue composition and structure. These studies will help to understand the mechanism for regulating tissue hydration, the effect of disc degeneration on material properties and biomechanical behavior, and the biomechanical etiology of disc failure in human IVDs. The results will be useful for the future development of theoretical modeling as well as minimally invasive diagnostic tools for disc degeneration. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EVALUATING YOGA FOR CHRONIC LOW BACK PAIN Principal Investigator & Institution: Sherman, Karen J.; Scientific Investigotor; Center for Health Studies Seattle, Wa 98101 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-APR-2004 Summary: Back problems are among the moist prevalent conditions afflicting adults and are a leading reason for using complementary or alternative medical (CAM therapies). Despite the common use of CAM therapies for back pain, little is known about how they compare with conventional treatments. Although there have been numerous randomized trials evaluating the effectiveness of spinal manipulation and acupuncture for back pain, no trials could be identified that evaluated yoga. This study will lay the groundwork for a full-scale trial that compares yoga with conventional exercise and usual care for chronic low back pain. During Phase I of this project, we will develop, test, and refine individual components of such a randomized clinical trial. This will include specification of protocols in the yoga and exercise groups, subject selection criteria, and recruitment and retention strategies. During Phase II, we will use the study components developed during Phase I to conduct a pilot trial of these interventions. We will randomized 30 persons with chronic low back pain to each of the following groups: yoga, a conventional therapeutic exercise program, and usual care. We will measure each treatment's impact on symptoms, function, quality of live, and back pain-related utilization and costs of care after 6 weeks, 122 weeks, and 6 months. The pilot study will permit us to identify and resolve unanticipated problems, to estimate the samples required for an adequately powered full-scale trial, and to obtain preliminary estimates of the effectiveness and safety of yoga and the therapeutic exercise program. At the conclusion of this project, we will be well-positioned to prepare a competitive grant proposal to evaluate the effectiveness of yoga as a treatment for persons with chronic low back pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

24

Back Pain

•

Project Title: EVALUATION OF A LOW BACK PAIN PATIENT EDUCATION PROGRAM Principal Investigator & Institution: Lorig, Kate R.; Associate Professor; Medicine; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2001; Project Start 04-FEB-1998; Project End 31-JAN-2003 Summary: This is a demonstration project which proposes to evaluate a new generation low back pain patient education program. Patients will be randomized either to the treatment group and followed for 6, 12, 18, and 24 months with the intervention, and then no intervention for 12 months for a control group which consists of usual care with a subscription incentive for 24 months, and then the intervention for 12 months from 24 to 36 months post-study enrollment. The intervention consists of a book and a videotape and is based on interaction with other participants in the program and health professionals through a closed password protected moderated Internet discussion group. Patients with low back pain will be recruited from Silcon Valley Employers and through the Internet, and the assessments will also be conducted through the Internet. Main outcomes will focus on pain, activity limitation, and health care utilization. Process studies will also be conducted to determine patients' use (quality and content) of the computerized intervention, patient satisfaction with the intervention delivery methods, and the quality and quantity of data collected on line compared to the data collected through postal questionnaires. This study is being coordinated with four other low back pain intervention studies that are currently being proposed or conducted at Group Health Cooperative Puget Sound, Indiana University of Multipurpose Arthritis and Muscular Disease Center and Department of Family Medicine at Stanford. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: FATIGUE & GENDER IN DYNAMIC STABILITY AND LOW-BACK PAIN Principal Investigator & Institution: Granata, Kevin P.; Associate Professor; Orthopaedic Surgery; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2001; Project Start 30-SEP-1998; Project End 31-AUG-2005 Summary: Occupationally-related low back disorders (LBDs) are the leading cause of lost work days and the most costly occupational safety and health problem facing industry today. Research concludes the biomechanical stability of the spine plays a significant role in low-back injury and prevention. Stability is achieved through a complex mechanical balance between external load and neurophysiologic control factors including active muscle stiffness, reaction time and response amplitude. Personal factors such as gender and fatigue contribute to LBD risk because they influence neuromuscular response characteristics and associated stability. Unfortunately, existing analyses of spinal stability ignore the dynamic response characteristics of the neuromuscular system. To control LBD risk, to assure safer gender inclusion in the workplace, to facilitate work/rest and training schedules to prevent fatigue related injury prevention, and to improve clinical and rehabilitation assessment; it is necessary to quantify how neuromuscular response dynamics influence spinal stability. It is also necessary to understand how gender, fatigue and spinal posture influence these neuromuscular control factors and the associated risk of spinal instability. The goal of this research is to quantify dynamic stability of the spine and the influence of gender, fatigue, and spinal posture on musculoskeletal stability. Neuro- physiologic components of dynamic spinal stability, including truck stiffness, reaction time and response amplitude, will be measured form a sudden loading protocol and incorporated into a

Studies

25

biomechanical model that will quantify dynamic spinal stability. Empirical measures of spinal stability will be recorded from potential energy protocols published from our laboratory. The experiments are designed to change spinal stability requirements without changing biomechanical equilibrium while observing trunk muscle coactivity associated with the recruitment of stability. These will provide empirical estimates of stability and be employed to validate the dynamic stability model. The influence of gender, fatigue and spinal posture on dynamic stability and neuromuscular response dynamics will be evaluated through each of these protocols. Research has established an epidemiologic link between neuromotor response behavior and LBD risk. The proposed effort represents the first to consider the biomechanics of dynamic neuromotor behavior in the control of spinal stability. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FLOOR SLOPE EFFECTS ON LIFTING KINEMATICS AND KINETICS Principal Investigator & Institution: Reiser, Raoul F.; Kinesiology and Health; University of Wyoming Box 3355, University Station Laramie, Wy 82071 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 29-SEP-2003 Summary: (provided by applicant): This is a revision of a previously submitted R03 proposal. The long-term objective of this research program is to develop guidelines for the Manual Materials Handling task of lifting an object from an inclined floor surface in order to reduce the risk of low-back pain and injury at the workplace. Specific aims include determining lifting capacities while facing up an incline, down an incline, and compare them to lifting the same object from a level floor surface. Additional efforts will be made to quantify the kinematics of lifting as well as the loading on the low back in order to understand how the different lifting conditions affect the lifter, and if one lifting condition places a person at an increased risk of injury compared to other conditions, Efforts will also be made to examine how different lifting techniques (altered foot placement) may reduce the likelihood of low-back pain or injury caused from lifting on an inclined surface. Two separate experimental protocols will be utilized in order to realize the long-term objectives of this two-year research program. The first protocol will determine lifting capacities under three distinctly different lifting situations with the feet placed in the same position relative to the lifted object: facing up an incline, facing down an incline, and on a level surface. The psychophysical method will be used to determine lifting capacities in each condition. This method has been used successfully in the past to determine lifting capacity guidelines for other situations. Also, as part of this protocol, kinematics of motion, the loading on the lower back, and muscle activity of key muscles in the back will be assessed in each condition. Sagittal plane cinematography will be combined with anthropometrics parameters to perform an inverse-dynamics analysis of the lifts. The second protocol will be conducted in the same manner as the first. However, foot placement will be staggered (one foot forward of the other) in the two inclined lifting situations while foot placement will be even in the level surface condition. Participant numbers will allow statistical comparisons of males, females, and the whole group. The results from these two protocols will be combined with the intent to produce guidelines related to lifting on inclined surfaces. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: FUNCTIONAL IMPACT OF PENS FOR 65+ CHRONIC LOW BACK PAIN Principal Investigator & Institution: Weiner, Debra K.; Medicine; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260

26

Back Pain

Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-MAY-2007 Summary: (provided by applicant): Chronic low back pain (CLBP) plagues greater than 6 million community dwelling older adults, and causes physical and psychosocial dysfunction as well as increased utilization of health care resources. While the mainstay of treatment for these individuals consists of non-opioid analgesics and physical therapy (PT), frail older adults with unrelieved symptoms have limited therapeutic alternatives. Opioid analgesics and surgical treatment may be inapplicable to those with prohibitive physical or cognitive comorbidities. Many individuals with chronic musculoskeletal pain seek out complementary and alternative treatments, although most have not been subjected to rigorous scientific investigation. Acupuncture is among the most commonly employed of these modalities. The purpose of this investigation is to explore the utility of percutaneous electrical nerve stimulation (PENS), a neuroanatomically guided form of electroacupuncture, as a safe non-pharmacologic analgesic alternative for the older adult with CLBP. In order to optimize physical performance and diminish disability, the value of a general conditioning and aerobic exercise (GCAE) program with and without PENS will also be studied. A randomized controlled clinical trial will be performed. Two hundred community dwelling older adults equal to or > age 65 with CLBP will receive either (1) PENS alone, (2) sham PENS alone, (3) PENS + GCAE, or (4) sham PENS + GCAE, twice a week for 6 weeks. All outcome measures will be collected pretreatment, at the completion of the 6 weeks protocol, and 6 months later. Primary outcome measures include pain intensity (short form McGill Pain Questionnaire) and pain-related disability (Roland Disability Scale). Because chronic pain is a complex, multidimensional experience, important secondary outcome measures will also be collected that assess key aspects of (1) physical function (self-reported and performancebased), (2) psychosocial function (mood, self-efficacy, self-rated health, cognitive coping, fear, sleep), and (3) health care utilization. This study represents the first wellcontrolled, comprehensive examination of an alternative medicine intervention for CLBP in older adults. If effective, this trial could lead to improved quality of life for millions of suffering older Americans, and by diminishing pain intensity and the use of toxic analgesic regimens, lead to substantial cost savings by decreasing health care utilization. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GEOGRAPHIC VARIATION IN SPINE CARE AMONG INJURED WORKERS Principal Investigator & Institution: Rischitelli, Gary; None; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 29-SEP-2005 Summary: (provided by applicant): This proposal addresses two National Occupational Research Agenda priority areas: occupational health services research and low back pain. Back pain among workers is an enormous medical, social, and economic burden in the United States. Back disorders account for 27% of all disabling occupational injuries in the United States and the average direct cost of a low back injury claim is more than twice that of other occupational injury claims combined. The primary goal of the study is to examine community differences in the rate and types of spinal surgery performed on injured workers using small area analysis. Small area analysis is a commonly employed method in health services research but there have been limited applications of this technique in occupational health research. Oregon, as well as a number of neighboring Western states, has been identified as having elevated rates of spine surgery compared to the rest of the nation and significant local variation exists

Studies

27

among communities based on prior analyses of Medicare claims data. We plan to evaluate whether a similar pattern of local variation exists for workers' compensation claims and to evaluate factors contributing to observed variations including physician specialty, physician supply, source of payment, and the effect of managed care. This project will pilot the use of an existing comprehensive state database of workers' compensation medical payments that provides rich opportunities for health services and outcomes research in occupational health. The methods described in this application can be applied to other geographic units or other diagnoses and thereby serves as a model for analyzing the individual, community and provider variables that influence the treatment of work-related injuries and illnesses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HUMAN LUMBAR FACET CAPSULE BIOMECHANICS Principal Investigator & Institution: Khalsa, Partap S.; Assistant Professor; Orthopaedics; State University New York Stony Brook Stony Brook, Ny 11794 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2005 Summary: (provided by applicant): Lumbar facet joints serve neurophysiological as well as biomechanical functions and, when subject to noxious stimulation, can produce low back pain. The facet joints are comprised of the articulating processes of adjacent vertebrae and a ligamentous capsule that tends to constrain the articular movements. As loads are transmitted by the facet joints, the joint surfaces move relative to each other and the capsule is deformed. Capsular deformations are thought to be an adequate neurological stimulus, evoking the discharge of sensory nerves innervating the capsule. Since the capsule is innervated by mechanoreceptors and nociceptors, it may function to signal position or loading of the facet joint. However, to date there are few quantitative studies of the mechanical state of the facet capsule during normal physiological ranges of motion of the spine. Thus, it is unknown if the capsule can be sufficiently loaded under physiological conditions to result in stimulation of the mechanically sensitive neurons known to innervate it. The long term goal of the investigators is to understand the functional interactions between spinal biomechanics and the nervous system. Knowledge gained through these studies will provide important and novel information regarding the mechanisms by which spine disorders can affect the nervous system. For example, disc degeneration and chemonucleolysis may increase the load on the facets. Until we know how the facet capsules respond under load, we will not be able to determine the relevance of these changes to the pathogenesis of low back pain. The short range goal of the investigators is to elucidate how the human facet joint capsule is loaded during physiological loads of the lumbar spine and to develop a computational model that will enable us to ultimately examine how manipulations of the spine affect capsule loading. This project, using un-embalmed human cadaveric lumbar spines, will: 1) Measure the plane strains developed during physiological motions of the lumbar spine; 2) Determine material properties of the facet joint capsule; and 3) Develop a mathematical model of the capsule using finite element analysis to enable estimating stress at any location within the capsule during loading. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: INTERVERTEBRAL DISC MECHANOREGULATION: AN EXPLANT MODEL Principal Investigator & Institution: Lee, Cynthia R.; Mechanical Engineering; University of Vermont & St Agric College 340 Waterman Building Burlington, Vt 05405

28

Back Pain

Timing: Fiscal Year 2003; Project Start 16-JUN-2003; Project End 15-JUN-2005 Summary: (provided by applicant): The first part of the proposed work is the development and validation of an intervertebral disc explant culture system. The second part of the proposed work is experimental studies investigating the effects of mechanical compression of the disc explants on the metabolic activity of the disc cells. Elucidation of the loading parameters that are beneficial and detrimental to disc health is necessary for the development of appropriate preventative measures and treatment therapies for low back pain and for the design of tissue engineered replacements of the degenerate disc. The establishment of a reliable in vitro culture system for intervertebral disc implants is an important step in furthering our understanding of the effects of mechanical loading on disc metabolism. The development of an in vitro explant culture system would provide for compromise between the in vivo and isolated cell systems, allowing for controlled evaluation of the effects of mechanical loading on disc cell metabolism. The initial experimental work that will be conducted under this proposed project will lay the groundwork for future in vitro and in vivo studies on intervertebral disc mechanobiology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INTERVERTEBRAL DISC RESPONSE TO CYCLIC LOADING IN VIVO Principal Investigator & Institution: Hung, Clark T.; Associate Professor; Biomedical Engineering; Columbia Univ New York Morningside 1210 Amsterdam Ave, Mc 2205 New York, Ny 10027 Timing: Fiscal Year 2002; Project Start 26-SEP-2002; Project End 31-AUG-2006 Summary: This grant proposal has been submitted in response to RFA-OH-02-004: Musculoskeletal Disorders: Prevention and Treatment, falling under the Biomechanical and Mechanobiology Research bullet. This grant brings together a multidisciplinary research team in the Departments of Biomedical Engineering and Orthopaedic Surgery at Columbia University to develop an animal model that can be used to establish the critical threshold loading level at which degenerative changes are observed in intervertebral discs (IVDs) subjected to cyclic loading under physiologic conditions. Occupational exposures (e.g., overstressed, high repetitive loading, whole body vibration) are generally accepted as an important cause of low back pain reports in industrialized countries. In the United States, back and spine problems represent the second greatest leading cause of disability among persons aged 15 years and older with low back pain from vibration exposure estimated to cost $80 billion annually. To better understand the impact of biomechanical factors on the etiology of disc degeneration, various animal models have introduced mechanical interventions on the spine or tail. These mechanical interventions cause morphologic changes in the intervertebral disc (IVD) and vertebrae similar to degenerative disc disease in humans. Amongst these models, pin instrumented mouse and rat tails have permitted significant insights to the effect of static loading or disuse on disc degeneration. There are,however, apparently no published studies using such models to study applied cyclic loading of the IVD in vivo. To address this apparent gap in spine research, we propose to adapt the in vivo rat tail model currently used by one of the co-Investigators (XE Guo) to study trabecular bone adaptation, to study loading-induced changes in the IVD. In this model, a well-defined loading regiment (static or temporally varying) can be applied to a specific vertebra and its adjacent discs via loading to surgical pins implanted in the neighboring vertebrae. With the ultimate goal of isolating the influence of joint-loading conditions on the response of the IVD, we set forth a number of specific hypotheses and specific aims test

Studies

29

our global hypothesis that there exists a range of loading magnitudes and frequencies that will safely maintain normal function and properties of the IVD. Outside of this range, non-physiologic compressive loading (overloading, high frequency, or static loading) of the IVD leads to disc degeneration as measured by decreased material properties (stiffness and modulus) and alterations to expression and levels of aggrecan, type I and II collagen, and cartilage oligomeric protein (COMP). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INTRAMUSCULAR ELECTRICAL STIMULATION FOR LOW BACK PAIN Principal Investigator & Institution: Fang, Zi-Ping; Vice President for Research and Developm; Neurocontrol Corporation 8333 Rockside Rd, 1St Fl Valley View, Oh 44125 Timing: Fiscal Year 2003; Project Start 24-SEP-2003; Project End 31-AUG-2004 Summary: (provided by applicant): The long-term goal of the proposed research is to develop and commercialize a cost-effective product for the treatment of chronic low back pain of muscular origin by using intramuscular electrical stimulation (IMES). In IMES, wire electrodes are temporarily implanted into muscles through the skin and connected to a portable stimulator for several weeks of stimulation treatment. The IMES product and treatment are expected to be: (1) more effective than transcutaneous electrical nerve stimulation (TENS) and conventional neuromuscular electrical stimulation (NMES) as the IMES uses intramuscular instead of skin-surface stimulation, permitting more intense and specific stimulation; (2) more effective than percutaneous electrical nerve stimulation (PENS) as the IMES uses indwelling wire electrodes instead of acupuncture needles, permitting more frequent and longer-lasting treatment sessions on a daily basis for many weeks; and (3) more convenient to use than the PENS as patients only need to visit the clinic once for electrode insertion and once for electrode pull-out instead of many treatment visits, saving time and money. A case-series clinical study will be conducted to assess the feasibility of the proposed IMES product and treatment. Specifically, (1) a total of 10 subjects with chronic low back pain will be enrolled in the study according to the proposed subject eligibility criteria; (2) a set of 8 intramuscular electrodes will be implanted into the low back muscles of each subject according to the proposed protocol; (3) a 6-week stimulation treatment will be completed in at least 8 subjects according to the proposed paradigm; (4) a complete set of data will be collected and analyzed on the results of the IMES treatment according to the proposed outcome measures and data collection schedule. The proposed Phase I feasibility study is critical to the ultimate market success of the IMES product. Specifically, (1) the clinical experience gained and experimental data collected during the Phase I study will provide a firm basis for the design of a pivotal randomized controlled trial to demonstrate the safety and effectiveness of the device and treatment in a Phase II study; and (2) the design and test results of the prototype device used in the Phase I study will provide a firm basis for the refinement of the product design during the Phase II study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: JOB-RELATED ARTHRITIS AND DISABILITY IN RETIREMENT Principal Investigator & Institution: Leigh, Paul P.; Epidemiology and Prev Medicine; University of California Davis Sponsored Programs, 118 Everson Hall Davis, Ca 95616 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 29-SEP-2002

30

Back Pain

Summary: Two widely-shared medical views motivate the proposed study: 1) Injuries to joints at some time in life can produce osteoarthritis in those joints later in life. 2) Perhaps the best predictor of future low-back pain is prior low-back pain. For our purposes, the time dimension is important. The initial injury or pain could occur on-thejob whereas the subsequent osteoarthritis or pain could occur much later, perhaps during retirement years. These subsequent osteoarthritis and pain events will generate direct costs (doctor visits, hospitalizations, drugs) and indirect costs (lost productivity on-the-job and in the home). Aim 1 is to estimate the costs of job-related osteoarthritis. Current estimates of all job-related injuries and illnesses ignore these costs. Aim 2 is to investigate the connection between employment in injury-producing jobs prior to retirement and functional disability after retirement. Costs of job-related osteoarthritis and functional disability in retirement are important for at least three reasons. First, ignoring them leads to a significant underestimate of the overall costs of job-related injuries and illnesses. Second, these costs were largely borne by victims, families, and taxpayers, not by workers' compensation (WC) systems. Third, current economic evaluations of some Occupational Safety and Health (OSHA) standards, such as those pertaining to ergonomics, also ignore these costs. If these standards reduce initial disorders and injuries, then they should also reduce the subsequent costs. The implication is that current ergonomic standards may be more cost-effective than is commonly believed. Prevalence and costs of osteoarthritis will be estimated with primary data from the National Health Interview Surveys, National Center for Health Statistics, the Bureau of Labor Statistics, and the Agency for Healthcare Research and Quality and with secondary data from published studies. We will present a range of estimates under clearly- stated assumptions so readers can select the scenario they find most reasonable. The connection between employment in injury-producing jobs and subsequent functional disability will be investigated with the National Health and Nutrition Examination Survey III (NHANES III). The NHANES III has information on the functional disability (Activities of Daily Living) of retirees, as well as information on subjects' longest held jobs prior to retirement. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LBP WITH RADICULOPATHY: AN INFLAMMATORY RESPONSE Principal Investigator & Institution: Deleo, Joyce A.; Associate Professor; Anesthesiology; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, Nh 03755 Timing: Fiscal Year 2001; Project Start 03-SEP-1997; Project End 31-JUL-2006 Summary: (provided by applicant): Low back pain is a major clinical problem second only to the common cold in its financial and symptomatic impact on human suffering. Our long-term objective is to understand the pathophysiological mechanisms of low back pain associated with lumbar radiculopathy. To achieve this goal, we will apply experience with animal models of lumbar radiculopathy and chronic neuropathic pain to evaluate and test our hypothesis. In the current proposal, we apply data from the previous funding period to investigate the following hypothesis: Lumbar nerve root injury produces a CNS immune mediator imbalance, which leads to an "autoimmune" syndrome that in turn manifests as persistent radicular pain. The research proposed in the present application, when integrated with our previous data, will determine the individual roles and the collective interactions of specific cytokines and chemotaxic cytokines, (chemokines) and cell trafficking in the etiology of persistent radicular pain. The central hypothesis will be tested by using established methods in our laboratory to investigate the following Specific Aims: 1. Assess the role of chemokines in the etiology of persistent radicular pain using the Chromic Lumbar Radiculopathy (C-LR) rodent

Studies

31

model. 2. Continue to address importance of site of injury in relationship to the DRG to pain generation. 3. Determine whether cells traffic from the periphery into the central nervous system in response to lumbar nerve root injury that results in persistent radicular pain. 4. Assess the contribution of mechanical root injury versus chemical inflammatory components in the generation of radicular pain. 5. Determine the effect of selective and global immunosuppressive therapy on the potential to alter sensory processing and on the central inflammatory cascade. When completed, this project will provide: Information on the in vivo kinetics of spinal proinflammatory cytokine and chemokine expression and production in a rodent radiculopathy models; Preliminary data to guide and support new pharmacological treatments of acute and chronic low back pain; New insight into the relationship between the neuroimmune response of nerve root injury and the clinical phenomenon of low back pain; Preliminary data to direct future studies that evaluate the impact of central neuroimmune activation in causation of low back pain with radiculopathy; New information on the pathogenetic distinction between nerve injury central or peripheral to the dorsal root ganglion (a clinically relevant anatomical location). This new knowledge will guide development of novel, non-addictive preventive therapies and treatments for chronic low back pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LOAD INDUCED DISC DEGENERATION IN A RAT TAIL MODEL Principal Investigator & Institution: Iatridis, James C.; Orthopedics and Rehabilitation; University of Vermont & St Agric College 340 Waterman Building Burlington, Vt 05405 Timing: Fiscal Year 2001; Project Start 01-SEP-1999; Project End 31-JUL-2004 Summary: The proposed K01 project was designed to test important hypotheses while creating an opportunity to increase the candidate's research skills in focal training areas. Dr. Iatridis proposes an intensive training program overseen by an Advisory Board to allow him to progress from mentored to independent scientist. His Advisory Board is comprised of members who are well-recognized for their contributions to biomechanical, computational, and biochemical research on the spine and intervertebral disc. Along with regular meetings with mentors, course work, and seminars, Dr. Iatridis will participate in extended training programs in biochemistry and molecular biology, computational modeling, and magnetic resonance imaging which address specific hypotheses of his research plan and increase his skill base. The long-term goal of the research plan is to isolate mechanical factors that lead to degenerative disc disease and spine pathology. The primary objective of the proposed research is to investigate the effect of mechanical loading conditions applied to the intervertebral disc on the physical signals that cuase a biosynthetic response from the cells and tissue remodeling. Specific aims were developed that are consistent with several future directions for research recommended by the 1995 NIH/AAOS workshop on low back pain and NIH PA97-058. A general hypothetical model is introduced where the intervertebral joint forces are related to dominant load carriage mechanics in the disc tissue and those physical signals that cause a biosynthetic response. The hypotheses test the influence of specific joint forces on on observed intervertebral disc remodeling. External fixators allow precise control over the joint forces applied to a rat tail in vivo. The tail will chronically be exposed to immobilization, low-force compression, high-force compression, and shear loading, as well as loading followed by removal of the fixators to probe for recovery (independent variables). Dependent variables describing the composition and biosynthetic response of the disc tissue will be measured using biochemical, in situ hybridization, and MRI techniques. The mechanical and electrochemical fields in the disc tissue will be calculated using a poroelastic and chemical electric finite element

32

Back Pain

model and mechanical properties measured in this study as input parameters. The biosynthetic response of the disc will be compared to the dominant load carriage mechanisms in the disc tissue in a site-specific manner. This combined experimental and theoretical project provides a framework for future developments on the cell scale by investigating cellular transduction mechanisms, and on the full joint scale by isolating joint forces that may acccelerate intervertebral disc degeneration in human spines. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LOCAL TISSUE BIOMECHANICS IN LOW BACK & RADICULAR PAIN Principal Investigator & Institution: Winkelstein, Beth A.; Assistant Professor of Bioengineering; Bioengineering; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 19-SEP-2002; Project End 31-AUG-2005 Summary: (provided by the applicant): This application aims to test hypotheses regarding low back pain while also increasing the candidate?s skills in pain and neurophysiologic research. As an independent researcher, she proposes a plan that will help in the transition to an independent researcher, combining both focused research and career development activities. Her long-term career goal is the development of an independent research program studying painful neck injury biomechanics. Immediate goals for achieving this are provided in a career development plan for this award that include both courses related to neurobiology and research directly related to low back pain. Under the mentorship of Dr. DeLeo, she proposes to incorporate these activities in her training and research. Dartmouth is said to be an ideal environment for such activities due to Dr. DeLeo?s leadership in the pain field and the institution as a whole having much collaboration between Anesthesiology, the Spine Center, and the Thayer School of Engineering. The proposed research incorporates aspects of biomechanics and the neuroimnmunology of pain to test the central hypothesis that lumbar radioculopathy depends on local nerve root deformation and central neuroplasticity that is directly influenced by the initial tissue deformation magnitude. While mechanisms of low back and radicular pain are believed to involve a mechanical component, there is an incomplete understanding of the local mechanical response of neural tissue in these diseases. The proposed work combines studying neuroinflammatory mechanisms leading to spinal sensitization with bioengineering analysis of tissue injury. An existing rat model of lumbar radioculopathy is utilized to: (1) quantify and correlate differences in mechanical and spinal neuroimmune activation responses for non-inflammatory and inflammatory compressive insults, (2) quantitatively assess reproducibility in applying a nerve root injury, (3) determine local tissue mechanics and subsequent neuroinflammation associated with acute and chronic radicular pain states, and (4) use these data to develop both strain-based and load-based criteria for painful nerve root injury. To accomplish this, in vivo tissue strains will be correlated with mechanical allodynia and neuroimmune mediators of persistent pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: LOSS OF GLOMERULAR FUNCTION IN SICKLE CELL DISEASE Principal Investigator & Institution: Wigfall, Delbert R.; Duke University Durham, Nc 27706 Timing: Fiscal Year 2001

Studies

33

Summary: Purpose: The questions that we wish to answer in the current study are whether the long term administration of an angiotensin II converting enzyme inhibitor in patients with sickle cell nephropathy 1) prevents or retards the development of renal insufficiency, and 2) reduces proteinuria on a long term basis. Methods: Patients are treated with either Enalapril or placebo. The primary outcome variable is change in the glomerular filtration rate. Results: We now have 5 patients at Duke who remain on the protocol. Fifteen patients initially enrolled in the study, with one withdrawn by physicians owing to an presumed idiosyncratic reaction to the drug (back pain), and one patient who withdrew from the study. Over twenty-four months, eight more patients have been lost to noncompliance/attrition ( 4 males and 4 females). As anticipated, the entire patient population is African-American. Enrollment for the study has ceased at DUMC. A total of 95 patients have been enrolled at the University of North Carolina, Duke University, East Carolina University, and the University of Alabama at Birmingham. An interim analysis was performed for safety and efficacy reasons. Initial review shows that the renal function in both treated and untreated patients is stable at two years demonstrating safety of this therapy. Additionally, there is a suggestion that the treated patients enjoy an incremental improvement in renal function, though the number of observations are small. Importantly, a decrement in the amount of proteinuria was observed in each patient treated with ACE inhibitor whereas no changes in proteinuria are observed in placebo-treated patients at 1 month and over time. There were no difference between males and females in this regard. Thus our interim analysis suggests that the long term by ACE inhibition is effective in ameliorating proteinuria in adults. Future plans: We are currently extending the trial down to age 5 years with continuation of the current and new protocols through the Duke-UNC Sickle Cell Center. We have been given approval by the Institutional Review Board to enroll children, and have three children with biopsy proven sickle nephropathy on ACE-inhibitor therapy. To date, these patients have evidenced a significant reduction in proteinuria from pre-treatment levels. Significance: Angiotensin II converting enzyme inhibitor therapy has been shown to reduce protein excretion in several forms of glomerular disease. This diminution of protein excretion occurs in the presence and absence of systemic hypertension. In human studies, it is reasonably certain that glomerular hypertension plays a role in the pathogenesis of experimental diabetic nephropathy, and angiotensin II converting enzyme inhibitor therapy has a salutary effect. From a previous short term prospective trial, we know that an angiotensin II converting enzyme inhibitor is capable of reducing proteinuria in patients with sickle cell nephropathy for a short interval. Important questions which are being evaluated are whether or not angiotensin II converting enzyme inhibitor therapy, by reducing glomerular capillary hypertension, can ameliorate proteinuria for an extended time and whether or not angiotensin II converting enzyme inhibitor therapy can retard the progressive decline in renal function in sickle cell disease patients with renal insufficiency. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LOW BACK PAIN IN CYCLIC AND PROLONGED ACTIVITIES Principal Investigator & Institution: Solomonow, Moshe; J. Calten Professor; Orthopaedics; Louisiana State Univ Hsc New Orleans New Orleans, La 70112 Timing: Fiscal Year 2001; Project Start 01-MAY-2000; Project End 30-APR-2003 Summary: The role of spinal ligaments in causing spinal instability, injury and low back pain in two types of occupational activities will be investigated. It is hypothesized that mechano-receptors in the spinal ligaments, when deformed due to loading, initiate

34

Back Pain

sustained reflex activity in the paraspinal muscles. As creep sets in the ligaments, over time, the receptors are desensitized and the reflexive muscular activity is lost, rendering the spine exposed to instability, injury and low back pain. This research, therefore, may provide an insight for a wide range of low back pain types, ranging from idiopathic pain due to ligament strain, to that resulting from the chain reaction of injury, disc herniation and nerve damage due to lack of musculature support. A three year experimental research program consisting of the feline model will systematically explore the relationship between the electrophysiological and mechanical properties of spinal ligaments in vivo and the activity of motor units of the paraspinal and abdominal muscles in cyclic and stationary loading conditions, when the ligaments are subjected to creep as well as their recovery pattern with rest. The results of this research will provide strong insight into the neurophysiology of low back pain in common occupational activities; provide an insight to the cause of lost muscle strength and coordination and prolongation of low back pain; and delineate occupational conditions that result in low back pain and other occupational conditions that may prevent it. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LOW BACK PAIN QUANTIFYING RISK FACTORS Principal Investigator & Institution: Garg, Arun; Professor; Indust & Manufacturing Engr; University of Wisconsin Milwaukee Box 413, 2200 Kenwood Blvd Milwaukee, Wi 53201 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 29-SEP-2006 Summary: This multi-center prospective cohort study will: (i) Determine baseline prevalence rates and subsequent incidence rates over a 2 year period for low back pain (LBP), LBP with neurological signs (sciatica), LBP-related impairments, lost time and modified duty-related LBP for 3 levels of job physical exposures (low, medium, high), (ii) Quantify job and individual risk factors (e.g., weights, frequency, horizontal and vertical locations, low back moments, etc.), (iii) Validate existing job analysis methods (especially Revised NIOSH Lifting Equation, Maximum Acceptable Weights land Forces, 3-D Static Strength Biomechanical Model, the Proposed TLV for Lifting, and the Washington State Checklist, and (iv) Develop a final model for determining MSD risks. A cohort of 678 workers (study drop-outs replaced) from 10 very different industries with a total worker population of over 10,000 in three diverse states will;) participate in the study to help ensure generalizability of the study results. To maximize objectivity and accuracy, job physical exposures will rely primarily on measurements to quantify exposures. To maximize clinical and epidemiological validity and reliability, all participants will have health outcomes assessments by Physical Therapists and qualified physicians. These will include: baseline questionnaires, structured interviews and standardized physical examinations. Changes in job physical exposures will be monitored monthly. LBP symptoms, sciatica, LBP impairments and LBP severity measures will be assessed monthly using a symptom questionnaire on all, and structured interviews/physical examinations on those with symptoms. Job physical exposure and health outcomes assessment teams will be blinded to each other throughout the field observation phase. Multivariate logistic regression models and survival analyses will be utilized to explore relationships between job physical risk factors and low back pain (LBP), sciatica, LBP impairments and LBP severity measures. In addition to quantifying ergonomic risk factors, interactions between various jobs, psychosocial and individual risk factors will be explored. This project is expected to result in the ability to improve the existing ergonomic job evaluation models that have robust predictive capabilities for a broad range of industries.

Studies

35

Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LOW BACK PAIN: PHYSICAL AND PSYCHOSOCIAL JOB FACTORS Principal Investigator & Institution: Krause, Niklas; Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 01-JUL-2000; Project End 30-JUN-2003 Summary: This project seeks to prospectively examine the role of physical and psychosocial job factors in the development of occupational low back pain (LBP) during five successive phases: (1) the pre- disability symptom phase, (2) the pre-disability formal injury report phase, and (3) three disability phases - acute, subacute, and chronic - defined by increasing durations of lost work time. It is hypothesized that both physical and psychosocial job factors are independent predictors of LBP at all five phases and that their relative effect sizes change across phases. The main objective is to determine phase-specific risk factor profiles with particular focus on the relative impact of psychosocial and biomechanical risk factors. The long-term goal is to yield useful information for the design of workplace interventions which combine organizational and ergonomic job redesign to prevent low back injuries and work disability. This project combines the resources of two existing data sets - two prospective cohorts of San Francisco urban transit operators (n = 1,449, n = 1,640). These two longitudinal studies provide workers' compensation data with 3 to 5 years of follow-up, allowing for the study of each phase of the disability process, including the chronic disability phase (greater than 90 days off work), which accounts for 80 percent of the costs associated with work-related low back injuries. Both studies provide comparable information on job-related, sociodemographic, injury, medico- legal, and economic factors. Primary analyses will examine the independent and combined effects of physical and psychosocial job factors, including psychological and physical job demands, job control, job strain and social support at work. In addition, unique data on job stress, measured by independent observers with an innovative job analysis instrument, will be used for agreement analyses with self-reported measures to evaluate the predictive validity of survey instruments used in large epidemiological studies of occupational LBP. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: LOW BACK PAIN--A MULTICENTER RANDOMIZED TRIAL Principal Investigator & Institution: Weinstein, James N.; Professor; Community and Family Medicine; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, Nh 03755 Timing: Fiscal Year 2001; Project Start 04-JUL-1999; Project End 31-MAY-2004 Summary: Low back pain is considered one of the most widely experienced health problems in the U.S. and the world. This condition is second only to the common cold as the condition for which patients most frequently see a physician or suffer days lost from work. Estimated costs to those who are severely disabled from low back pain range from 30-70 billion dollars annually. Rates of spinal surgery in the U.S. have increased sharply over time, and 15-fold geographic variation in rates of these surgeries has been documented. In many cases the rates of surgery appear to be determined by where one lives and who one sees. Despite these trends, there is little evidence proving the effectiveness/efficacy of these therapies over non-operative management. This study will use the unique resource of the National Spine Network to conduct multicentered, randomized, controlled trials for the three most common diagnostic groups for which spine surgery is performed: lumbar intervertebral disc herniation (IDH), spinal stenosis (SpS) and spinal stenosis secondary to degenerative spondylolithesis (DS). The trials will

36

Back Pain

compare the most commonly used standard surgical treatments to the most commonly used standard non-operative treatments. The study will be conducted at 16 sites throughout the United States. The primary endpoints of the study will be changes in general health-related quality of life as measured by the SF-36 health status questionnaire and spine-related disability as measured by the Oswestry Low Back Pain questionnaire. Secondary endpoints will include patient satisfaction with treatment, resource utilization for estimation of cost, and utility for current health for estimation of quality-adjusted life years (QALYs). The latter two endpoints will be used to complete a formal cost-effectiveness evaluation. Patients will be followed a minimum of 24 months with visits scheduled at 3, 6, 12, and 24 months. Data on all endpoints will be collected at each study visit. If possible, extended follow-up visits will be scheduled at 36 and 48 months. We anticipate that a total of 1450 subjects will be enrolled and randomly allocated. An additional observational cohort will be tracked to assess health and resource outcomes. Data from the RCT and observational cohorts will be integrated to formally estimate the cost-effectiveness of operative versus non-operative interventions for IDH, SpS, and DS. Based on this trial we will, for the first time, have scientific evidence as to the relative effectiveness/efficacy of surgical versus non-surgical treatment for these three common lumbar spine conditions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MAINE LUMBAR SPINE STUDY Principal Investigator & Institution: Keller, Robert B.; Executive Director; Maine Medical Assessment Foundation Manchester, Me 043510249 Timing: Fiscal Year 2001; Project Start 30-SEP-1998; Project End 31-JUL-2002 Summary: This proposed follow-up study is a competitive renewal of the Maine Lumbar Spine Study (MLSS). The MLSS, initially funded as part of the Low Back Pain PORT, enrolled over 600 patients with either sciatica or spinal stenosis in 1990/92. Patients were recruited through community-based physicians (orthopedists, neurosurgeons, and occupational medicine) for this observational study. The main goal was to compare patient-centered outcomes for patients who underwent surgery vs. those who did not. After extensive baseline data collection, patients have been resurveyed every year, with a good retention rate of approximately 80% of the surviving cohort at 8 years. The study has so far published 11 peer-reviewed papers with results of up to 5 years of follow-up. Data covering 8 years of follow-up have already been collected, years 9 and 10 are in process, and funding is requested to complete the 10 years of follow-up for all retained participants and to perform additional analyses. This application requests continued funding for 18 months, at a reduced level. The PI is based in Maine, which is the location of the cohort, and is now a consultant for the applicant organization. Subcontracts with MGH (Dr. Atlas), and the University of Washington (Dr. Deyo) are proposed, to continue collaborative efforts with investigators who have been involved with MLSS since its inception. Dr. Singer (MGH) is also proposed as a consultant, but not through the MGH subcontract. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: MANAGED CARE AND PHYSICIAN SATISFACTION Principal Investigator & Institution: Grembowski, David E.; Professor; Health Services; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 29-SEP-2002

Studies

37

Summary: Background: Two research topics will be addressed through analysis of secondary data from our previous Physician Referral Study (AHRQ HS06833). In the era of market competition and managed care, more and more primary physicians are dissatisfied with their jobs. We know very little about whether primary physician dissatisfaction is harming patient-physician relationships and health outcomes. Second, patients in more managed plans are less satisfied with their primary physicians, but far less is known about managed care and patient satisfaction with specialists and health outcomes. Aims: Aims are: 1) to determine the associations between managed care, primary physician satisfaction, the patient-primary physician relationship, and health outcomes; and 2) to determine the association between managed care, patient satisfaction with specialists, and health outcomes. Design: Prospective cohort study in offices of 261 primary physicians in private practice in Seattle. Patients (n=l7,187) were screened in waiting rooms, enrolling 2,850 patients in three groups: (1) patients with pain only (n=l, 5 14; 53%); (2) patients with depressive symptoms only (n=575; 20%); and (3) patients with pain and depressive symptoms (n=761; 27%). Patients (n=2004)completed follow-up surveys at one, three, and six months. About 95% of participating physicians and 96% of office managers completed self-administered questionnaires. Physician Satisfaction: Physician job satisfaction index, physician referral satisfaction index. Patient-Physician Relationship: Patient rating of primary physician, patient-primary physician relationship index, primary physician continuity, patient rating of specialists. Measures of Managed Care: For each patient, the managedness of the patient?s health plan, plan benefit indexes, presence or absence of a mental health carve-out, intensity of managed care in the patient?s primary care office, physician financial incentives, and whether the physician read or used AHCPR clinical guidelines for back pain and depression. Outcome Measurements: For pain patients, pain bothersomeness, pain interference, restricted activity days, and patient satisfaction with primary physician. For patients with depressive symptoms, outcomes were the Symptom Checklist for Depression, restricted activity days, and patient satisfaction with primary physician. Data Analysis: Multiple regression analysis to determine associations in Aims 1 and 2. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MASS SPECTROMETRY ANALYSIS OF THE HUMAN CSF PROTEOME Principal Investigator & Institution: Desiderio, Dominic M.; Professor of Neurology; Neurology; University of Tennessee Health Sci Ctr Health Science Center Memphis, Tn 38163 Timing: Fiscal Year 2001; Project Start 01-SEP-1999; Project End 30-JUN-2002 Summary: (adapted from applicant's abstract) We hypothesize that the proteome obtained from human cerebrospinal fluid (CSF) differs between controls and those patients who are diagnosed with idiopathic low back pain because our preliminary data clearly demonstrate significant differences in those two groups in the amount of a specific opioid and a specific tachykinin neuropeptide. We will expand our study to include proteins and enzymes. We will experimentally test our hypothesis by first qualitatively and quantitatively analyzing the opioid and tachykinin neuropeptidergic systems in the CSF proteome, including each neuropeptide precursor and associated enzymes. Endomorphins and other pertinent neuropeptide systems will also be studied. The proteome will be analyzed with electrophoresis and mass spectrometry. We will analyze the neuropeptide-containing proteins in the metabolic cascade that synthesizes each neuropeptide in the neuron: DNA -> RNA -> intermediate-sized proteins->

38

Back Pain

neuropeptide ->metabolites. That cascade involves several different enzymes (prohormone convertases, aminopeptidases, peptidyl glycine-amidating monooxygenase, enkephalinase, and others). A differential spinal diagnosis with lidocaine readily differentiates among the three different low back pain patient populations-controls (pain; non-pain patients), physiologic responders (require surgery), and nonphysiologic responders. The non-physiologic responders contain two subgroups: malingerers and idiopathic low back patients. Malingerers are readily identified (> ca. 95% accuracy) by a psychological test (MMPI), and are readily excluded from this study. Our hypothesis focuses only on the idiopathic low back pain group, which has no known reason for their pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MECHANICALLY-BASED IMPAIRMENT MEASURES OF LOW BACK PAIN Principal Investigator & Institution: Van Dillen, Linda R.; Physical Therapy Education; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2001; Project Start 01-MAR-2000; Project End 28-FEB-2005 Summary: (Adapted from Applicant's Description): The goal of this Mentored Research Scientist Development Award is to allow the applicant to develop the research skills necessary to be independent in the investigation of movement impairments in people with spinal pain conditions using clinical and instrumented measures. The long term goals of the proposed research are to understand the nature and specificity of the movement impairments found in spinal pain conditions and to use this information to design and test rehabilitation and prevention strategies for these conditions. Studies have been designed to test the general hypothesis that mechanical low back pain (MLBP) results, in part, from a tendency of the lumbar spine to favor movement in a specific direction when moving the trunk or limbs. The tendency to move in a specific direction is proposed to develop as a consequence of repetition of movements performed during daily work and leisure activities. The experiments will address whether or not (1) distinguishable groups of MLBP can be identified based on directionspecific impairments measured during a clinical examination, (2) there is a relationship between the specific directions in which trunk movements are performed repeatedly and specific types of movement impairments identified in people with MLBP, and (3) there are altered patterns of trunk muscle recruitment in people with MLBP that perform trunk movements repeatedly in a specific direction. To address these hypotheses, data from tests from a clinical examination that assesses direction-specific, mechanically-based impairments, as well as kinematic and electromyographic (EMG) data will be examined. In the first experiment, a data set of direction-specific clinical examination variables from people with MLBP will be tested for the presence of distinguishable groups of MLBP using advanced, multivariate techniques. A second experiment will compare the number and extent of direction-specific impairments in a cohort of people with MLBP performing repeated trunk movements in a specific direction, and a control group. A third experiment will examine the relationship between hip and trunk rotation impairments in people with and without MLBP performing repeated trunk rotation movements. Finally, trunk muscle recruitment patterns during extremity movements will be compared in a cohort of people with MLBP performing repeated trunk movements in a specific direction, and a control group. The proposed experiments are designed to determine the nature of the movement impairments in MLBP and to relate these impairments to specific, everyday activities the persons perform repeatedly.

Studies

39


Project Title: MECHANISMS MANIPULATION

AND

EFFECTS

OF

CHIROPRACTIC

Principal Investigator & Institution: Meeker, William C.; Director of Research; Div of Research & Development; Palmer Chiropractic University-West 90 E Tasman Dr San Jose, Ca 94043 Timing: Fiscal Year 2003; Project Start 22-SEP-2003; Project End 31-MAY-2006 Summary: Palmer Center for Chiropractic Research (PCCR) proposes to establish a 3 year multidisciplinary Developmental Center for the Study of Mechanisms and Effects of Chiropractic Manipulation (Center) to increase the level and quality of the ongoing research program, to advance scientific expertise and research infrastructure, and to support enhanced communication and partnering among 12 investigators at Palmer Chiropractic University, the University of Iowa, Kansas State University, State University of New York, and National University of Health Sciences. The Center will facilitate 4 synergistic research projects. The central scientific theme of the Center is focused on spinal manipulation (SM), low back pain (LBP), and the mechanisms of action of SM. The long range goal is to explore and understand the clinical role of SM and the physiological and biomechanical mechanisms of SM loads. Project 1 will study the biomechanical and neurological effects of vertebral loading on the facet joint capsule using an animal model. Project 2 will study the behavioral, biomechanical and biological effects of SM in a rat spine fixation model. Project 3 will explore variables that predict an important clinical effect of SM in patients with LBP, examine changes in biomechanical and physiological functions of patients undergoing SM, and biomechanically characterize 2 forms of SM. Project 4 will study the effect of vertebral loading on sympathetic nerve regulation in an animal model. Projects will be supported by the Data Management and Biostatistics Core, the Biomechanics Core and the Administration Core. Investigators will use pilot data to submit competitive grant applications to NIH, and will provide research training experiences for future CAM investigators. The developmental Center will build on and extend the successful recent history of the NIH supported, Consortial Center for Chiropractic Research at PCCR. It will provide the focus and direction to synergistically increase the "critical mass" of personnel and resources to address an important unmet public health need. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MECHANISMS OF SPECIFIC TRUNK EXERCISES IN LOW BACK PAIN Principal Investigator & Institution: Henry, Sharon M.; Physical Therapy; University of Vermont & St Agric College 340 Waterman Building Burlington, Vt 05405 Timing: Fiscal Year 2003; Project Start 24-MAR-2003; Project End 29-FEB-2008 Summary: (provided by applicant): Poor neuromuscular control, such as delayed muscle recruitment or alterations in levels of muscle activation, can lead to abnormal loads on joints and ligaments of the spine, leading to spinal instability and lower back pain (LBP). Active contraction of trunk muscles helps to control inter-segmental movement and stability in the lumbar spine by adding stiffness to the trunk. Muscle dysfunction associated with LBP has been thought to involve deep, local trunk muscles the transversus abdominis (TA) and multifidus muscles. These muscles are hypothesized to provide stability to the lumbar spine. Treatments which focus on retraining TA and multifidus by using low level isometric contractions of these specific

40

Back Pain

deep trunk muscles during particular tasks and functional activities have been effective at reducing LBP and improving function for selected subgroups of LBP subjects. The precise muscle dysfunction associated with LBP has not been satisfactorily characterized, in part because muscles such as TA and multifidus are difficult to characterize directly given their anatomical location. However, analytical modeling can assist in characterizing these deeper muscles. A more complete characterization of the function of these muscles can lead to more precise treatments of LBP. The three major aims of this project are: 1) to characterize the pre-treatment motor control alterations (alterations in muscle latencies or in modulation of muscle activity level) in subjects with spondylolisthesis and mechanical LBP compared to healthy control subjects, and to determine whether specific deep trunk-muscle exercises (low level isometric contractions of TA and multifidus) improve these alterations compared to a general exercise protocol. We hypothesize that prior to treatment, muscle latencies will be earlier in LBP groups compared to the control group and that the latencies will improve (increase) in LBP subjects receiving specific trunk exercise protocol but not in subjects receiving a general exercise protocol at all time points post-treatment; 2) to employ biomechanical modeling to study mechanisms underlying these specific deep trunk muscle exercises. We hypothesize that increased activation of TA and multifidus muscles increases stability of the trunk by reducing intervetebral motion; and 3) to determine the effects of specific trunk exercises compared to more general strengthening and endurance exercises on pain and function during activities of daily living in the LBP subjects. We hypothesize that subjects in a specific exercise protocol will have decreased pain and increased functional ability compared to subjects in a general exercise protocol, at all time points post-treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MINIMALLY INVASIVE VERTEBRAL TRACKING SYSTEM FOR CAS Principal Investigator & Institution: Glossop, Neil D.; Traxtal Technologies 5116 Bissonnet, #324 Bellaire, Tx 77401 Timing: Fiscal Year 2002; Project Start 26-SEP-2002; Project End 31-AUG-2003 Summary: (provided by applicant): This project will characterize the accuracy of a small magnetic tracking system and develop techniques to improve image-guided, minimally invasive spine interventions. Tracking systems are an integral part of image-guided surgery systems and allow the position of instruments to be followed in threedimensional space. This new generation of magnetic trackers is well suited to less invasive, percutaneous spine interventions because of their small size. The accuracy of the magnetic tracking system will be compared with existing optical tracking systems using well-established engineering methods. New techniques and instrumentation will be developed for embedding these trackers in vertebral bodies and evaluated using an interventional phantom (Phase I) and animal models and cadavers (Phase II). It is anticipated that improved tracking systems for image guidance will enhance minimally invasive spine procedures and lead to decreased morbidity in these commonly performed interventions. Potential clinical applications include percutaneous interventions for low back pain and therapeutic treatments for spinal metastases. The commercial potential for these tracking systems is large, as the market for minimally invasive spine interventions has expanded dramatically in the past decade and is expected to continue to do so. The instrumentation developed here will be offered to computer assisted surgery (CAS) vendors for incorporation into their product lines. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

Studies

•

41

Project Title: MINORITY PREDOCTORAL FELLOWSHIP PROGRAM Principal Investigator & Institution: Vega, Adriana L.; Biomedical Engineering; University of Miami Coral Gables University Sta Coral Gables, Fl 33124 Timing: Fiscal Year 2003; Project Start 01-DEC-2003 Summary: (provided by applicant): High incidences of low-back pain make it a major socio-economic problem in this country. The exact etiology for low-back pain is unknown; however, degenerative changes of the intervertebral disc (IVD), a stabilizing component of the human spine, have been implicated as a possible source of pain. In addition, spine curvature in idiopathic scoliosis is believed to be influenced by IVD properties. The objectives of this research project are to study the biotransport and bioelectrical properties of the intervertebral disc in order to understand the biomechanical behavior of the tissue. The approach to meet these objectives is to determine how these material properties of the IVD relate to tissue composition and structure. It is hypothesized that the transport and electrical properties of the annulus fibrosis (AF), an integral part of the IVD, are dependent on the water content of the tissue. The specific aims and approaches to be addressed in this study are: to test this hypothesis by determining strain-dependent hydraulic permeability (Specific Aim 1), to measure the swelling-dependent electrical conductivity (Specific Aim 2), and to theoretically analyze hydration-dependent ion transport behavior (Specific Aim 3) in lumbar IVDs. The question of anisotropy will be introduced when measuring these properties. Results from these experiments will provide a better understanding of material properties of the IVD, leading to more effective methods of diagnosing, treating, or preventing its degeneration. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: RESISTANCE

MODIFICATION

OF

INTERVERTEBRAL

DISK

FATIGUE

Principal Investigator & Institution: Hedman, Thomas P.; Ampac Biotechnology 25665 Frost Ln Los Angeles, Ca 91381 Timing: Fiscal Year 2001; Project Start 25-SEP-2001; Project End 24-SEP-2002 Summary: (Provided by Applicant): An investigation is proposed exploring the use of biochemical reagents to improve fatigue resistance of intervertebral disc tissue. While not well quantified, the capacity of spinal tissue to withstand repetitive loading is a critically important factor in the progression of spinal osteoarthritis. Current treatments for spinal instability and low-back pain, including spinal fusion, are generally ineffective in slowing the progression of degeneration. Biochemical alterations in the structure of the annular matrix could have significant effects on the disc's ability to withstand repetitive mechanical loading. We intend to study the effectiveness of certain reagents in maintaining the mechanical properties of disc tissues subjected to non-traumatic fatigue loading. Preliminary experiments in our laboratory using novel destructive and nondestructive mechanical testing techniques have shown degradation of elastic-plastic and viscoelastic material properties of disc tissues subjected to non-traumatic cyclic loads. If these reagents are effective in improving fatigue resistance of intervertebral discs, a new, minimally invasive treatment may be developed which will be able to improve the degenerated disc's ability to withstand repetitive physiological loads. This type of treatment has the potential of improving or even replacing numerous surgical interventions directed at the ubiquitous problems of low back pain and instability. PROPOSED COMMERCIAL APPLICATION: Back pain and disability associated with spinal degeneration and instability is without question one of the costliest health

42

Back Pain

problems in western civilization (in the range of $20 billion U.S. annually- low-backpain alone). The commercial potential of a minimally invasive treatment (perhaps a series of injections) capable of arresting degradation and stabilizing intervertebral discs would be staggering. In addition, such treatment could be used as an additional preventative procedure in fusion surgery, where accelerated degeneration commonly occurs at the level adjacent to the fusion. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MOTOR CONTROL DEFICIT IN LOW BACK PAIN: CAUSE OR EFFECT? Principal Investigator & Institution: Cholewicki, Jacek; Associate Professor; Orthopedics and Rehabilitation; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2001; Project Start 01-MAY-2001; Project End 30-APR-2004 Summary: (Verbatim from application) Revised Application: Because the specific causes underlying low back pain LBP have not yet been identified, it continues to be a significant public health problem. Many of the factors associated with low-back pain are mechanical in nature. Epidemiological and biomechanical studies have suggested that there is a link between sudden and unexpected loading, such as slips and falls, and lowback injuries. Under these circumstances, motor control of the mechanical stability of the lumbar spine is crucial in determining trunk kinematic response to sudden loading and the subsequent likelihood of injury. Compared to healthy controls, however, LBP patients exhibit deficits in motor control such as delayed trunk muscle reflex response, poor trunk positioning sense, and impaired postural control. These deficits may constitute predisposing risk factors for sustaining an injury, a compensation/pain avoidance mechanism, or they may be the consequence of damage sustained by the lumbar spine tissues. The objective of the proposed research is to improve our understanding of the relationship between the measured motor control deficit and LBP. Two experimental studies and a post-hoc analysis of the entire data set form the 3 specific aims. The first prospective design study will consist of the initial testing and a 2year follow-up of varsity athletes. The goal is to determine whether poor motor control of the lumbar spine increases the risk for sustaining a low-back injury. The second randomized prospective study will be conducted to document the changes in motor control of the lumbar spine in LBP patients before and after standard and modified rehabilitation programs that emphasize motor control training. Several tests, developed in preliminary studies, will quantify the deficit in the motor control in LBP individuals: response of trunk muscles to a sudden, multi-directional load release and the stability of the lumbar spine, and postural control of the trunk in unstable sitting. Correlations between the above measures of motor control and other variables in the LBP population will be determined in the third specific aim. These additional variables will include: trunk position and motion proprioception, objective and subjective measures of physical function, diagnosis and duration of symptoms, and personal characteristics such as age and gender. The results of the proposed research will have a significant clinical relevance for designing more effective prevention, diagnosis, and rehabilitation strategies for LBP. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

Studies

•

43

Project Title: MULTIPURPOSE ARTHRITIS & MUSCULOSKELETAL DISEASES CENTER Principal Investigator & Institution: Brandt, Kenneth D.; Professor; Medicine; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2000; Project Start 15-SEP-1977; Project End 31-MAR-2004 Summary: The Indiana University Multipurpose Arthritis and Musculoskeletal Diseases Center (IUMAMDC) consists of a Biomedical Research Component, an Epidemiology/Education/Health Services Research (EEHSR) Component and an Administration Unit. Major biomedical research interests include the pathogenesis and treatment of osteoarthritis (OA), the causes of pain and disability in OA, and amyloidosis. Four new Developmental and Feasibility Studies are proposed in this application: one examines the reproducibility of radiographic measurement of joint space width [an issue of great relevance to the design of clinical trials of diseasemodifying OA drugs (DMOADs)]; the second examines the role of arthrogenous muscle inhibition (AMI) as a cause of quadriceps weakness and a risk factor for disability, knee pain and muscle atrophy in subjects with knee OA; the third examines the use and (misuse) of magnetic resonance imaging by primary care physicians evaluating patients with low back pain; the fourth relates to inflammatory arthritis and probes the role of the receptor for platelet activating factor in cellular responses. Our EEHSR component is concerned with training of Fellows, house staff, medical students and arthritis health professionals (AHPs) and includes outreach programs and a variety of interactions with community organizations. Four new EEHSR projects are proposed, 3 of which relate to OA: the first compares the rate of tibiofemoral joint space narrowing among various subsets of subjects representing likely target populations for clinical trials of DMOADs; the second, a prospective study of patients with knee OA treated by primary care physicians in a managed care setting, compares outcomes achieved with standard care to those inpatients treated with a comprehensive program of nonpharmocologic and pharmacologic measures, graduated with respect to risk of side effects, cost and convenience. The third project builds on our observation during the current funding period that quadriceps weakness is common in community-based subjects with knee OA even in the absence of joint pain; it examines the effects of lower extremity strength training on the progression of knee pain, functional impairment and radiographic changes in the elderly. The fourth project examines the clinical and economic effects of a psychosocial intervention inpatients with recurrent acute low back pain. To support the research activities of IUMAMDC, 2 Core units are proposed: Biostatistics and Data Acquisition. Overall Center activities are supported by an Administration Unit. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: MUTATIONS CAUSING DISC DISEASE AND SCIATICA Principal Investigator & Institution: Ala-Kokka, Leena M.; Center for Gene Therapy; Tulane University of Louisiana New Orleans, La 70118 Timing: Fiscal Year 2001; Project Start 27-SEP-1999; Project End 31-AUG-2004 Summary: Low back pain and sciatica are the most common musculoskeletal complaints. Even though secondary factors such as environmental and anthropometric risk factors contribute to intervertebral disc disease, genetic factors may play a significant role in the pathogenesis of the disease. The role of genetic factors is supported by our recent findings: We showed that a tryptophan for glutamine substitution in the alpha2 chain of collagen IX co- segregated with sciatica and

44

Back Pain

intervertebral disc disease in four families with a LOD score of 4.5. Subsequent linkage disequilibrium analysis conditional on linkage gave an additional LOD score of 7.1. Thus, the joint lod score is 11.6 (4.5 + 7.1). In addition, we identified another tryptophan mutation in collagen IX (alpha3 chain). The mutation is significantly associated with the disease (p value: 0.000013) and it increases the relative risk for the disease by a factor of 2.6 (95 percent confidence interval, 1.6 to 4.3). The Specific Aims of the present proposal are: (1) To use the new sequence data from the genes and the new protocols we have developed to analyze DNA from 150 probands with sciatica and 100 probands that have had surgery for herniated discs for mutations in eight candidate genes: three genes for collagen IX (COL9A1, COL9A2 and COL9A3), three genes for collagen XI (COL11A1, COL11A2 and COL11A3 or COL2A1), the aggrecan gene, and the gene for link protein. (2) To evaluate the significance of the sequence variations as disease-causing mutations by analyzing the family members of the probands and non-symptomatic individuals for the presence of the sequence variations. (3) To distinguish neutral polymorphisms from mutations that cause or predispose to intervertebral disc disease, we will also synthesize the normal and mutated recombinant human proteins and determine whether the mutations alter the biological function of collagens IX and XI by assays that include (a) the thermostability of triple helices of the collagens; (b) binding to collagen II; and (c) potential of the collagen IX and XI to alter the self-assembly of collagen II into fibrils in vitro. (4) To do genome-wide screen on 100 affected sib pairs and/or families to identify additional loci for intervertebral disc disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NATURAL PAIN/RADICULOPATHY

HISTORY

OF

ACUTE

LOW

BACK

Principal Investigator & Institution: Modic, Michael T.; Cleveland Clinic Foundation 9500 Euclid Ave Cleveland, Oh 44195 Timing: Fiscal Year 2001; Project Start 01-APR-1999; Project End 31-MAR-2003 Summary: (adapted from Investigator's abstract) Low back pain (LBP) with and without radiculopathy is a poorly defined condition resulting from an interplay of biologic and nonbiologic factors. There is uncertainty regarding its natural history as well as the meaningfulness of many clinical findings. Lumbar magnetic resonance imaging (MRI) is frequently employed in the diagnostic work-up of patients with acute LBP. While this technology provides a high yield relative to detection of morphologic variation within the lumbar spine and associated tissues, the predictive validity of most of these findings remains uncertain. Recent reports have described a high prevalence of morphologic variation in asymptomatic people as well as low correlations between lumbar intervertebral disc impairment and symptom distribution. Thus, in the absence of clinical findings suggestive of serious disease uncertainty exists relative to the diagnostic usefulness and cost- effectiveness of lumbar MRI especially when used in individuals with a recent onset of symptoms. Specific concerns relate to the identification of findings which may guide treatment decision making as well as the role of a patient's awareness of his or her MRI findings in long-term outcome. Because of this, and considering the high cost of this procedure, there is a strong need to investigate the diagnostic efficacy of lumbar MRI's role in the management of patients with LBP and/or radiculopathy. The investigators are proposing a prospective, longitudinal, randomized study which correlates repeated lumbar MRI findings with a series of patient reports and examination findings on large group of people with LBP and/or radiculopathy. The specific aims of this study are to: 1. document the natural morphologic history of LBP in people with and lower extremity radiculopathy, 2.

Studies

45

identify morphologic characteristics of prognostic value, 3. measure the value of diagnostic information per se and 4. estimate the cost- effectiveness of early imaging. The investigators are hypothesizing that findings from lumbar MRI do not predict outcome and that indications for management are clinically based. In addition the authors are hypothesizing that any reduction in anxiety or reassurance associated with knowledge of MRI findings is not cost- effective. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NERVE GROWTH FACTOR DELIVERY FOR ALZHEIMER'S DISEASE Principal Investigator & Institution: Bishop, Katherine M.; Ceregene, Inc. 9381 Judicial Dr, Ste 130 San Diego, Ca 92121 Timing: Fiscal Year 2003; Project Start 30-SEP-2002; Project End 31-AUG-2005 Summary: (provided by applicant): Alzheimer's disease (AD) is the most common dementia, resulting in devastating declines in cognition, quality of life, and financial burden to society. Unfortunately, the prevalence of Alzheimer's disease and the associated costs are predicted to dramatically increase in the future, due to shifts in life expectancy and demographics. Current treatments with cholinesterase inhibitors provide only modest symptomatic relief to a proportion of patients and do not alter disease progression. It has been well established in animal studies that nerve growth factor (NGF) delivery to the brain can prevent the death of and reverse the decline of the same cholinergic neurons associated with the cognitive decline in aging and AD. However, attempts to apply these data to clinical patients by application of intracerebroventricular (ICV) NGF protein infusion resulted in significant adverse effects of weight loss and back pain, due to NGF effects in non-target regions of the CNS. Thus, a means of precisely, selectively, and chronically delivering NGF to degenerating basal forebrain cholinergic neurons in Alzheimer's brains are required. Gene therapy potentially offers such a means. In vivo gene therapy, where vectors are directly injected into the brain, is the most feasible approach for wide-scale commercialization of gene delivery to the central nervous system (CNS). Ceregene Inc. is pursuing commercialization of in vivo gene therapy to deliver NGF to degenerating cholinergic neurons in the nucleus basalis of Meynert (NBM) in patients with Alzheimer's disease. Studies completed in our SBIR Phase I grant period resulted in the design and selection of our lead clinical vector, CERE-110, a replication incompetent genetically engineered adeno-associated virus carrying the human NGF transgene. In our SBIR Phase II grant period, we aim to complete preclinical pharmacology and toxicology/safety studies of CERE-110 in rats and monkeys and file an IND for a Phase 1/11clinical study of CERE-110 in patients with mild Alzheimer's disease. Successful clinical trials would result in the commercialization of CERE-110 as a therapeutic agent for patients with Alzheimer's disease, providing for the first time a means of reducing actual cell loss in any human neurological disorder. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: NEUROBIOLOGY OF MUSCULOSKELETAL PAIN Principal Investigator & Institution: Sluka, Kathleen A.; Physical Therapy and Rehabilitation Science; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2001; Project Start 01-JUL-2001; Project End 30-JUN-2006 Summary: (Taken from the applicant's abstract): The long-term goals are to gain a better understanding of pain associated with the musculoskeletal system and the analgesia produced by physical therapy treatments. The award will allow more research-related

46

Back Pain

time to expand current and develop new collaborative efforts. These collaborative efforts will be aimed at developing new techniques (isolated primary afferent recording and push-pull perfusion), new ideas (mechanisms of analgesia produced by joint mobilization) and expanding current ideas (TENS, microdialysis, muscle hyperalgesia). Interactions with scientists from multiple basic science (Anatomy, Neurosciences, Pharmacology, Chemistry, Molecular Biology) and clinical disciplines (Physical Therapy, Internal Medicine, Anesthesia, Pathology, Chiropractic) provide an interdisciplinary perspective to the examination of musculoskeletal pain and physical therapy pain treatments. Group journal clubs and laboratory meetings are held weekly with several laboratories (Gebhart, Brennan, Hammond, Proudfit, Sluka) investigating pain. The research proposal in this application is designed to characterize a newly developed animal model of chronic pain induced by two unilateral injections of low pH saline into the gastrocnemius muscle. In the work proposed they hypothesize that the development of the long lasting bilateral hyperalgesia is dependent initially on activation of acid sensing ion channels (ASIC) from the site of injection. Activation of acid sensing ion channels results in long lasting, widespread hyperalgesia that is sustained by activation of central mechanisms in the spinal cord. These proposed studies are intended to help in the understanding and thus potential treatment of chronic muscle pain including such conditions as fibromyalgia, myofascial pain and low back pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NEURO-FUZZY PREDICTION OF SPINE LOADS IN RESPONSE TO RI* Principal Investigator & Institution: Marras, William S.; Professor and Director; Industrial, Welding & Sys Engr; Ohio State University 1800 Cannon Dr, Rm 1210 Columbus, Oh 43210 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2006 Summary: Occupationally-related low back disorders (LBDs) continue to be the leading cause of lost work days and the most costly occupational safety and health problem facing industry today. It has been well established that most occupationally-related LBD risk is associated with manual materials handling activities as well as psychosocial influences in the workplace (National Academy of Sciences, 2001). In addition, individual factors can influence risk. However, our ability to characterize risk associated with these various dimensions of LBD risk has been rather poorly understood. Recent literature indicates that a common link within each of these risk dimensions involves increases in trunk muscle coactivation that can lead to increased spine loading and subsequent LBD. Electromyographic (EMG)-assisted models provide the only means to accurately assess and quantify the effect of changes in trunk muscle coactivation upon spinal loading. However, the collection of EMG under most industrial conditions is impractical. The objective of this work is to develop a Spine Loading Assessment System (SLAS) that has the capacity to assess trunk muscle coactivation patterns and subsequent spine loading in response to multiple risk dimensions. This system would permit one to accurately estimate spine loading as a result of physical workplace factors, psychosocial factors, and individual factors but would not require the use of EMG. This objective will be achieved through the development of a Hybrid Neuro-Fuzzy Engine (HNFE). This engine would act as a system artificial "brain" able to synthesize information about the workplace and assess how the trunk musculature would behave. The engine will interface with a well-developed biologically-driven dynamic biomechanical model of the trunk. In this manner, we will be able to accurately predict

Studies

47

spine loading in the workplace in response to various risk factor dimensions without the need to collect EMG data in the workplace. Collectively, the SLAS will have several benefits. First, it can be used to assess the risk of spine structure damage believed to contribute to low back pain as a function of work dimensions commonly associated with the workplace. Hence, this model will have immediate applications to workplace designs. Second, the system will provide insights as to how the various dimensions of risk synergistically impact the musculoskeletal system. Finally, it will facilitate further investigations regarding stability and coactivity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NEUROPHYSIOLOGY OF THE LUMBAR DISC AND ADJACENT TISSUE Principal Investigator & Institution: Cavanaugh, John M.; Associate Professor; Bioengineering Center; Wayne State University 656 W. Kirby Detroit, Mi 48202 Timing: Fiscal Year 2001; Project Start 01-SEP-1994; Project End 30-NOV-2002 Summary: (Adapted from the Applicant's Abstract): This is a re-submission of a competing renewal which has the objective of evaluating the neural mechanisms of low back pain and which attempts to evaluate the potential utility of pharmacological agents designed to treat these disorders in animal models. The central hypothesis of this proposal is that the nucleus pulposus material from herniated discs or injury to the annulus causes inflammatory responses and release of algesic and neurotoxic chemicals that influence the activity of nerve cells within the spinal canal. It is hypothesized that the effects on nerve endings in disc and adjacent tissue lead to low back pain, while the effects on dorsal roots and dorsal root ganglia lead to sciatica. The specific aims of the proposal are to examine these mechanisms using neurophysiological, histological, immunocytochemical and molecular-biologic techniques. The applicants propose to determine whether chemicals known to exist in disc and inflamed tissue act to sensitize nerve endings in spinal cord roots. Additional goals are to determine if this central sensitization occurs in the rat spinal cord when vertebrae are exposed to nucleus pulposus or disc injury and to determine if the sympathetic nervous system contributes to this sensitization. The applicants believe that these approaches will lead to a better understanding of the role of disc injury and nuclear material in low back pain and sciatica, and that the outcomes may be useful in guiding treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: NOCICEPTOR AXONS AND NEURAL INFLAMMATION Principal Investigator & Institution: Bove, Geoffrey M.; Beth Israel Deaconess Medical Center St 1005 Boston, Ma 02215 Timing: Fiscal Year 2001; Project Start 05-FEB-2001; Project End 31-DEC-2002 Summary: (APPLICANT'S ABSTRACT): Neuropathic pain can result from nerve injury or numerous disease processes, and occur without axonal injury. Symptoms are typically difficult to manage clinically, and include nerve trunk pain, perceived locally at the nerve, and dysesthetic pain, perceived in the nerve's distal distribution. Painful symptoms can be spontaneous, and can also be reproduced by many cases of dysesthetic pain by movement of the affected nerve, or the tissue surrounding it. Observations of mechanically-evoked dysesthetic pain imply that axons have or acquire a transductive mechanism at the site of pathology. The proposed experiments address the hypothesis that dysesthetic pain results from sensitivity changes of nociceptor axons due to inflammation of the nerve that carries its axon. Single-unit recording will be

48

Back Pain

made from dorsal root C-fibers with a nociceptive receptive field in the hind limb. The sciatic nerve will be identified in mid thigh, remote from the receptive field. Endogenous algesic chemicals, inflammatory mediators, and pro-inflammatory agents will be applied to the nerve. The properties of the neuron, including the mechanical sensitivity of the axon, will be tested before and at various times following application. In other experiments, a chronic neuritis will be induced and the neurons similarly tested. These experiments test the hypothesis that inflammation of a nerve induces changes in neuronal function. Additional, the answers to the posed questions will address part of a novel hypothesis of movement-induced pain generation. Descriptions of neuropathic pain are similar to those characteristics of some forms of chronic musculoskeletal pain, such as myofascial pain syndrome, fibromyalgia, and back pain. Research into these disorders has focused on various somatic tissues as a pain source, but the etiologies remain elusive and thus the disorder are different to treat. It is possible that these disorders are misdiagnosed neuropathy. Existing data suggest that focal neuropathies are the root pathology in some chronic musculoskeletal diseases, especially back pain, that typically are symptomatically worsened by movement. The information provided by the proposed studies will help form a foundation for development of an animal model of chronic, movement-induced musculoskeletal pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: OCCUPATIONAL HEALTH GRADIENTS IN HOSPITAL WORKERS: THE Principal Investigator & Institution: Blanc, Paul D.; Professor of Medicine; Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 28-SEP-2000; Project End 31-AUG-2005 Summary: (Taken from the Investigators' Abstract) Socioeconomic gradients in health status are ubiquitous in space, persistent in time, and pervasive across diverse health outcomes. Yet little is known of how they arise, and specifically, how great a contribution is made to them by working conditions during adult life. Existing occupational cohort studies, such as the landmark Whitehall publications, have failed to convince some observers that work-related "psychosocial" exposures, e.g., the degree of control felt by employees over their jobs, constitute the key causal influences responsible for socioeconomic gradients in the health of the general adult population, especially gradients in chronic disease. Largely missing in the debate thus far is high-quality evidence on gradients from workplaces with a wide range of jobs -- Whitehall, for example, is fundamentally an office worker study. The present proposal is premised on the view that rich insights into the genesis of such health "gradients" may be gained by studying in detail, over some years, a workplace, such as a hospital, that has a very wide range of jobs, and of employees from different social classes. By far the major "shortterm" occupational health problem of this workforce, and many others, is work-related musculoskeletal disorders (WRMSDs) -- a broad class of outcomes including low back pain and upper extremity injuries, such as tendinitis and carpal tunnel syndrome. Both psychosocial and physical-ergonomic exposures at work are now thought to be joint determinants of these musculoskeletal problems. Thus, psychosocial aspects of work are increasingly recognized as risk factors for both sorts of illness processes: traumatic and chronic disease. Yet there appears to be a dearth of research linking socioeconomic and job-category disparities in the risk of WRMSDs, with well-known gradients in many longer-term health outcomes, particularly coronary heart disease and its risk factors (such as hypertension). The investigators propose a study to shed light on the nature and multi-factorial etiology of hospital gradients, across job categories and employee

Studies

49

social class backgrounds, in the occurrence of several potentially work-related health outcomes in hospitals. The outcomes studied will be lost-time, work-related musculoskeletal disorders, non-invasive measures of allostatic load (salivary cortisol and blood pressure), overall health-related quality-of-life and injury-specific functional status, mental health status, and total sickness/injury absence from work. The influence of both directly observed physical-ergonomic factors at work and psychosocial occupational exposures on socioeconomic gradients in the risk of these conditions will be assessed. Finally they propose to examine, through qualitative research methods, the social contextual factors within participating hospitals, which influence working conditions. The study team will also work with a labor-management team to develop possible interventions for the problems that are identified by this study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: OCCUPATIONAL LOW BACK PAIN IN RESIDENTIAL CARPENTRY Principal Investigator & Institution: Herron, Robin E.; Environmental & Radiological Health Sciences; Colorado State University Fort Collins, Co 80523 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 29-SEP-2003 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: PAIN IN ADOLESCENTS: BIOLOGIC/PSYCHOSOCIAL RISK FACTORS Principal Investigator & Institution: Leresche, Linda A.; Research Professor; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 01-JAN-1989; Project End 31-AUG-2004 Summary: We propose a five-year program of research aimed at assessing the prevalence and incidence of temporomandibular disorder (TMD) pain, headache, back pain, and abdominal pain in adolescents., and identifying risk factors for onset of each of these common pain {{symptoms}}. Because the prevalence of headache and TMD pain is much higher in adult women than in adult men, the studies are designed to test the global hypothesis that this prevalence differences begin in adolescence and are associated with the hormonal change of puberty. The specific aims of study 1 are: 1) In a telephone survey, assess the prevalence, severity and temporal characteristics of TMD pain, headache, backpain and abdominal pain in an age- and sex-stratified random sample of adolescents, ages 11- 17 (final n= 2970) from a defined population; 2) Identify potential risk factors for pain at each of these four sites; 3) Conduct standardized examinations and interviews for all respondents reporting TMD pain, as well as a sample of those without TMD pain (expected n's = 130 per respondents reporting TMD pain, as well as a sample of those without TMD pain (expected n's = 130 peer group) in order to: a) compare the rates of clinical signs and symptoms of temporomandibular disorders in cases and controls, and b) estimate the prevalence of specific clinical subtypes of TMD (myofascial pain, disc displacements, arthralgia, arthritis/arthrosis) using standardized examination methods and diagnostic algorithms. Examinations will be conducted in subjects' homes by Registered Dental Hygienists training and calibrated for reliability. The specific aims of Study 2 are: 1) Follow the cohort of 11 year old respondents from Study 1 (n= 1902) over a 3-year follow up period, using brief mail-in surveys and more extensive follow up data collection at 18 months and 3 years. Monitor rates of onset of TMD pain, headache, back pain and abdominal pain. Assess the impact of these pain problems in terms of interference with activities, use of medications and

50

Back Pain

rates of health care use for pain; 2) Identify risk factors for onset of {{TMD pain, headache, back and abdominal pain}}> Hypothesized risk factors for all pains include: female gender, number of existing pain complaints, and other somatic symptoms, numbers of health care visits in the prior year, and psychological distress; in addition, we hypothesize that sexual maturity is a risk factor for onset of TMD pain and headache; 3) Estimate rates of offset and recurrence of each of the pain c9ompliants over the 3-year follow up period; and, 4) Conduct examinations of the incidence cases of TMD pain, using examination methods and diagnostic algorithms as described for Study 1, to estimate the prevalence of specific subtypes of TMD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PAIN REGULATORY SYSTEM DYSFUNCTION IN CHRONIC PAIN Principal Investigator & Institution: Bruehl, Stephen; Anesthesiology; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2001; Project Start 15-JAN-1999; Project End 31-DEC-2002 Summary: Elevated resting blood pressure (BP) is consistently related to diminished acute pain sensitivity. Ibis cardIovascular-related antinociception (mediated in part by endogenous opioids) is an important component of adaptation to pain in healthy individuals. it is unknown whether these antinociceptive mechanisms operate normally in chronic pain patients. Previous research indicates deficits in endogenous opioid levels in chronic pain patients, although little is known about the functional impact (e.g., diminished analgesia) of these deficits. Given the mediating role of endogenous opioids in cardiovascular-related antinociception and likely opioid deficits in chronic pain conditions, it is hypothesized that chronic pain patients will display alterations in these normally adaptive cardiovascular-pain regulatory relationships. The long-term objective of these studies is to explore the nature of dysfunction in the endogenous pain regulatory systems of chronic pain patients. improved understanding of the mechanisms contributing to chronic pain has the potential to lead to improved treatment for chronic pain patients. The specific aims of these studies are threefold: 1) examine the relationship between resting blood pressure and acute pain sensitivity in both neuropathic and nociceptive chronic pain patients as contrasted to normals, 2) examine possible differences in degree of endogenous opioid mediation of the relationship between resting blood pressure and acute pain sensitivity across the pain patient and normal control subgroups, and 3) examine whether endogenous opioid dysfunction in chronic pain is progressive and therefore related to pain duration. Sixty chronic pain patients (study l=neuropathic back pain, study 2=nociceptive back pain) and 60 healthy controls will undergo a laboratory ischemic pain stimulus once under placebo and once under opioid blockade with naloxone (randomized, counterbalanced order). in both sessions, resting BP will be determined at baseline. Pain patients will also rate their clinical pain before and after drug administration. it is expected that controls will display significant negative correlations between resting BP and acute pain sensitivity, which is at least partially eliminated by naloxone. Pain patients are expected to demonstrate no correlation or a positive correlation between resting BP and acute pain responsiveness, and will be unresponsive to opioid blockade. Greater pain duration is expected to be associated with smaller changes in the BP/pain relationship in response to opioid blockade. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

Studies

•

51

Project Title: PARASPINAL MUSCLE DENERVATION AND SYMPTOMS IN LUMBAR SS Principal Investigator & Institution: Haig, Andrew J.; Phys Med and Rehabilitation; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2001; Project Start 01-JUN-2001; Project End 31-MAY-2004 Summary: Objectives: The clinical syndrome of spinal stenosis is a significant problem for older Americans. Although stenosis causes neurogenic claudication, spinal canal size does not accurately predict the severity of symptoms. A pilot study shows that paraspinal muscle denervation relates to spinal canal size in symptomatic persons. It is possible that paraspinal denervation is a more accurate marker for the clinical syndrome than anatomical imaging. Other research shows that paraspinal denervation in a particular distribution also occurs in younger asymptomatic persons, and denervation increases with age. It is possible that paraspinal denervation causes subtle hypermobility and contributes to Kirkaldy-Willis's degenerative cascade of facet hypertrophy and canal stenosis. Specific Aims: 1. To assess whether paraspinal EMG scores or MRI measurements of stenosis relate best with the clinical syndrome in older persons. 2. To assess whether paraspinal EMG scores predict future symptoms of stenosis and future symptom severity in older persons with and without spinal stenosis. 3. To assess whether change in clinical status relates better to change in paraspinal EMG scores or change in MRI measurement of stenosis. 4. To assess the rate of denervation of the paraspinal muscles in older persons with and without back symptoms. Research Design: Blinded longitudinal study. Methods: Five groups of 30 subjects older than 55 years old, including: asymptomatic persons (healthy persons without low back pain) from the community, persons with lock back pain (LBP) but no stenosis on MRI, persons with stenosis symptoms with mild, moderate, and severe radiographic findings. An experienced neuroradiologist will measure spinal canal size and assign subjects to appropriate categories. A patient questionnaire, physical examination, a walking tolerance test with long latency nerve conduction studies (F- and H- waves) before and after walking, a 7-day pedometer test, and a measure of the flexion-relaxation phenomenon will be administered to the subjects. An unblinded examiner will perform one aspect of the MiniPM paraspinal EMG technique to acclimatize the patient, then a blinded examiner will perform the entire MiniPM, one extremity EMG, sensory and motor nerve conduction studies. Subjects will repeat the test battery (MRI, EMG, and clinical evaluation) approximately 18 months later. Appropriate statistics will test each of the four hypotheses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: PREVENTING CO-MORBID MENTAL & PHYSICAL HEALTH DISABILITY Principal Investigator & Institution: Gatchel, Robert J.; Professor; Psychiatry; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2003; Project Start 01-AUG-1991; Project End 30-APR-2008 Summary: (provided by applicant): Nowhere do psychiatric and physical pathologies interface more prominently than in pain disorders. Patients with chronic pain are at increased risk for anxiety disorders, substance abuse disorders, depression, suicide and sleep disorders. There is now a consensus that it is important to effectively treat pain patients in the acute stage in order to prevent the development of chronic and costly comorbid mental and physical health disability problems. As a continuation of two

52

Back Pain

earlier NIMH funded projects, the present proposed study is designed to evaluate the therapeutic- and cost effectiveness of a three-component biopsychosocial model of early intervention in order to maximize the prevention of chronicity in high-risk acute low back pain patients. This translational biopsychosocial research will be conducted in partnership with the largest workers' compensation company in the U.S. (Liberty Mutual). For this study, high-risk acute low back pain patients will be randomly assigned to one of four intervention conditions, one of which is a non-intervention condition (45 subjects/condition). The differential impact of these conditions will be evaluated in terms of the prevention of chronic mental and physical health disability evaluated during a one-year follow-up period after intervention. A secondary goal of this project is to begin to evaluate the validity of Melzack's neuromatrix model of the relationship between emotional distress and pain within the context of the present experimental design. Major mental health outcome variables will include DSM-IV Axis I and Axis II diagnoses, anxiety/fear, depression, coping skills, and psychotropic medication use. Major physical health outcomes will include socioeconomic variables such as return-to-work, injury recurrence, healthcare utilization, and functional disability related to pain, as well as associated free cortisol levels. It is hypothesized that the high-risk non-intervention group patients will display significantly higher rates of chronic mental and physical health disability at one year relative to the other intervention groups; the most comprehensive biopsychosocial intervention will be associated with the lowest rates. These results will have implications for potentially significant healthcare cost savings for this highly prevalent co-morbid disability problem. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROGRAM PROJECT GRANT Principal Investigator & Institution: Andersson, Gunnar Bj.; Professor and Chairman; Rush-Presbyterian-St Lukes Medical Ctr Chicago, Il 60612 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-JUL-2006 Summary: (provided by applicant): The underlying primary hypothesis of the Program project is that intervertebral disc degeneration contributes to low back pain and a second hypothesis is that the process of degeneration can be prevented, retarded or repaired. Our premise is that both biological and biomechanical factors contribute to the pathogenesis of disc degeneration. The Program project therefore, addresses both the biomechanical and biological aspects of disc degeneration. By improving our understanding of the degenerative process and by exploring different approaches to diagnose, prevent, retard or repair the degenerative process, we will ultimately decrease the problem of low back pain in society. The approach taken in this Program project is to address (1) diagnostic techniques by which the impact of the degenerative changes can be assessed in vivo; (2) mechanical factors contributing to the development of degenerative disc changes; (3) biochemical changes occurring with disc degeneration and; (4) methods to slow, reverse or repair the degenerative process. The Program project will be completed using a multi-disciplinary approach with the participation of members from orthopedic surgery, radiology, biomechanics, anatomy, biochemistry, and molecular biology. Project I will study in vivo segmental spine motion of the lumbar spine in normal volunteers and discogenic low-back-pain patients. Project 2 will look at the relationship between disc injury and repetitive loading using finite element models with experimental validation. Project 3 will determine how changes in disc structure and composition correlate with changes in the metabolism of cells from the NP and AF and will use culture models in vitro to study degenerative processes and the

Studies

53

ability of specific growth factors to promote repair. Project 4 will study regeneration of the intervertebral disc matrix by assessing the effects of growth factors and gene gun mediated gene transfer of growth factors to intervertebral disc cells. At the end of the program period we will have: (1) New diagnostic techniques to better assess clinically the mechanical consequences of disc degeneration on the intervertebral disc. (2) An improved understanding of the effects of repetitive loading on the mechanical integrity of the intervertebral disc, and this information can be used to identify appropriate subjects for treatment. (3) Knowledge about the relationship between disc degeneration and changes in the metabolism of the extracellular matrix of the intervertebral disc as well as alterations in the expression of specific genes by disc cells. This will provide a platform for biochemical or molecular therapeutic approaches for intervertebral disc degeneration. (4) Knowledge about alternative approaches to prevent, retard or repair disc degeneration based on the degree of degeneration. Each of the projects are highly integrated with each other and supported by Biomechanics, Biochemistry and Administrative Cores. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PSYCHOSOCIAL, BEHAVIOR AND IMMUNE FACTORS IN BACK PAIN Principal Investigator & Institution: Hurwitz, Eric L.; Assistant Professor; Epidemiology; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2001; Project Start 01-MAY-2000; Project End 30-APR-2005 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: QUANTATIVE MEASUREMENT OF LOW BACK IMPAIRMENT Principal Investigator & Institution: Kotzar, Geoffrey M.; Research Scientist; Biomec, Inc. 1771 E 30Th St Cleveland, Oh 44114 Timing: Fiscal Year 2002; Project Start 19-SEP-2002; Project End 31-AUG-2003 Summary: (provided by applicant): Injuries to the lower back are the second most prevalent disorder presented to medical practitioners today (second only to upper respiratory ailments) and are often the most difficult to diagnose or treat. The myriad of current methods used in evaluating lower back injuries and disorders (LBDs) are very subjective. Consequentially, the number of insurance claims and the amount of each claim push this ailments costs over the $100 billion mark in the US alone. There are no clinical methods/devices that remove the subjectivity from the assessment of impairment due to LBDs for most patients. A quantitative laboratory research tool (device) has been developed and shown to add objectivity to the evaluation of LBDs. One objective of this project is to update the technology, making a device suitable for clinical use. Another objective is to assess the new tool against the current one in the laboratory to assure that no feature of the original device has been lost or compromised. Based on this assessment, a clinically viable device will be available for the quantitative evaluation of LBDs, which promises to reduce the subjectivity of the clinical evaluation and the subsequent costs in treating the disorder. PROPOSED COMMERCIAL APPLICATION: According to the U.S. Center for Healthcare Statistics, 80% of adults seek care for low back pain at some time in their lives, and 50% of adults have an episode of low back pain in any given year. The problem is wide spread, difficult to diagnose and expensive to treat. The potential markets for the device we propose to

54

Back Pain

develop are physical therapy clinics, insurance companies, government organizations (NIOSH, OSHA, etc.), manufacturing companies (workplace assessment), orthopedic clinics, and companies that make office equiment (ergonomic assessment). Focussing only on the physical therapy clinics, there are over 98,000 such clinics according to data from the American Physical Therapy Association and the American Hospital Association. This number has remained relatively stable and could be expected to remain static over a forecast period of the next five years. Even with a small market penetration of only 0.1% per year, our sales can be expected to reach $2 million the first year and increase by $2 million per year over the next five years, for a total of 0.5% penetration and $10 million annually at the end of five years. At this rate, market saturation will not occur in any forseeable future. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RACE AND OUTCOMES IN WORK-RELATED BACK INJURIES Principal Investigator & Institution: Tait, Raymond C.; Psychiatry; St. Louis University St. Louis, Mo 63110 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 31-JAN-2005 Summary: Occupational low back injury, a significant economic and healthcare problem in the U.S., has proven difficult to manage consistently and cost-effectively. Recent studies have shown medical management of low back pain to be highly variable. With respect to Workers' Compensation, apparent disparities in assessment and treatment associated with race have also been identified. While this research demonstrated potentially inequitable treatment of injured minorities with low back injuries, the representativeness of the results and their implications for post-settlement outcomes (i.e., clinical adjustment and employability) remain unknown. This historical cohort study is designed to identify potential race-related disparities in occupational healthcare, define the scope of the problem, and to assess the impact of such disparities on post-settlement adjustment. The study will examine a cohort of African Americans and White workers who incurred disabling low back injuries in the State of Missouri and whose disability claims were settled during the year 2001. Records of the Missouri Division of Workers' Compensation (MODWC) will be used to identify those claims from three Missouri population centers (St. Louis City, St. Louis County, Jackson County), where the majority of African Americans in Missouri reside. MODWC records will provide data relevant to medical costs, temporary total disability costs, permanent disability costs, and other injury-related matters for all claimants with work-related low back injuries leading to missed work time. Computer Assisted Telephone Interviewing methods will be used to assess post-settlement adjustment. Regression models will be used to assess the relationship of race and legal representation, alone and in interaction, with Workers' Compensation outcomes and post-settlement adjustment of claimants. The historical cohort design will address three weaknesses in the present state of knowledge. First, it addresses potential associations between race, treatment, and disability outcomes, an area that has been neglected. Second, it addresses relations among the above constructs and the post-settlement adjustment of claimants. Moreover, because of the sample size and the design, we will be able to separate the effects of potentially confounding variables (e.g., job type, socioeconomic status), both alone and in interaction with race. Finally, by dint of the procedures needed to recruit participants, the study will establish a cohort of injured workers whose adjustment can be monitored not only at the time of this study, but potentially beyond that time frame. If the cohort is examined at a later point in time, it will be possible to track true long-term outcomes of occupational healthcare.

Studies

55


Project Title: RACE IN PHYSICIAN DECISION TO PRESCRIBE OPIOID ANALGESIA Principal Investigator & Institution: Sarver, Joshua H.; Metrohealth System 2500 Metrohealth Dr Cleveland, Oh 44109 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2004 Summary: (provided by applicant) Several studies have shown that racial and ethnic minorities are less likely to receive analgesics. This study presents a theoretical framework for understanding these differences. The aim of this study is to begin to test this framework by conducting a series of mail surveys with case scenarios to determine: 1) the effect of race on physicians? use of analgesics for 3 acute, painful conditions (back pain with sciatica, ankle fracture, and migraine headache); 2) whether providing information on patients? socioeconomic status, role impairment, and likelihood that narcotics might be misused mitigates the effect of race on physicians? decisions to prescribe analgesics; and 3) whether physician characteristics are related to differential treatment of racial and ethnic minorities. Phase 1 of this study will determine clinical factors that influence physicians? decisions to prescribe opioid analgesics for the 3 conditions (regardless of patients? race/ethnicity) using individual physician interviews and a mail survey of 650 emergency department physicians. In phase 2, information from phase 1 will be used to construct scenarios that include information on the most important clinical factors affecting prescribing opioid analgesics. Two versions of each of the 3 scenarios will be constructed: 1) clinical factors plus race (race only); and 2) clinical factors, race, and information on patients? socioeconomic status, role impairment, and likelihood that narcotics might be misused (race plus). These scenarios will be mailed in random order to 6075 emergency department physicians. Responses will be analyzed to determine whether racial and ethnic minorities are less likely to receive opioids with the race only scenarios (Aim 1), whether any difference in treatment persists for the race plus scenarios (Aim 2), and whether physician characteristics obtained from the phase 2 mailing explain lower use of opioid analgesics (Aim 3). This study moves investigation beyond documentation of racial disparities in treatment and toward theory based hypothesis testing. Understanding the causes of racial disparities will permit careful development of targeted interventions to address possible racial disparities in physician treatment decisions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: RADIOTHERAPY--PREVENT LAMINECTOMY

FIBROSIS

AFTER

LUMBAR

Principal Investigator & Institution: Gerszten, Peter C.; Neurological Surgery; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 31-JUL-2003 Summary: Perineural scar formation, also known as peridural fibrosis, is a common occurrence after lumbar discectomy surgery. Peridural fibrosis can cause compression or tethering of the nerve root and has been implicated in recurrent radicular and/or low back pain after a lumbar discectomy. Fibrosis may be the underlying cause in as many as a quarter of all failed back surgery syndrome cases. Reoperation with the intention of excising this fibrous tissue often produces a poor surgical result and further scarring. Furthermore, a large variety of materials have been implanted onto the dura in animal models with the goal of preventing perineural fibrosis with only modest success. Low

56

Back Pain

dose radiation has long been known to inhibit fibroblast and osteoblast activity. Perioperative radiation therapy has been demonstrated to be a useful method to prevent both keloid and heterotopic bone formation in human trials. Radiation has not previously been studied as a means to inhibit peridural fibrosis. Our previous studies investigating in both rat and dog models showed a significant reduction in peridural fibrosis after laminectomy using low dose external beam radiation (700 cGy) given 24 hours prior to surgery. Based on these preliminary data, we will test the hypotheses that (1) preoperative low dose external beam radiation given 24 hours prior to surgery will decrease the amount of peridural fibrosis in humans, and (2) this reduction in peridural fibrosis will lead to an improvement in patient outcome. For this study, patients will be enrolled in a randomized double-blinded controlled clinical investigation either to preoperative radiation (treatment group) or no preoperative radiation (control group) prior to surgery. Patients will be followed at 1, 3, 6, and 12 months with self- report instruments of function, measures of impairment, and magnetic resonance imaging. As more than 10,000 patients per year in the United States have failed back surgery syndrome thought secondary to peridural fibrosis, this novel treatment strategy would be efficacious to a large number of patients with this disease process. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RAPID MR VS XRAY: RANDOMIZED OUTCOME TRIAL FOR BACK PAIN Principal Investigator & Institution: Jarvik, Jeffrey G.; Professor; Radiology; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 30-SEP-1998; Project End 31-DEC-2002 Summary: We have developed a rapid magnetic resonance imaging (MRI) study of the lumbar spine that can be performed using nearly all clinical MRI scanners. Because the total imaging time is only approximately 2 minutes, the rapid MRI is cost competitive with plain films. Thus, it has the potential for playing a major role in the diagnosis and subsequent treatment of patients with low back pain. Our goal is to examine the consequences of substituting the rapid magnetic resonance (MR) scan for plain film xrays as the initial imaging examination in patients with low back pain. We will test the hypothesis that substituting a rapid MRI for plain films will not only result in better patient outcomes, but will also be more cost-effective. Using a rapid MRI early in the care of patients with low back pain might benefit patients by: 1) providing a more rapid definitive diagnosis; 2) obviating further imaging or referral; and 3) reassuring both patient and physician that there is no serious disease. There is a risk that the incidental abnormalities commonly seen on lumbar spine MRI might lead to unnecessary diagnostic and therapeutic interventions that otherwise would not have been performed, resulting in both worse patient outcomes and higher costs. Evaluating these competing possibilities requires measuring actual patient outcomes, and not merely image quality or diagnostic accuracy. To test our hypothesis, we will recruit 372 patients with low back pain for whom plain x-rays have been requested, and randomly assign them to receive either plain films or the rapid MRI. Patients will then be followed for 12 months to ascertain clinical outcome and patient satisfaction, impact on diagnostic and therapeutic decision-making, and utilization of resources. Estimates of the total annual direct and indirect costs attributable to low back pain in the U.S. approach 50 billion dollars. Even if the rapid MRI saves only 1 percent of only the direct medical costs, this translates into 240 million dollars/year. It is likely that use of the rapid lumbar MRI will increase over the next several years. Our goal is to evaluate the practical and realistic consequences of replacing lumbar spine x-rays with this promising new technology. We

Studies

57

have a window of opportunity before the rapid MRI becomes widely disseminated and a randomized trial is made impossible by the expectations of both patients and physicians. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SAFETY OF LUMBAR FUSION SURGERY FOR CHRONIC BACK PAIN Principal Investigator & Institution: Mirza, Sohail K.; Associate Orthopaedics/Sports Medicine; University of Washington Seattle, Wa 98195

Professor;

Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 30-JUN-2007 Summary: (provided by applicant): Although I have been successful as a spine surgeon in an academic environment, building a respected clinical practice and completing spine biomechanics research for competitively funded projects, I realize that clinical research most directly addresses my motivation for choosing an academic career, and that highquality clinical research is complex, requiring a long-term commitment and specialized skills. I am in an excellent environment to develop these skills, with supportive colleagues and a supportive chairman. I have developed a five-year training schedule, with the first three years devoted to obtaining an MPH degree. A team of three outstanding individuals has committed to working with me for the next five years and guiding my career development. My immediate goal is to gain practical clinical research experience by conducting a five-year prospective study with this team of experienced and highly respected researchers. My long-term career goals are to help identify spine patient populations more concretely, measure end-results of spinal disorders in general, and define outcomes for treated and untreated back pain and whiplash injuries in particular. Research Project: The use of surgery for back pain is rapidly growing; data on its safety and outcomes are sorely needed. We propose a prospective cohort study to measure the frequency of complications in lumbar fusion surgery, variation in rates of specific serious complications with different types of lumbar fusion, clinical and functional consequences for specific types of complications, and patient or treatment characteristics that predict particularly severe complications. Over a two-year interval, we propose to enroll 1000 patients choosing fusion surgery for treatment of disc degeneration, spondylolisthesis, spinal stenosis, and adult degenerative scoliosis. We will follow these patients for two years, measure predictor patient and treatment characteristics, and measure consequences with clinical and functional outcomes. Accumulating data will be stored in an existing central database. The analysis will use appropriate univariate and multivariate techniques to address the study questions. This study will provide data on the relative benefits and risks of lumbar fusion surgery in treating back pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SEGMENTAL SPINE MOTION OF THE LUMBAR SPINE Principal Investigator & Institution: Lim, Tae-Hong; Rush-Presbyterian-St Lukes Medical Ctr Chicago, Il 60612 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-JUL-2006 Summary: (provided by applicant): Segmental instability and degenerative changes of the lumbar spine is considered a major etiology of persistent low back pain. However, the anatomic changes in the intervertebral disc, vertebral body, and facet joints associated with instability are not clearly known yet, and their relationship with pain is even more elusive. Because of the widespread nature of disc degeneration which can

58

Back Pain

occur with and without segmental instability, it is essential to develop methods to diagnose this entity and to provide effective treatment, which is the long-term goal of our research. We propose a 5-year study of the in vivo relationship of degenerative changes and segmental instability of the lumbar spine. In this study, we will compare 56 asymptomatic normal volunteers and 56 age- and sex-matched symptomatic patients. Hypotheses that we will test in this study are: (1) in vivo torsional instability of the lumbar spine is greater in grade 3 or 4 (moderate or severe) degenerated discs than in normal or grade 5 (advanced) degenerated discs; (2) Degenerative changes in the facet joints and vertebral bodies are significantly correlated with torsional instability and disc degeneration; and (3) There are significant differences in these relationships between the asymptomatic volunteers? group and the symptomatic patients? group. The specific aims are: (1) To establish an in vivo relationship between segmental motion characteristics and degenerative conditions of the intervertebral disc and facet joints; and (2) To compare the in vivo relationship between motion and degenerative conditions found in asymptomatic normal volunteers with that determined in age- and sex-matched symptomatic patients. Torsional motions resulting from passive manipulation of the trunk will be measured using computed tomography (CT) based non-invasive 3-D motion analysis method that we have previously developed. Flexionextension motions will be measured from dynamic radiographs taken in the lateral decubitus position when the subjects produce the maximum voluntary motions. Dynamic radiographs will also be used to measure any osteophytes on the vertebral bodies. Degenerative changes of the discs and facet joints will be measured using T2weighted sagittal and proton density axial magnetic resonance (MR) images. Pain level will be evaluated using an analogue visual scale from 0 to 10, and the subjects' physical conditions, such as other disease and activity levels, will be evaluated using a Subject Information Sheet designed for patient evaluation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SELF SYSTEM THERAPY AND CHRONIC LOW BACK PAIN Principal Investigator & Institution: Keefe, Francis J.; Professor and Associate Director; Psychiatry; Duke University Durham, Nc 27706 Timing: Fiscal Year 2003; Project Start 15-JUN-2003; Project End 31-MAY-2007 Summary: (provided by applicant): Patients with chronic low back pain (CLBP) cope with numerous major life challenges associated with their disorder, including changes in their ability to work, as well as decrements in physical and emotional well being. These changes alter CLBP patients' ability to pursue and achieve important personal goals and live up to personal standards. As a result, CLBP patients are highly likely to experience substantial difficulties with self-regulation, i.e., the ongoing process of evaluating and regulating one's behaviors so as to meet important personal goals and standards. In turn, the inability to attain important goals and standards increases risk for depression. The long-range goal of this research is to reduce the depression, pain, psychological disability, and physical disability experienced by CLBP patients suffering from depression. The proposed study seeks to evaluate the efficacy of Self-System Therapy (SST), a new therapy for depression specifically targeting problems in selfregulation. A total of 174 CLBP patients who meet DSM-IV criteria for major depressive disorder will be randomly assigned to one of three conditions: 1) Self-System Therapy (SST) - a twelve-session version of SST adapted to the concerns of CLBP patients; 2) Back Pain Education - a comparison condition that provides patients with information on the nature and treatment of chronic low back pain; or, 3) Standard Care Condition - a control condition in which patients will receive care requested by them and made

Studies

59

available to them by their health care provider. Assessment measures to be gathered before and after treatment and at 6- and 12-month follow-up will include depression, physical and psychosocial disability, pain and coping self-efficacy, self-regulatory focus, and self-discrepancies. Daily measures of pain, mood, goal activation/attainment, and stress will also be gathered. Converting basic knowledge about the causes and consequences of unsuccessful self-regulation to the diagnosis and treatment of depression in CLBP patients represents a promising avenue for identifying treatment options appropriate for these individuals. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: STABILITY OF MUSCULAR LOADING OF THE LUMBAR SPINE Principal Investigator & Institution: Stokes, Ian A.; Research Professor; Orthopedics and Rehabilitation; University of Vermont & St Agric College 340 Waterman Building Burlington, Vt 05405 Timing: Fiscal Year 2001; Project Start 01-SEP-1994; Project End 30-JUN-2003 Summary: A combination of muscle stiffness and spinal motion segment stiffness protect the lumbar spine against the possibility of buckling instabilities. This is an application to support continued research (of R01 AR 44119) analyzing and quantifying the degree of muscle stiffness required for stability under a variety of loading conditions and spinal postures. Previous analyses have predicted that antagonistic muscle activation would increase stability, and the existence of such antagonistic activity has been confirmed in experimental studies documenting muscle activation electromyographically. The overall hypothesis is that impaired muscular control might predispose the lumbar spine to injurious buckling episodes. The proposed continuation studies will focus on four main areas of work: (1) human subject experiments to characterize muscle activation patterns under gradually increasing efforts and under perturbed loading conditions, and to measure driving point stiffness of the trunk, from which muscle stiffness will be deduced under differing activation conditions; (2) Experimental quantification of the stiffness of lumbar spinal motion segments (with and without intact posterior elements) under physiological conditions of axial compressive loading and surrounding fluid medium. (3 Simulations of these experiments will be performed using a new analytical model which calculates the muscle activation pattern required to optimize a variable combination of five cost function components, namely the global motion of the spine, intervertebral displacements, loading of intervertebral motion segments, the sum of cubed muscle stress and stability (via the magnitude of eigenvalues of the system stiffness). Some of the experimental data from human subject and motion segment studies will be used to assign values to parameters in the model, other data will be used to validate the model. (4) Longitudinal studies of muscle function in subjects with intermittent low back pain will indicate whether these individuals have muscle activation behaviors conducive to spinal instability. These studies will help to define the relative roles of muscle stiffness and spinal stiffness in stabilizing the spinal column. They will identify the conditions under which (1) reduced motion segment stiffness, (2) reduced muscular stiffness or (3) abnormal patterns of muscle recruitment might place the lumbar spine at risk for self-injurious buckling episodes under apparently benign external loading conditions. In addition, the specific roles of individual muscles will be better elucidated, which will be helpful in guiding therapy for people with low back dysfunction. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

60

Back Pain

•

Project Title: STUDY OF CHEMOGENIC LOW BACK PAIN Principal Investigator & Institution: Zhang, Junming; Anesthesiology; University of Arkansas Med Scis Ltl Rock 4301 W Markham St Little Rock, Ar 72205 Timing: Fiscal Year 2001; Project Start 01-JUL-2000; Project End 30-JUN-2004 Summary: (adapted from applicant's abstract): The overall goal of our research is to better understand the etiology and mechanisms of low back pain and sciatica. Clinical studies indicate that degenerative changes and traumatic injuries of the spine are often associated with mechanical compression and chemical irritation of dorsal root ganglia (DRG). DRG neurons can be exposed to inflammatory cytokines that are released from a herniated nucleus pulposus (HNP) or synthesized inside the ganglion in response to injury. However, the specific role of cytokines and cytokine-induced inflammation in the generation of spontaneous activity and enhancement of neuronal excitability is still unknown. We hypothesize that DRG neurons may develop hyperexcitability in response to peripheral nerve or ganglion injury such that the release of inflammatory cytokines from the injured neurons, the macrophages, the glial cells or the HNP activate hyperexcitable DRG neurons and lead to pain. Using a new animal model of neuropathic pain, involving compression of the L5 lumbar ganglion with a hollow stainless steel rod, we will test our hypothesis via 3 Specific Aims. SA1. Determine whether elevated release/synthesis of cytokines enhances the excitability of normal DRG neurons. SA2. Determine if endogenous inflammatory cytokines contribute to the generation and maintenance of spontaneous activity in compressed DRG neurons and if exogenous cytokines enhance this activity. SA3. Determine whether cytokines contribute to the development and maintenance of cutaneous hypersensitivity in CCD rats. A novel feature of our animal model is that the inserted rod allows local delivery of cytokines to the compressed ganglion in vivo. With this model, we will study how cytokines affect the excitability of DRG neurons and correlate these effects to behavioral measures of hyperalgesia and allodynia. If a relationship between specific cytokines and the sensory hyperexcitability responsible for neuropathic pain is identified, then new therapeutic approaches involving pharmacological modulation of cytokine release or synthesis could be developed to control pain in individuals with an acutely herniated lumbar disc, spinal stenosis, tumor, or other injury or disease of the spine. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: THE EFFECTS OF POSITIONING AND ADJUSTING ON THE Z JOINT Principal Investigator & Institution: Cramer, Gregory D.; Dean of Research; Research; National University of Health Sciences 200 E Roosevelt Rd Lombard, Il 60148 Timing: Fiscal Year 2001; Project Start 05-JUN-2000; Project End 31-MAR-2003 Summary: (adapted from Investigator's abstract) This is a "proof of concept" study evaluating the mechanism of action of lumbar spinal manipulation. A fundamental hypothesis of chiropractic is that adhesions develop in the zygapophysial joints (Z joints) following hypomobility of these structures. Such adhesions are thought to be alleviated by separation (gapping) of the Z joints. Side posture adjusting is thought by many to gap the Z joints, yet no measurable differences of the Z joints before and after spinal manipulation have ever been published. The purpose of this study is to determine if differences can be measured in the L3-S1 Z joint spaces before and during side posture positioning of the lumbar region and also before and after lumbar side posture spinal adjusting. More specifically, this study will evaluate gapping of the L3/L4, L4/L5, and L5/S1 Z joints by taking measurements directly from MRI scans of

Studies

61

the Z joints before and during positioning for a side posture adjustment and before and after side posture adjusting. To begin this study, healthy volunteers (32 female and 32 male) will be solicited. The volunteers will then be randomized into one of four groups: 1) neutral position followed by side posture positioning (trunk rotated to the subject's right), 2) neutral position followed by side posture spinal adjusting followed by neutral positioning, 3) neutral position followed by side posture spinal adjusting followed by side posture positioning, and 4) neutral position followed by neutral position (control group). MRI scans will be taken with the subjects in the original neutral position and in the final position (either second neutral position or side posture positioning). The experiments for each subject will be conducted over approximately a forty-five minute period. Three independent observers will be trained to make measurements of the Z joints directly from the MRI scans. The measurements will evaluate the anterior-toposterior dimensions (gap) between the superior and inferior articular facets. The observers will not have access to the results of one another, and the MRI scans will be coded so that the observers will have no subject information and no indication as to whether any scan is pre- or post-treatment. The data will be analyzed to determine if differences exist between the before and during side posture positioning scans, the preand post manipulation scans, and the control group. The results of this 'proof of concept" study will be used to increase understanding of the mechanism of action of the lumbar side posture adjustment. If the results of this trial demonstrate gapping of the Z joints following manipulation, the next logical step would be the design and implementation of larger clinical trials using these same methods to evaluate the effects of side posture adjusting on the Z joints of subjects with acute and then chronic low back pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TRUNK CONTROL IN SUBJECTS WITH AND WITHOUT LOW BACK PAIN Principal Investigator & Institution: Cacciatore, Timothy W.; None; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2002; Project Start 14-JUN-2001 Summary: The overall goals of the proposed research are to gain a better understanding of how the nervous system coordinates the trunk to maintain equilibrium, and to determine if subjects with idiopathic low back pain have abnormal coordination. A movable platform will be used to translate the support surface and perturb equilibrium. The resulting response to maintain balance will be examined by extensively measuring trunk kinematics, surface reaction forces, and the activity of many trunk muscles. The first specific aim is to examine normal subjects: (A) To determine the overall kinematic and muscular strategies for stabilizing the trunk during sitting and standing in response to perturbations in different directions. This will address is there are different strategies and whether they are similar for sitting and standing; (b) To determine the degree to which the nervous system controls trunk muscles together or in fixed patterns. This will be determined by measuring spatial and temporal correlations of trunk muscles, and will address how the nervous system controls the large number of back muscles. The second specific aim is to determine if selected groups of patients with idiopathic low back pain have abnormal coordination of the trunk. To avoid confounding different pathologies, this study will only examine patients which fall into two homogeneous classes based on clinical measures. Using the same protocols as normals, the proposed study will examine whether either group of low back pain patients has abnormal motor control, and if abnormalities are different between the two groups. Through measuring

62

Back Pain

kinematics, forces and muscular activity, this study will increase our basic knowledge of how the trunk is controlled and determine if subjects with low back pain have altered motor control. A detailed characterization of the abnormalities of low back pain subjects will provide a basis to examine causal relationships between motor control and back pain and to develop therapeutic interventions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: USUAL CARE VS. CHOICE OF ALTERNATIVE RX: LOW BACK PAIN Principal Investigator & Institution: Eisenberg, David M.; Instructor in Medicine; Beth Israel Deaconess Medical Center St 1005 Boston, Ma 02215 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-AUG-2002 Summary: This study, which implements procedures used in a completed pilot study (n=60), compares two approaches to the management of acute low back pain: usual care (standard benefit) vs. the choice of: usual care, chiropractic, acupuncture or massage therapy (expanded benefit). 480 subjects will be recruited from a health maintenance organization, Harvard Pilgrim Health Care/Harvard Vanguard Medical Associates. Patients with uncomplicated, acute low back pain will be randomized to either usual care (n=160) or choice of expanded benefits (n=320). Patients' preferences for individual therapies and expectations of improvement will be measured at baseline and throughout the study. Subjects randomized to the expanded benefits arm who choose chiropractic, acupuncture or massage will receive up to 10 treatments over a five-week period. Additional treatments will be available after the fifth week but will require a copayment. Treatments will be provided by licensed providers who have met strict credentialing criteria. Chiropractic, acupuncture or massage treatments will begin within 48 hours. Chiropractic, acupuncture and massage therapy scope of practice guidelines for the treatment of acute low back pain have been developed as have detailed data tracking procedures to be used at each patient visit. Symptom relief, functional status, restricted activity days, use of health care, and patient and provider satisfaction will be assessed at 2, 5,12, 26 and 52 weeks after initiation of treatment. Primary outcomes will include: 1) change in symptoms; 2) change in functional status; 3) patient satisfaction; and 4) total utilization of services associated with care for low back pain. Medical records and the HMO's cost management information system will identify use of services. All procedures have been successfully incorporated in an ongoing pilot (feasibility) study. It is hypothesized that patients offered their choice of expanded benefits will experience a more rapid improvement in symptoms, a faster return to baseline functional status, a decrease in utilization of conventional medical services, and will be more satisfied with their care. The study is a direct examination of the effectiveness of an insurance eligibility intervention, not a test of the efficacy of specific, non-allopathic treatment regimens. The results of this study will provide valuable information to clinicians, patients and third party payers on the relative benefits and costs of an "expanded benefits" treatment option which incorporates chiropractic, acupuncture and massage services for low back pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: VERTEBRAL POSITION ALTERS MUSCLE SPINDLE SENSITIVITY Principal Investigator & Institution: Pickar, Joel G.; Associate Professor; Research and Development; Palmer Chiropractic Universtiy 1000 Brady St Davenport, Ia 52803 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2007

Studies

63

Summary: (provided by applicant): Idiopathic low back pain and the therapeutic use of spinal manipulation make a significant impact clinically, socially, and financially. It has been estimated that more than 75 percent of us will experience low-back pain at some time in our lives costing an estimated $20-$50 billion annually. Recent findings from meta-analyses indicate that spinal manipulation can be recommended clinically for the treatment of acute and chronic idiopathic low back pain. Chiropractors deliver more than 90 percent of spinal manipulations performed in the United and annual expenditures on chiropractic services exceed $4.7 billion annually. Neither the causes of idiopathic low back pain nor the mechanisms underlying the physiological effects of spinal manipulation are well understood. Recent investigations by the applicant indicate that the mechanical history of a vertebra alters the sensitivity of lumbar paraspinal muscle spindles to subsequent vertebral movement. Muscle spindle discharge in response to vertebral gliding (translation) depended upon whether the vertebra had been previously held in a position that unloaded or loaded the spindle for as little as 5 seconds. We believe this novel finding in the spine is important because motion segments are continually subjected to passive forces that can fix their spatial orientation. The proposed experiments are based upon 3 hypotheses. (1) Sensitivity of paraspinal muscle spindles to vertebral translation increases when linear displacement of the vertebra has previously unloaded the paraspinal muscle spindle. (2) Sensitivity of paraspinal muscle spindles to vertebral translation decreases when linear displacement of the vertebra has previously loaded the paraspinal muscle spindle. (3) The therapeutic effects of spinal manipulation may be mediated, in part, by its ability to correct the positional-history-dependent changes in paraspinal muscle spindle sensitivity. Historydependent alterations in sensory feedback from paraspinal muscle spindles could lead to proprioceptive errors and adversely affect neural control of segmental motion. Knowledge of mechanical factors that affect sensory input from vertebral tissues will help provide a better understanding of the most appropriate preventive and therapeutic interventions for spinal care. Spinal manipulation is inherently a biomechanical intervention and the therapeutic successes of spinal manipulation for idiopathic low back pain may relate, in part, to the mechanical component of idiopathic low back. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VIBRATION, PROPRIOCEPTION, AND LOW BACK STABILITY Principal Investigator & Institution: Wilson, Sara E.; Mechanical Engineering; University of Kansas Lawrence Lawrence, Ks 66045 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 29-SEP-2005 Summary: (provided by applicant): Occupational vibration exposure is a known risk factor for low back disorders. While past research has investigated issues such as transmission of vibration, the means by which vibration might result in low back pain is still not well understood. A possible mechanism by which vibration might result in low back injury is by a disruption of the proprioceptive system leading to decreased spinal stability and increased susceptibility to injury. Vibration has been shown in the past to alter several measures of proprioception in the joints of the extremities. These alterations change with the frequency of the vibration and last after the vibration has been withdrawn. However, these changes in proprioception have yet to be thoroughly investigated in the low back. The aims of this research are to begin to investigate the effects of vibration on proprioception in the low back and spinal stability. It is hypothesized that reposition sense error (one measure of proprioception) will increase with exposure to vibration. Further, it is expected that this increase will be different with different frequencies of vibration exposure. The temporal properties of these changes

64

Back Pain

will be investigated. It is hypothesized that after removal of the vibration, the increased error will persist for some time before eventually returning to baseline. Finally, these changes in proprioception will be compared to changes in sudden load dynamics using a model of spinal dynamics in order to assess the effect of proprioception on spinal stability. This research is important to better understand what types of vibrations put a worker at risk, how these vibrations increase risk, and what may be done to reduce risk. For example, if it is found that proprioceptive changes last for 10 minutes after exposure, it may be prudent to recommend truck drivers and heavy equipment operators rest for 10 minutes before participating in heavy lifting activities. This work will provide the ground work for future research examining how proprioception is altered by occupational vibration exposure and how it affects the overall spinal stabilization. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “back pain” (or synonyms) into the search box. This search gives you access to fulltext articles. The following is a sample of items found for back pain in the PubMed Central database: •

Acute low back pain. by Car J, Sheikh A.; 2003 Sep 6; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=192848

•

Acute low back pain: systematic review of its prognosis. by Pengel LH, Herbert RD, Maher CG, Refshauge KM.; 2003 Aug 9; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=169642

•

Back pain in Britain: comparison of two prevalence surveys at an interval of 10 years. by Palmer KT, Walsh K, Bendall H, Cooper C, Coggon D.; 2000 Jun 10; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27402

•

Chronic low back pain. by Samanta J, Kendall J, Samanta A.; 2003 Mar 8; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=150466

•

Community survey of factors associated with consultation for low back pain. by Waxman R, Tennant A, Helliwell P.; 1998 Dec 5; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28737

•

Effect of UK national guidelines on services to treat patients with acute low back pain: follow up questionnaire survey. by Barnett AG, Underwood MR, Vickers MR.; 1999 Apr 3; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27816

3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

Studies

65

•

Factors affecting general practitioners' decisions about plain radiography for back pain: implications for classification of guideline barriers -- a qualitative study. by Espeland A, Baerheim A.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=153534

•

Long-term experience with implanted intrathecal drug administration systems for failed back syndrome and chronic mechanical low back pain. by Raphael JH, Southall JL, Gnanadurai TV, Treharne GJ, Kitas GD.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=116675

•

Low back pain and widespread pain predict sickness absence among industrial workers. by Morken T, Riise T, Moen B, Hauge SH, Holien S, Langedrag A, Pedersen S, Saue IL, Seljebo GM, Thoppil V.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=200978

•

Multidisciplinary rehabilitation for chronic low back pain: systematic review. by Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C.; 2001 Jun 23; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=33389

•

Outcome of low back pain in general practice: a prospective study. by Croft PR, Macfarlane GJ, Papageorgiou AC, Thomas E, Silman AJ.; 1998 May 2; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28536

•

Population based intervention to change back pain beliefs and disability: three part evaluation. by Buchbinder R, Jolley D, Wyatt M.; 2001 Jun 23; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=33390

•

Predicting who develops chronic low back pain in primary care: a prospective study. by Thomas E, Silman AJ, Croft PR, Papageorgiou AC, Jayson MI, Macfarlane GJ.; 1999 Jun 19; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28145

•

Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial. by Kendrick D, Fielding K, Bentley E, Kerslake R, Miller P, Pringle M.; 2001 Feb 17; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=26570

•

Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences. by Moffett JK, Torgerson D, Bell-Syer S, Jackson D, Llewlyn-Phillips H, Farrin A, Barber J.; 1999 Jul 31; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28176

•

Recruitment curve of the soleus H-reflex in chronic back pain and lumbosacral radiculopathy. by Mazzocchio R, Scarfo GB, Mariottini A, Muzii VF, Palma L.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=60003

•

Rheumatology: 13. Minimizing disability in patients with low-back pain. by Wing PC.; 2001 May 15; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=81075

•

UK Back pain Exercise And Manipulation (UK BEAM) trial -- national randomised trial of physical treatments for back pain in primary care: objectives, design and interventions [ISRCTN32683578]. by [No authors listed]; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=194218

•

Use of back belts to prevent occupational low-back pain. by [No authors listed]; 2003 Aug 5; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=167124

66

Back Pain

•

Which treatment for low back pain? A factorial randomised controlled trial comparing intravenous analgesics with oral analgesics in the emergency department and a centrally acting muscle relaxant with placebo over three days [ISRCTN09719705]. by Havel C, Sieder A, Herkner H, Domanovits H, Schmied M, Segel R, Koreny M, Laggner AN, Mullner M.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=59893

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with back pain, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “back pain” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for back pain (hyperlinks lead to article summaries): •

A 15-year-old with blurred vision, nausea, back pain, and abdominal pain. Author(s): Kuensting LL. Source: Journal of Emergency Nursing: Jen : Official Publication of the Emergency Department Nurses Association. 2003 April; 29(2): 171-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12660705&dopt=Abstract

•

A 16-year-old boy with back pain. Author(s): Sheah K, Peh WC, Tan SB. Source: Am J Orthop. 2002 February; 31(2): 101-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11878315&dopt=Abstract

•

A double-blind, multicentre, randomised clinical trial comparing the efficacy and tolerability of aceclofenac with diclofenac resinate in patients with acute low back pain. Author(s): Schattenkirchner M, Milachowski KA. Source: Clinical Rheumatology. 2003 May; 22(2): 127-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12740678&dopt=Abstract

6

PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

Studies

67

•

A focused review of the use of botulinum toxins for low back pain. Author(s): Difazio M, Jabbari B. Source: The Clinical Journal of Pain. 2002 November-December; 18(6 Suppl): S155-62. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12569963&dopt=Abstract

•

A low-key social insurance reform--effects of multidisciplinary outpatient treatment for back pain patients in Norway. Author(s): Aakvik A, Holmas TH, Kjerstad E. Source: Journal of Health Economics. 2003 September; 22(5): 747-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12946457&dopt=Abstract

•

A pilot study of the prevalence of lumbar disc degeneration in elite athletes with lower back pain at the Sydney 2000 Olympic Games. Author(s): Ong A, Anderson J, Roche J. Source: British Journal of Sports Medicine. 2003 June; 37(3): 263-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12782554&dopt=Abstract

•

A randomized controlled trial of two strategies to implement active sick leave for patients with low back pain. Author(s): Scheel IB, Hagen KB, Herrin J, Oxman AD. Source: Spine. 2002 March 15; 27(6): 561-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11884902&dopt=Abstract

•

A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Author(s): Pincus T, Burton AK, Vogel S, Field AP. Source: Spine. 2002 March 1; 27(5): E109-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11880847&dopt=Abstract

•

Active sick leave for patients with back pain: all the players onside, but still no action. Author(s): Scheel IB, Hagen KB, Oxman AD. Source: Spine. 2002 March 15; 27(6): 654-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11884914&dopt=Abstract

•

Acute low back pain. Author(s): Car J, Sheikh A. Source: Bmj (Clinical Research Ed.). 2003 September 6; 327(7414): 541. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12958115&dopt=Abstract

68

Back Pain

•

Acute low back pain: systematic review of its prognosis. Author(s): Pengel LH, Herbert RD, Maher CG, Refshauge KM. Source: Bmj (Clinical Research Ed.). 2003 August 9; 327(7410): 323. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12907487&dopt=Abstract

•

Acute renal infarction as a cause of low-back pain. Author(s): de la Iglesia F, Asensio P, Diaz A, Darriba M, Nicolas R, Diz-Lois F. Source: Southern Medical Journal. 2003 May; 96(5): 497-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12911191&dopt=Abstract

•

Adherence to rehabilitation in patients with low back pain. Author(s): Kolt GS, McEvoy JF. Source: Manual Therapy. 2003 May; 8(2): 110-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12890439&dopt=Abstract

•

Advances in the field of low back pain in primary care: a report from the fourth international forum. Author(s): Borkan J, Van Tulder M, Reis S, Schoene ML, Croft P, Hermoni D. Source: Spine. 2002 March 1; 27(5): E128-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11880849&dopt=Abstract

•

Application of the HOAC II: an episode of care for a patient with low back pain. Author(s): Riddle DL, Rothstein JM, Echternach JL. Source: Physical Therapy. 2003 May; 83(5): 471-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12718712&dopt=Abstract

•

Association between dorsolateral prefrontal N-acetyl aspartate and depression in chronic back pain: an in vivo proton magnetic resonance spectroscopy study. Author(s): Grachev ID, Ramachandran TS, Thomas PS, Szeverenyi NM, Fredrickson BE. Source: Journal of Neural Transmission (Vienna, Austria : 1996). 2003 March; 110(3): 287312. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12658377&dopt=Abstract

•

Associations between back pain history and lumbar MRI findings. Author(s): Videman T, Battie MC, Gibbons LE, Maravilla K, Manninen H, Kaprio J. Source: Spine. 2003 March 15; 28(6): 582-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12642766&dopt=Abstract

•

Back pain and a growing rash. Author(s): Meehan K. Source: Jaapa. 2002 August; 15(8): 55-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12271857&dopt=Abstract

Studies

69

•

Back pain and systemic compromise. Author(s): Dyer AA, Ashkan K, Norris J. Source: Postgraduate Medical Journal. 2002 June; 78(920): 373, 377. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12151700&dopt=Abstract

•

Back pain and the resolution of diagnostic uncertainty in illness narratives. Author(s): Lillrank A. Source: Social Science & Medicine (1982). 2003 September; 57(6): 1045-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12878104&dopt=Abstract

•

Back pain in intercollegiate rowers. Author(s): Teitz CC, O'Kane J, Lind BK, Hannafin JA. Source: The American Journal of Sports Medicine. 2002 September-October; 30(5): 674-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12239000&dopt=Abstract

•

Back pain in pregnancy--magnetic resonance imaging correlation. Author(s): Chan YL, Lam WW, Lau TK, Metreweli C, Chan DP. Source: Clinical Radiology. 2002 December; 57(12): 1109-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12475536&dopt=Abstract

•

Back pain online: a cross-sectional survey of the quality of web-based information on low back pain. Author(s): Butler L, Foster NE. Source: Spine. 2003 February 15; 28(4): 395-401. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12590218&dopt=Abstract

•

Back pain, a common problem in primary care. Author(s): Prior CM. Source: Military Medicine. 2003 September; 168(9): Xi-Xii. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14529263&dopt=Abstract

•

Back pain, physical function, and estimates of aerobic capacity: what are the relationships among methods and measures? Author(s): Filho IT, Simmonds MJ, Protas EJ, Jones S. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2002 December; 81(12): 913-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12447090&dopt=Abstract

70

Back Pain

•

Back Performance Scale for the assessment of mobility-related activities in people with back pain. Author(s): Strand LI, Moe-Nilssen R, Ljunggren AE. Source: Physical Therapy. 2002 December; 82(12): 1213-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12444880&dopt=Abstract

•

Back strength cannot be predicted accurately from anthropometric measures in subjects with and without chronic low back pain. Author(s): Lariviere C, Gravel D, Gagnon D, Arsenault AB, Loisel P, Lepage Y. Source: Clinical Biomechanics (Bristol, Avon). 2003 July; 18(6): 473-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12828894&dopt=Abstract

•

Barriers to patient information provision in primary care: patients' and general practitioners' experiences and expectations of information for low back pain. Author(s): McIntosh A, Shaw CF. Source: Health Expectations : an International Journal of Public Participation in Health Care and Health Policy. 2003 March; 6(1): 19-29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12603625&dopt=Abstract

•

Bed rest or continuation of activity for acute low back pain? Author(s): Standaert CJ. Source: Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine. 2003 July; 13(4): 275. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12918494&dopt=Abstract

•

Bed rest or normal activity for patients with acute low back pain: a randomized controlled trial. Author(s): Rozenberg S, Delval C, Rezvani Y, Olivieri-Apicella N, Kuntz JL, Legrand E, Valat JP, Blotman F, Meadeb J, Rolland D, Hary S, Duplan B, Feldmann JL, Bourgeois P. Source: Spine. 2002 July 15; 27(14): 1487-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12131705&dopt=Abstract

•

Biomechanical comparison of isokinetic lifting and free lifting when applied to chronic low back pain rehabilitation. Author(s): Bouilland S, Loslever P, Lepoutre FX. Source: Medical & Biological Engineering & Computing. 2002 March; 40(2): 183-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12043799&dopt=Abstract

•

Blind faith? The effects of promoting active sick leave for back pain patients: a cluster-randomized controlled trial. Author(s): Scheel IB, Hagen KB, Herrin J, Carling C, Oxman AD. Source: Spine. 2002 December 1; 27(23): 2734-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12461401&dopt=Abstract

Studies

71

•

Body motion during repetitive isodynamic lifting: a comparative study of normal subjects and low-back pain patients. Author(s): Rudy TE, Boston JR, Lieber SJ, Kubinski JA, Stacey BR. Source: Pain. 2003 September; 105(1-2): 319-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14499450&dopt=Abstract

•

Bone density in chronic low back pain: a pilot study. Author(s): Gaber TA, McGlashan KA, Love S, Jenner JR, Crisp AJ. Source: Clinical Rehabilitation. 2002 December; 16(8): 867-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12506878&dopt=Abstract

•

Brain chemistry reflects dual states of pain and anxiety in chronic low back pain. Author(s): Grachev ID, Fredrickson BE, Apkarian AV. Source: Journal of Neural Transmission (Vienna, Austria : 1996). 2002 October; 109(10): 1309-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12373563&dopt=Abstract

•

Changes in lumbar lordosis in young patients with low back pain during a 10-year period. Author(s): Murata Y, Utsumi T, Hanaoka E, Takahashi K, Yamagata M, Moriya H. Source: Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association. 2002; 7(6): 618-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12486463&dopt=Abstract

•

Chronic back pain caused by an abdominal aortic aneurysm: case report and review of the literature. Author(s): Edwards JZ, Weiner SD. Source: Orthopedics. 2003 February; 26(2): 191-2. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12597227&dopt=Abstract

•

Chronic low back pain: more relevant guidelines have been published. Author(s): Davidson MJ. Source: Bmj (Clinical Research Ed.). 2003 July 12; 327(7406): 107. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12855544&dopt=Abstract

•

Chronic low back pain: patient had chronic rather than acute pain. Author(s): Watson PJ, Collett B. Source: Bmj (Clinical Research Ed.). 2003 July 12; 327(7406): 107. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12855547&dopt=Abstract

72

Back Pain

•

Chronic neck pain following road traffic accidents in an Irish setting and it's relationship to seat belt use and low back pain. Author(s): Mulhall KJ, Moloney M, Burke TE, Masterson E. Source: Ir Med J. 2003 February; 96(2): 53-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12674157&dopt=Abstract

•

Clinical characteristics of chronic back pain as a function of gender and oral opioid use. Author(s): Fillingim RB, Doleys DM, Edwards RR, Lowery D. Source: Spine. 2003 January 15; 28(2): 143-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12544931&dopt=Abstract

•

Clinical spinal instability and low back pain. Author(s): Panjabi MM. Source: Journal of Electromyography and Kinesiology : Official Journal of the International Society of Electrophysiological Kinesiology. 2003 August; 13(4): 371-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12832167&dopt=Abstract

•

Cognitive-behavioral therapy and psychosocial factors in low back pain: directions for the future. Author(s): Pincus T, Vlaeyen JW, Kendall NA, Von Korff MR, Kalauokalani DA, Reis S. Source: Spine. 2002 March 1; 27(5): E133-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11880850&dopt=Abstract

•

Comparison of spine motion in elite golfers with and without low back pain. Author(s): Lindsay D, Horton J. Source: Journal of Sports Sciences. 2002 August; 20(8): 599-605. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12190279&dopt=Abstract

•

Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group. Author(s): Fritzell P, Hagg O, Nordwall A; Swedish Lumbar Spine Study Group. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2003 April; 12(2): 178-89. Epub 2003 February 14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709856&dopt=Abstract

•

Computed tomography in low back pain and sciatica. A retrospective study of 132 patients in the Haute-Vienne district of France. Author(s): Hourcade S, Treves R. Source: Joint, Bone, Spine : Revue Du Rhumatisme. 2002 December; 69(6): 589-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12537267&dopt=Abstract

Studies

73

•

Continuous low-level heatwrap therapy for treating acute nonspecific low back pain. Author(s): Nadler SF, Steiner DJ, Erasala GN, Hengehold DA, Abeln SB, Weingand KW. Source: Archives of Physical Medicine and Rehabilitation. 2003 March; 84(3): 329-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12638099&dopt=Abstract

•

Conventional radiography, rapid MR imaging, and conventional MR imaging for low back pain: activity-based costs and reimbursement. Author(s): Gray DT, Hollingworth W, Blackmore CC, Alotis MA, Martin BI, Sullivan SD, Deyo RA, Jarvik JG. Source: Radiology. 2003 June; 227(3): 669-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12773674&dopt=Abstract

•

Core stability exercise in chronic low back pain. Author(s): Hodges PW. Source: The Orthopedic Clinics of North America. 2003 April; 34(2): 245-54. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12914264&dopt=Abstract

•

Course of low back pain among nurses: a longitudinal study across eight years. Author(s): Maul I, Laubli T, Klipstein A, Krueger H. Source: Occupational and Environmental Medicine. 2003 July; 60(7): 497-503. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12819283&dopt=Abstract

•

Developing patient-centred information for back pain sufferers. Author(s): Glenton C. Source: Health Expectations : an International Journal of Public Participation in Health Care and Health Policy. 2002 December; 5(4): 319-29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12460221&dopt=Abstract

•

Development of an implementation strategy for physiotherapy guidelines on low back pain. Author(s): Bekkering GE, Engers AJ, Wensing M, Hendriks HJ, van Tulder MW, Oostendorp RA, Bouter LM. Source: The Australian Journal of Physiotherapy. 2003; 49(3): 208-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12952520&dopt=Abstract

•

Diagnostic evaluation of low back pain with emphasis on imaging. Author(s): Jarvik JG, Deyo RA. Source: Annals of Internal Medicine. 2002 October 1; 137(7): 586-97. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12353946&dopt=Abstract

74

Back Pain

•

Differences in electromyographic activity in the multifidus muscle and the iliocostalis lumborum between healthy subjects and patients with sub-acute and chronic low back pain. Author(s): Danneels LA, Coorevits PL, Cools AM, Vanderstraeten GG, Cambier DC, Witvrouw EE, De CH. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2002 February; 11(1): 13-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11931058&dopt=Abstract

•

Differentiating temporal electromyographic waveforms between those with chronic low back pain and healthy controls. Author(s): Hubley-Kozey CL, Vezina MJ. Source: Clinical Biomechanics (Bristol, Avon). 2002 November-December; 17(9-10): 6219. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12446158&dopt=Abstract

•

Disability in depression and back pain: evaluation of the World Health Organization Disability Assessment Schedule (WHO DAS II) in a primary care setting. Author(s): Chwastiak LA, Von Korff M. Source: Journal of Clinical Epidemiology. 2003 June; 56(6): 507-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873644&dopt=Abstract

•

Discriminant validity and relative precision for classifying patients with nonspecific neck and back pain by anatomic pain patterns. Author(s): Werneke M, Hart DL. Source: Spine. 2003 January 15; 28(2): 161-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12544933&dopt=Abstract

•

Disseminating and implementing the results of back pain research in primary care. Author(s): van Tulder MW, Croft PR, van Splunteren P, Miedema HS, Underwood MR, Hendriks HJ, Wyatt ME, Borkan JM. Source: Spine. 2002 March 1; 27(5): E121-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11880848&dopt=Abstract

•

Disuse and deconditioning in chronic low back pain: concepts and hypotheses on contributing mechanisms. Author(s): Verbunt JA, Seelen HA, Vlaeyen JW, van de Heijden GJ, Heuts PH, Pons K, Knottnerus JA. Source: European Journal of Pain (London, England). 2003; 7(1): 9-21. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12527313&dopt=Abstract

Studies

75

•

Do NSAIDs help in acute or chronic low back pain? Author(s): Griffin G, Tudiver F, Grant WD. Source: American Family Physician. 2002 April 1; 65(7): 1319-21. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11996413&dopt=Abstract

•

Does provocative discography screening of discogenic back pain improve surgical outcome? Author(s): Madan S, Gundanna M, Harley JM, Boeree NR, Sampson M. Source: Journal of Spinal Disorders & Techniques. 2002 June; 15(3): 245-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12131428&dopt=Abstract

•

Does respiration perturb body balance more in chronic low back pain subjects than in healthy subjects? Author(s): Hamaoui A, Do M, Poupard L, Bouisset S. Source: Clinical Biomechanics (Bristol, Avon). 2002 August; 17(7): 548-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12206948&dopt=Abstract

•

Does the neurologist contribute to the care of patients with chronic back pain? Author(s): Benbadis SR, Herrera M, Orazi U. Source: European Neurology. 2002; 48(2): 61-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12186994&dopt=Abstract

•

Drug-related problems and quality of life in arthritis and low back pain sufferers. Author(s): Ernst ME, Iyer SS, Doucette WR. Source: Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research. 2003 January-February; 6(1): 51-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12535238&dopt=Abstract

•

Dural ectasia and back pain: review of the literature and case report. Author(s): Nallamshetty L, Ahn NU, Ahn UM, Nallamshetty HS, Rose PS, Buchowski JM, Sponseller PD. Source: Journal of Spinal Disorders & Techniques. 2002 August; 15(4): 326-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12177551&dopt=Abstract

•

Early occupational health management of patients with back pain: a randomized controlled trial. Author(s): Verbeek JH, van der Weide WE, van Dijk FJ. Source: Spine. 2002 September 1; 27(17): 1844-51; Discussion 1851. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12221346&dopt=Abstract

76

Back Pain

•

Educating patient educators: enhancing instructional effectiveness in physical therapy for low back pain patients. Author(s): Kerssens JJ, Sluijs EM, Verhaak PF, Knibbe HJ, Hermans IM. Source: Patient Education and Counseling. 1999 June; 37(2): 165-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14528543&dopt=Abstract

•

Effect of applying different “levels of evidence” criteria on conclusions of Cochrane reviews of interventions for low back pain. Author(s): Ferreira PH, Ferreira ML, Maher CG, Refshauge K, Herbert RD, Latimer J. Source: Journal of Clinical Epidemiology. 2002 November; 55(11): 1126-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12507677&dopt=Abstract

•

Effect of positioning on back pain after coronary angiography. Author(s): Chair SY, Taylor-Piliae RE, Lam G, Chan S. Source: Journal of Advanced Nursing. 2003 June; 42(5): 470-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12752867&dopt=Abstract

•

Effect of preexisting back pain on the incidence and severity of back pain in intercollegiate rowers. Author(s): O'Kane JW, Teitz CC, Lind BK. Source: The American Journal of Sports Medicine. 2003 January-February; 31(1): 80-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12531762&dopt=Abstract

•

Effect of the “sitting pelvic tilt exercise” during the third trimester in primigravidas on back pain. Author(s): Suputtitada A, Wacharapreechanont T, Chaisayan P. Source: J Med Assoc Thai. 2002 June; 85 Suppl 1: S170-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12188409&dopt=Abstract

•

Effectiveness and safety of new oxycodone/acetaminophen formulations with reduced acetaminophen for the treatment of low back pain. Author(s): Gammaitoni AR, Galer BS, Lacouture P, Domingos J, Schlagheck T. Source: Pain Medicine (Malden, Mass.). 2003 March; 4(1): 21-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873275&dopt=Abstract

•

Effects of chronic low back pain, age and gender on vertical spinal creep. Author(s): Kanlayanaphotporn R, Trott P, Williams M, Fulton I. Source: Ergonomics. 2003 May 15; 46(6): 561-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12745688&dopt=Abstract

Studies

77

•

Efficacy and tolerability of piroxicam-beta-cyclodextrin in the outpatient management of chronic back pain. Author(s): Pijak MR, Turcani P, Turcaniova Z, Buran I, Gogolak I, Mihal A, Gazdik F. Source: Bratisl Lek Listy. 2002; 103(12): 467-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12696775&dopt=Abstract

•

Efficacy of low power laser therapy and exercise on pain and functions in chronic low back pain. Author(s): Gur A, Karakoc M, Cevik R, Nas K, Sarac AJ, Karakoc M. Source: Lasers in Surgery and Medicine. 2003; 32(3): 233-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12605431&dopt=Abstract

•

Enhancing function in older adults with chronic low back pain: a pilot study of endurance training. Author(s): Iversen MD, Fossel AH, Katz JN. Source: Archives of Physical Medicine and Rehabilitation. 2003 September; 84(9): 132431. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13680569&dopt=Abstract

•

Episodes of low back pain: a proposal for uniform definitions to be used in research. Author(s): de Vet HC, Heymans MW, Dunn KM, Pope DP, van der Beek AJ, Macfarlane GJ, Bouter LM, Croft PR. Source: Spine. 2002 November 1; 27(21): 2409-16. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12438991&dopt=Abstract

•

European guidelines for the management of low back pain. Author(s): European Commission COST B13 Management Committee. Source: Acta Orthop Scand Suppl. 2002 October; 73(305): 20-5. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12545659&dopt=Abstract

•

Evaluation and treatment of low back pain: an evidence-based approach to clinical care. Author(s): Atlas SJ, Nardin RA. Source: Muscle & Nerve. 2003 March; 27(3): 265-84. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12635113&dopt=Abstract

•

Evaluation of the impact of a low back pain educational intervention on physicians' practice patterns and patients' outcomes. Author(s): Derebery VJ, Giang GM, Saracino G, Fogarty WT. Source: Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 2002 October; 44(10): 977-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12391778&dopt=Abstract

78

Back Pain

•

Exposure to physical movements in low back pain patients: restricted effects of generalization. Author(s): Crombez G, Eccleston C, Vlaeyen JW, Vansteenwegen D, Lysens R, Eelen P. Source: Health Psychology : Official Journal of the Division of Health Psychology, American Psychological Association. 2002 November; 21(6): 573-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12433009&dopt=Abstract

•

Factors associated with medical care-seeking due to low-back pain in scaffolders. Author(s): Molano SM, Burdorf A, Elders LA. Source: American Journal of Industrial Medicine. 2001 September; 40(3): 275-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11598974&dopt=Abstract

•

Factors contributing to low back pain among professional drivers: a review of current literature and possible ergonomic controls. Author(s): Lyons J. Source: Work (Reading, Mass.). 2002; 19(1): 95-102. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12454355&dopt=Abstract

•

Factors contributing to low back pain in rowers. Author(s): Reid DA, McNair PJ. Source: British Journal of Sports Medicine. 2000 October; 34(5): 321-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11049136&dopt=Abstract

•

Fast relief for back pain. Author(s): Smith IK. Source: Time. 2001 September 3; 158(9): 94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11550616&dopt=Abstract

•

Fatigue-related changes in torque output and electromyographic parameters of trunk muscles during isometric axial rotation exertion: an investigation in patients with back pain and in healthy subjects. Author(s): Ng JK, Richardson CA, Parnianpour M, Kippers V. Source: Spine. 2002 March 15; 27(6): 637-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11884912&dopt=Abstract

•

Fear of injury and physical deconditioning in patients with chronic low back pain. Author(s): Verbunt JA, Seelen HA, Vlaeyen JW, van der Heijden GJ, Knottnerus JA. Source: Archives of Physical Medicine and Rehabilitation. 2003 August; 84(8): 1227-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12917865&dopt=Abstract

Studies

79

•

Fear of movement/(re)injury, disability and participation in acute low back pain. Author(s): Swinkels-Meewisse IE, Roelofs J, Verbeek AL, Oostendorp RA, Vlaeyen JW. Source: Pain. 2003 September; 105(1-2): 371-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14499456&dopt=Abstract

•

Fear-avoidance beliefs and catastrophizing: occurrence and risk factor in back pain and ADL in the general population. Author(s): Buer N, Linton SJ. Source: Pain. 2002 October; 99(3): 485-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12406524&dopt=Abstract

•

Feasibility of lumbar supports for home care workers with low back pain. Author(s): Jellema P, Bierma-Zeinstra SM, Van Poppel MN, Bernsen RM, Koes BW. Source: Occupational Medicine (Oxford, England). 2002 September; 52(6): 317-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12361993&dopt=Abstract

•

Fibro-fatty nodules and low back pain. The back mouse masquerade. Author(s): Curtis P, Gibbons G, Price J. Source: The Journal of Family Practice. 2000 April; 49(4): 345-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10778841&dopt=Abstract

•

Finding cancer in primary care outpatients with low back pain: a comparison of diagnostic strategies. Author(s): Joines JD, McNutt RA, Carey TS, Deyo RA, Rouhani R. Source: Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine. 2001 January; 16(1): 14-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11251746&dopt=Abstract

•

First lifetime back pain and psychiatry treatment: psychological factors and recovery in compensated workers. Author(s): Sewitch MJ, Rossignol M, Bellavance F, Leclaire R, Esdaile JM, Suissa S, Proulx R, Dupuis M. Source: Aaohn Journal : Official Journal of the American Association of Occupational Health Nurses. 2000 May; 48(5): 234-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11881626&dopt=Abstract

•

Flexion and rotation of the trunk and lifting at work are risk factors for low back pain: results of a prospective cohort study. Author(s): Hoogendoorn WE, Bongers PM, de Vet HC, Douwes M, Koes BW, Miedema MC, Ariens GA, Bouter LM. Source: Spine. 2000 December 1; 25(23): 3087-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11145822&dopt=Abstract

80

Back Pain

•

Follicular carcinoma of the thyroid presenting as back pain and paravertebral mass. Author(s): Zeidman A, Sender BZ, Badear J, Fradin Z. Source: Isr Med Assoc J. 2000 September; 2(9): 720-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11062782&dopt=Abstract

•

Formal education and back pain: a review. Author(s): Dionne CE, Von Korff M, Koepsell TD, Deyo RA, Barlow WE, Checkoway H. Source: Journal of Epidemiology and Community Health. 2001 July; 55(7): 455-68. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11413174&dopt=Abstract

•

Functional activities and psychosocial factors in the rehabilitation of patients with low back pain. Author(s): Gard G, Gille KA, Grahn B. Source: Scandinavian Journal of Caring Sciences. 2000; 14(2): 75-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12035279&dopt=Abstract

•

Functional deficits in athletes with a history of low back pain: a pilot study. Author(s): Nadler SF, Moley P, Malanga GA, Rubbani M, Prybicien M, Feinberg JH. Source: Archives of Physical Medicine and Rehabilitation. 2002 December; 83(12): 17538. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12474182&dopt=Abstract

•

Functional restoration versus outpatient physical training in chronic low back pain: a randomized comparative study. Author(s): Bendix T, Bendix A, Labriola M, Haestrup C, Ebbehoj N. Source: Spine. 2000 October 1; 25(19): 2494-500. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11013502&dopt=Abstract

•

Fusion surgery is slightly better than non-surgical treatment in patients with severe chronic non-specific low back pain. Author(s): Holm I. Source: The Australian Journal of Physiotherapy. 2002; 48(2): 133. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12143780&dopt=Abstract

•

Gender differences in sick leave related to back pain diagnoses: influence of pregnancy. Author(s): Sydsjo A, Alexanderson K, Dastserri M, Sydsjo G. Source: Spine. 2003 February 15; 28(4): 385-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12590216&dopt=Abstract

Studies

81

•

Gender-age environmental associates of adolescent low back pain. Author(s): Grimmer K, Williams M. Source: Applied Ergonomics. 2000 August; 31(4): 343-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10975661&dopt=Abstract

•

General practitioners' management of low back pain: impact of clinical guidelines in a non-English-speaking country. Author(s): Negrini S, Politano E, Carabalona R, Mambrini A. Source: Spine. 2001 December 15; 26(24): 2727-33; Discussion 2734. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11740363&dopt=Abstract

•

Generalised estimating equations and low back pain. Author(s): Harkness EF, Nahit ES, Macfarlane GJ, Silman AJ, McBeth J, Dunn G. Source: Occupational and Environmental Medicine. 2003 May; 60(5): 378-80; Author Reply 380-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709527&dopt=Abstract

•

Graded exposure in vivo in the treatment of pain-related fear: a replicated single-case experimental design in four patients with chronic low back pain. Author(s): Vlaeyen JW, de Jong J, Geilen M, Heuts PH, van Breukelen G. Source: Behaviour Research and Therapy. 2001 February; 39(2): 151-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11153970&dopt=Abstract

•

Guide to outcomes measurement for patients with low back pain syndromes. Author(s): Resnik L, Dobrzykowski E. Source: The Journal of Orthopaedic and Sports Physical Therapy. 2003 June; 33(6): 30716; Discussion 317-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12839205&dopt=Abstract

•

Guidelines for low back pain: changes in GP management. Author(s): Frankel BS, Moffett JK, Keen S, Jackson D. Source: Family Practice. 1999 June; 16(3): 216-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10439973&dopt=Abstract

•

Health care and indemnity costs across the natural history of disability in occupational low back pain. Author(s): Williams DA, Feuerstein M, Durbin D, Pezzullo J. Source: Spine. 1998 November 1; 23(21): 2329-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9820914&dopt=Abstract

82

Back Pain

•

Health care providers should use a common language in relation to low back pain patients. Author(s): Cedraschi C, Nordin M, Nachemson AL, Vischer TL. Source: Baillieres Clin Rheumatol. 1998 February; 12(1): 1-15. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9668954&dopt=Abstract

•

Health-related fitness, physical activity, and history of back pain. Author(s): Payne N, Gledhill N, Katzmarzyk PT, Jamnik V. Source: Canadian Journal of Applied Physiology = Revue Canadienne De Physiologie Appliquee. 2000 August; 25(4): 236-49. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10953062&dopt=Abstract

•

Health-related quality of life using the SF-36 in patients with bipolar disorder compared with patients with chronic back pain and the general population. Author(s): Arnold LM, Witzeman KA, Swank ML, McElroy SL, Keck PE Jr. Source: Journal of Affective Disorders. 2000 January-March; 57(1-3): 235-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10708837&dopt=Abstract

•

Hepatobiliary and pancreatic: awoman with a back pain and increased urinary amylase. Author(s): Yamaguchi T, Ishihara T, Saisho H, Okuda K. Source: Journal of Gastroenterology and Hepatology. 2001 November; 16(11): 1303, 1309. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11903751&dopt=Abstract

•

Hermeneutics and experiences of the body. The case of low back pain. Author(s): Dekkers W. Source: Theoretical Medicine and Bioethics. 1998 June; 19(3): 277-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9691789&dopt=Abstract

•

High physical work load and low job satisfaction increase the risk of sickness absence due to low back pain: results of a prospective cohort study. Author(s): Hoogendoorn WE, Bongers PM, de Vet HC, Ariens GA, van Mechelen W, Bouter LM. Source: Occupational and Environmental Medicine. 2002 May; 59(5): 323-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11983847&dopt=Abstract

•

Higher levels of antibodies against the psoriasis-associated antigen pso p27 in cerebrospinal fluid from patients with low back pain and sciatica. Author(s): Zwart JA, Iversen OJ, Sand T, Dale LG, Unsgard G. Source: Spine. 1999 February 15; 24(4): 373-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10065522&dopt=Abstract

Studies

83

•

Hip muscle imbalance and low back pain in athletes: influence of core strengthening. Author(s): Nadler SF, Malanga GA, Bartoli LA, Feinberg JH, Prybicien M, Deprince M. Source: Medicine and Science in Sports and Exercise. 2002 January; 34(1): 9-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11782641&dopt=Abstract

•

Hospital referrals for low back pain: more coherence needed. Author(s): Silman AJ, Jayson MI, Papageorgiou AC, Croft PR. Source: Journal of the Royal Society of Medicine. 2000 March; 93(3): 135-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10741313&dopt=Abstract

•

How effective are exercise and physical therapy for chronic low back pain? Author(s): Carter IR, Lord JL. Source: The Journal of Family Practice. 2002 March; 51(3): 209. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11978228&dopt=Abstract

•

How effective are guidelines for the management of low back pain? Author(s): Sheehan NJ. Source: Quality in Health Care : Qhc. 2001 September; 10(3): 197. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11573479&dopt=Abstract

•

How effective is the acute low back pain screening questionnaire for predicting 1year follow-up in patients with low back pain? Author(s): Hurley DA, Dusoir TE, McDonough SM, Moore AP, Baxter GD. Source: The Clinical Journal of Pain. 2001 September; 17(3): 256-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11587118&dopt=Abstract

•

How safe and effective are nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of acute or chronic nonspecific low back pain (LBP)? Author(s): Griffin G. Source: The Journal of Family Practice. 2000 September; 49(9): 780-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11032195&dopt=Abstract

•

How to recognize and treat specific low back pain? Author(s): Balague F, Borenstein DG. Source: Baillieres Clin Rheumatol. 1998 February; 12(1): 37-73. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9668956&dopt=Abstract

84

Back Pain

•

How to use evidence-based practice to distinguish between three different patients with low back pain. Author(s): Cibulka MT, Aslin K. Source: The Journal of Orthopaedic and Sports Physical Therapy. 2001 December; 31(12): 678-88; Discussion 689-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11767244&dopt=Abstract

•

Hypoxic brain damage after intramuscular self-injection of diclofenac for acute back pain. Author(s): Schabitz WR, Berger C, Knauth M, Meinck HM, Steiner T. Source: European Journal of Anaesthesiology. 2001 November; 18(11): 763-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11580784&dopt=Abstract

•

Identifying psychosocial variables in patients with acute work-related low back pain: the importance of fear-avoidance beliefs. Author(s): Fritz JM, George SZ. Source: Physical Therapy. 2002 October; 82(10): 973-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12350212&dopt=Abstract

•

Impact of ergonomic intervention on back pain among nurses. Author(s): Smedley J, Trevelyan F, Inskip H, Buckle P, Cooper C, Coggon D. Source: Scand J Work Environ Health. 2003 April; 29(2): 117-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12718497&dopt=Abstract

•

Impact of quality scales on levels of evidence inferred from a systematic review of exercise therapy and low back pain. Author(s): Colle F, Rannou F, Revel M, Fermanian J, Poiraudeau S. Source: Archives of Physical Medicine and Rehabilitation. 2002 December; 83(12): 174552. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12474181&dopt=Abstract

•

Impact of repetitive manual materials handling and psychosocial work factors on the future prevalence of chronic low-back pain among construction workers. Author(s): Latza U, Pfahlberg A, Gefeller O. Source: Scand J Work Environ Health. 2002 October; 28(5): 314-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12432984&dopt=Abstract

•

Impact of waist/hip ratio on the therapeutic efficacy of lumbosacral corsets for chronic muscular low back pain. Author(s): Toda Y. Source: Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association. 2002; 7(6): 644-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12486467&dopt=Abstract

Studies

85

•

Impaired postural compensation for respiration in people with recurrent low back pain. Author(s): Grimstone SK, Hodges PW. Source: Experimental Brain Research. Experimentelle Hirnforschung. Experimentation Cerebrale. 2003 July; 151(2): 218-24. Epub 2003 May 21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12759796&dopt=Abstract

•

Implicit attitude towards pictures of back-stressing activities in pain-free subjects and patients with low back pain: an affective priming study. Author(s): Goubert L, Crombez G, Hermans D, Vanderstraeten G. Source: European Journal of Pain (London, England). 2003; 7(1): 33-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12527315&dopt=Abstract

•

Incidence of low back pain in workage adults in rural North India. Author(s): Sharma SC, Singh R, Sharma AK, Mittal R. Source: Indian Journal of Medical Sciences. 2003 April; 57(4): 145-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14510345&dopt=Abstract

•

Indications, techniques, and outcomes of posterior surgery for chronic low back pain. Author(s): Kwon BK, Vaccaro AR, Grauer JN, Beiner J. Source: The Orthopedic Clinics of North America. 2003 April; 34(2): 297-308. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12914269&dopt=Abstract

•

Industrial medicine and acute musculoskeletal rehabilitation. 1. Diagnosing and managing the injured worker with low back pain. Author(s): Prather H, Foye PM, Cianca JC. Source: Archives of Physical Medicine and Rehabilitation. 2002 March; 83(3 Suppl 1): S36, S33-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11973688&dopt=Abstract

•

Ineffective disability management by doctors is an obstacle for return-to-work: a cohort study on low back pain patients sicklisted for 3-4 months. Author(s): Anema JR, Van Der Giezen AM, Buijs PC, Van Mechelen W. Source: Occupational and Environmental Medicine. 2002 November; 59(11): 729-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12409530&dopt=Abstract

•

Intensive group training versus cognitive intervention in sub-acute low back pain: short-term results of a single-blind randomized controlled trial. Author(s): Storheim K, Brox JI, Holm I, Koller AK, Bo K. Source: Journal of Rehabilitation Medicine : Official Journal of the Uems European Board of Physical and Rehabilitation Medicine. 2003 May; 35(3): 132-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12809196&dopt=Abstract

86

Back Pain

•

Intradiscal electrothermal therapy in the treatment of discogenic low back pain. Author(s): Eckel TS, Ortiz AO. Source: Techniques in Vascular and Interventional Radiology. 2002 December; 5(4): 21722. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12599173&dopt=Abstract

•

Intradiscal electrothermal therapy used to manage chronic discogenic low back pain: new directions and interventions. Author(s): Wetzel FT, McNally TA, Phillips FM. Source: Spine. 2002 November 15; 27(22): 2621-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12436005&dopt=Abstract

•

Intradiscal electrothermal treatment for chronic discogenic low back pain: prospective outcome study with a minimum 2-year follow-up. Author(s): Saal JA, Saal JS. Source: Spine. 2002 May 1; 27(9): 966-73; Discussion 973-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11979172&dopt=Abstract

•

Is a condition-specific instrument for patients with low back pain/leg symptoms really necessary? The responsiveness of the Oswestry Disability Index, MODEMS, and the SF-36. Author(s): Walsh TL, Hanscom B, Lurie JD, Weinstein JN. Source: Spine. 2003 March 15; 28(6): 607-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12642770&dopt=Abstract

•

Is MRI useful for evaluation of acute low back pain? Author(s): Grover F, Pereira SL. Source: The Journal of Family Practice. 2003 March; 52(3): 231-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12620180&dopt=Abstract

•

Italian version of the Roland Disability Questionnaire, specific for low back pain: cross-cultural adaptation and validation. Author(s): Padua R, Padua L, Ceccarelli E, Romanini E, Zanoli G, Bondi R, Campi A. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2002 April; 11(2): 126-9. Epub 2001 July 17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11956918&dopt=Abstract

Studies

87

•

Joint coordination during whole-body lifting in women with low back pain after pregnancy. Author(s): Commissaris DA, Nilsson-Wikmar LB, Van Dieen JH, Hirschfeld H. Source: Archives of Physical Medicine and Rehabilitation. 2002 September; 83(9): 127989. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12235609&dopt=Abstract

•

Kappa Delta Award. Low back pain and whole body vibration. Author(s): Pope MH, Magnusson M, Wilder DG. Source: Clinical Orthopaedics and Related Research. 1998 September; (354): 241-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9755785&dopt=Abstract

•

Ketorolac versus acetaminophen-codeine in the emergency department treatment of acute low back pain. Author(s): Innes GD, Croskerry P, Worthington J, Beveridge R, Jones D. Source: The Journal of Emergency Medicine. 1998 July-August; 16(4): 549-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9696169&dopt=Abstract

•

Ketorolac versus meperidine: ED treatment of severe musculoskeletal low back pain. Author(s): Veenema KR, Leahey N, Schneider S. Source: The American Journal of Emergency Medicine. 2000 July; 18(4): 404-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10919528&dopt=Abstract

•

Lack of relationships between cumulative methylprednisolone dose and bone mineral density in healthy men and postmenopausal women with chronic low back pain. Author(s): Dubois EF, Wagemans MF, Verdouw BC, Zwinderman AH, Van Boxtel CJ, Dekhuijzen PN, Schweitzer DH. Source: Clinical Rheumatology. 2003 February; 22(1): 12-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12605311&dopt=Abstract

•

Low back pain and psychiatric disorders. Author(s): Mayr M, Hogler S, Ghedina W, Berek K. Source: Lancet. 2003 February 8; 361(9356): 531. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12583974&dopt=Abstract

•

Low back pain as a predictor of long-term work disability. Author(s): Natvig B, Eriksen W, Bruusgaard D. Source: Scandinavian Journal of Public Health. 2002; 30(4): 288-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12680505&dopt=Abstract

88

Back Pain

•

Low back pain during streptokinase infusion. Author(s): Pinheiro RF, Pedrolo AS, Nigri M, Carvalho AC. Source: Arquivos Brasileiros De Cardiologia. 2002 February; 78(2): 230-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11887199&dopt=Abstract

•

Low back pain in a 13-year-old girl. Author(s): Erol B, Segal L, Huff D, States L, Dormans JP. Source: Clinical Orthopaedics and Related Research. 2003 August; (413): 323-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12897625&dopt=Abstract

•

Low back pain in Flemish adolescents and the role of perceived social support and effect on the perception of back pain. Author(s): Staes F, Stappaerts K, Lesaffre E, Vertommen H. Source: Acta Paediatrica (Oslo, Norway : 1992). 2003 April; 92(4): 444-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12801111&dopt=Abstract

•

Low back pain in individuals with chronic airflow limitation and their partners--a preliminary prevalence study. Author(s): Synnot A, Williams M. Source: Physiotherapy Research International : the Journal for Researchers and Clinicians in Physical Therapy. 2002; 7(4): 215-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12528577&dopt=Abstract

•

Low back pain in rural Tibet. Author(s): Mariette S, Mariette X. Source: Lancet. 2003 May 10; 361(9369): 1654. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12747911&dopt=Abstract

•

Low back pain in rural Tibet. Author(s): Moreno-Reyes R, Boelaert M. Source: Lancet. 2003 May 10; 361(9369): 1654. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12747910&dopt=Abstract

•

Low back pain in rural Tibet. Author(s): Barker K, Fairbank J. Source: Lancet. 2003 May 10; 361(9369): 1653-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12747908&dopt=Abstract

•

Low back pain in rural Tibet. Author(s): Hoy D, Toole MJ, Morgan D, Morgan C. Source: Lancet. 2003 January 18; 361(9353): 225-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12547548&dopt=Abstract

Studies

89

•

Low back pain in schoolchildren: the role of mechanical and psychosocial factors. Author(s): Watson KD, Papageorgiou AC, Jones GT, Taylor S, Symmons DP, Silman AJ, Macfarlane GJ. Source: Archives of Disease in Childhood. 2003 January; 88(1): 12-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12495949&dopt=Abstract

•

Low back pain, sacroiliitis, and the relationship with HLA-B27 in Crohn's disease. Author(s): Steer S, Jones H, Hibbert J, Kondeatis E, Vaughan R, Sanderson J, Gibson T. Source: The Journal of Rheumatology. 2003 March; 30(3): 518-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12610811&dopt=Abstract

•

Low back pain: eliminating myths and elucidating realities. Author(s): Zanni GR, Wick JY. Source: J Am Pharm Assoc (Wash Dc). 2003 May-June; 43(3): 357-62. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12836785&dopt=Abstract

•

Low back pain: what is the long-term course? A review of studies of general patient populations. Author(s): Hestbaek L, Leboeuf-Yde C, Manniche C. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2003 April; 12(2): 149-65. Epub 2003 January 28. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709853&dopt=Abstract

•

Low-back pain in children. Author(s): Balague F, Dudler J, Nordin M. Source: Lancet. 2003 April 26; 361(9367): 1403-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12727390&dopt=Abstract

•

Low-back pain in morbidly obese patients and the effect of weight loss following surgery. Author(s): Melissas J, Volakakis E, Hadjipavlou A. Source: Obesity Surgery : the Official Journal of the American Society for Bariatric Surgery and of the Obesity Surgery Society of Australia and New Zealand. 2003 June; 13(3): 389-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12841899&dopt=Abstract

•

Lumbar lordosis: study of patients with and without low back pain. Author(s): Murrie VL, Dixon AK, Hollingworth W, Wilson H, Doyle TA. Source: Clinical Anatomy (New York, N.Y.). 2003 March; 16(2): 144-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12589669&dopt=Abstract

90

Back Pain

•

Measurement error associated with spinal mobility measures in children with and without low-back pain. Author(s): Jones MA, Stratton G, Reilly T, Unnithan VB. Source: Acta Paediatrica (Oslo, Norway : 1992). 2002; 91(12): 1339-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12578292&dopt=Abstract

•

Measuring the effect of novel therapies for back pain. Author(s): Haughton VM, Fine J. Source: Ajnr. American Journal of Neuroradiology. 2003 May; 24(5): 784-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12748071&dopt=Abstract

•

Meralgia paresthetica in differential diagnosis of low-back pain. Author(s): Erbay H. Source: The Clinical Journal of Pain. 2002 March-April; 18(2): 132-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11882778&dopt=Abstract

•

Methodological challenges in studying recurrence of low back pain. Author(s): Wasiak R, Pransky GS, Webster BS. Source: Journal of Occupational Rehabilitation. 2003 March; 13(1): 21-31. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12611028&dopt=Abstract

•

Mini-intervention for subacute low back pain: a randomized controlled trial. Author(s): Karjalainen K, Malmivaara A, Pohjolainen T, Hurri H, Mutanen P, Rissanen P, Pahkajarvi H, Levon H, Karpoff H, Roine R. Source: Spine. 2003 March 15; 28(6): 533-40; Discussion 540-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12642757&dopt=Abstract

•

Movement system impairment-based categories for low back pain: stage 1 validation. Author(s): Van Dillen LR, Sahrmann SA, Norton BJ, Caldwell CA, McDonnell MK, Bloom NJ. Source: The Journal of Orthopaedic and Sports Physical Therapy. 2003 March; 33(3): 12642. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12683688&dopt=Abstract

•

MRI for regional back pain: need for less imaging, better understanding. Author(s): Hadler NM. Source: Jama : the Journal of the American Medical Association. 2003 June 4; 289(21): 2863-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12783918&dopt=Abstract

Studies

91

•

Multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working age adults. Author(s): Karjalainen K, Malmivaara A, van Tulder M, Roine R, Jauhiainen M, Hurri H, Koes B. Source: Cochrane Database Syst Rev. 2003; (2): Cd002193. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12804427&dopt=Abstract

•

Multiple embolism in a female patient with infective endocarditis. Low back pain and hematuria as the initial clinical manifestations. Author(s): Vieira ML, Schmidt ML, de Resende MV, de Andre Junior LS. Source: Arquivos Brasileiros De Cardiologia. 2002 June; 78(6): 592-7. English, Portuguese. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12185859&dopt=Abstract

•

Muscle relaxants for non-specific low back pain. Author(s): van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Source: Cochrane Database Syst Rev. 2003; (2): Cd004252. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12804507&dopt=Abstract

•

Neck and low back pain. Author(s): Devereaux MW. Source: The Medical Clinics of North America. 2003 May; 87(3): 643-62. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12812407&dopt=Abstract

•

Nerve root injuries in patients with chronic low back pain. Author(s): Brisby H. Source: The Orthopedic Clinics of North America. 2003 April; 34(2): 221-30. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12914261&dopt=Abstract

•

Neuroimaging in low back pain. Author(s): Humphreys SC, Eck JC, Hodges SD. Source: American Family Physician. 2002 June 1; 65(11): 2299-306. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12074530&dopt=Abstract

•

Neuromuscular control of walking with chronic low-back pain. Author(s): Vogt L, Pfeifer K, Banzer W. Source: Manual Therapy. 2003 February; 8(1): 21-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12586558&dopt=Abstract

92

Back Pain

•

No significant differences between intervention programmes on neck, shoulder and low back pain: a prospective randomized study among home-care personnel. Author(s): Horneij E, Hemborg B, Jensen I, Ekdahl C. Source: Journal of Rehabilitation Medicine : Official Journal of the Uems European Board of Physical and Rehabilitation Medicine. 2001 July; 33(4): 170-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11506215&dopt=Abstract

•

Nonorganic pain drawings are associated with low psychological scores on the preoperative SF-36 questionnaire in patients with chronic low back pain. Author(s): Dahl B, Gehrchen PM, Kiaer T, Blyme P, Tondevold E, Bendix T. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2001 June; 10(3): 211-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11469731&dopt=Abstract

•

Non-specific back pain in children and adolescents: a prospective study until maturity. Author(s): Mirovsky Y, Jakim I, Halperin N, Lev L. Source: Journal of Pediatric Orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America. 2002 October; 11(4): 275-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12370575&dopt=Abstract

•

Nurses' back pain. Author(s): Hilts T. Source: The American Journal of Nursing. 2003 July; 103(7): 13; Author Reply 13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12877123&dopt=Abstract

•

Nurses' back pain. Author(s): Peter J. Source: The American Journal of Nursing. 2003 July; 103(7): 13; Author Reply 13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12877122&dopt=Abstract

•

Nurses' back pain. Author(s): Gwinn E. Source: The American Journal of Nursing. 2003 July; 103(7): 13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12865636&dopt=Abstract

•

Obesity and low back pain. Author(s): Bener A, Alwash R, Gaber T, Lovasz G. Source: Coll Antropol. 2003 June; 27(1): 95-104. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12974137&dopt=Abstract

Studies

93

•

Occupational factors affecting sick leave attributed to low-back pain. Author(s): Wickstrom GJ, Pentti J. Source: Scand J Work Environ Health. 1998 April; 24(2): 145-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9630063&dopt=Abstract

•

Occupational health guidelines for the management of low back pain: an international comparison. Author(s): Staal JB, Hlobil H, van Tulder MW, Waddell G, Burton AK, Koes BW, van Mechelen W. Source: Occupational and Environmental Medicine. 2003 September; 60(9): 618-26. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12937181&dopt=Abstract

•

October 2001: 40-year-old Xhosa male with back pain and leg weakness. Author(s): Rutherfoord GS, Lamprecht D, Hewlett RH. Source: Brain Pathology (Zurich, Switzerland). 2002 April; 12(2): 263-4, 269. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11958381&dopt=Abstract

•

Osteoblastoma of the lumbar spine as a cause of chronic low back pain. Author(s): Sonel B, Yagmurlu B, Tuncer S, Erden I, Us AK. Source: Rheumatology International. 2002 April; 21(6): 253-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12036215&dopt=Abstract

•

Outcome research in patients with chronic low back pain. Author(s): Schaufele MK, Boden SD. Source: The Orthopedic Clinics of North America. 2003 April; 34(2): 231-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12914262&dopt=Abstract

•

Outpatients with low back pain: an analysis of the rate per day of pain improvement that may be expected and factors affecting improvement. Author(s): Granger CV, Lackner JM, Kulas M, Russell CF. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2003 April; 82(4): 253-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12649649&dopt=Abstract

•

Overnight use of continuous low-level heatwrap therapy for relief of low back pain. Author(s): Nadler SF, Steiner DJ, Petty SR, Erasala GN, Hengehold DA, Weingand KW. Source: Archives of Physical Medicine and Rehabilitation. 2003 March; 84(3): 335-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12638100&dopt=Abstract

94

Back Pain

•

Perceived pain and self-estimated activity limitations in women with back pain postpartum. Author(s): Nilsson-Wikmar L, Pilo C, Pahlback M, Harms-Ringdahl K. Source: Physiotherapy Research International : the Journal for Researchers and Clinicians in Physical Therapy. 2003; 8(1): 23-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12701463&dopt=Abstract

•

Persistent low back pain and sciatica in the United States: treatment outcomes. Author(s): BenDebba M, Torgerson WS, Boyd RJ, Dawson EG, Hardy RW, Robertson JT, Sypert GW, Watts C, Long DM. Source: Journal of Spinal Disorders & Techniques. 2002 February; 15(1): 2-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11891445&dopt=Abstract

•

Pharmacotherapy of neuropathic low back pain. Author(s): Moskowitz MH. Source: Current Pain and Headache Reports. 2003 June; 7(3): 178-87. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12720597&dopt=Abstract

•

Physical inactivity: a risk factor for low back pain in the general population? Author(s): Picavet HS, Schuit AJ. Source: Journal of Epidemiology and Community Health. 2003 July; 57(7): 517-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12821698&dopt=Abstract

•

Planning grant awarded to study CAM in treatment of migraines and lower back pain. Author(s): Horrigan B, Block B. Source: Alternative Therapies in Health and Medicine. 2003 May-June; 9(3): 22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776472&dopt=Abstract

•

Potential sources of neck and back pain in clinical conditions of dogs and cats: a review. Author(s): Webb AA. Source: Veterinary Journal (London, England : 1997). 2003 May; 165(3): 193-213. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12672365&dopt=Abstract

•

Predictors of low back pain in British schoolchildren: a population-based prospective cohort study. Author(s): Jones GT, Watson KD, Silman AJ, Symmons DP, Macfarlane GJ. Source: Pediatrics. 2003 April; 111(4 Pt 1): 822-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12671119&dopt=Abstract

Studies

95

•

Predictors of outcome in fusion surgery for chronic low back pain. A report from the Swedish Lumbar Spine Study. Author(s): Hagg O, Fritzell P, Ekselius L, Nordwall A; Swedish Lumbar Spine Study. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2003 February; 12(1): 22-33. Epub 2002 October 23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12592544&dopt=Abstract

•

Psychometric properties of a generic health measure in Chinese patients with low back pain in Hong Kong. Author(s): Leung AS, Lam TH, Hedley AJ, Twomey LT. Source: Manual Therapy. 2003 August; 8(3): 151-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12909435&dopt=Abstract

•

Quality of life and back pain: outcome 16.7 years after Harrington instrumentation. Author(s): Gotze C, Liljenqvist UR, Slomka A, Gotze HG, Steinbeck J. Source: Spine. 2002 July 1; 27(13): 1456-63; Discussion 1463-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12131746&dopt=Abstract

•

Quicker fix for back pain. Device speeds healing, but docs crave competition. Author(s): Hensley S. Source: Modern Healthcare. 1997 August 11; 27(32): 68. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10169138&dopt=Abstract

•

Radiofrequency facet joint denervation in the treatment of low back pain: a placebocontrolled clinical trial to assess efficacy. Author(s): Dreyfuss P, Baker R, Leclaire R, Fortin L, Lambert R, Bergeron Y, Rossignol M. Source: Spine. 2002 March 1; 27(5): 556-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11880846&dopt=Abstract

•

Randomized trial of a self-management program for primary care patients with acute low back pain: short-term effects. Author(s): Damush TM, Weinberger M, Perkins SM, Rao JK, Tierney WM, Qi R, Clark DO. Source: Arthritis and Rheumatism. 2003 April 15; 49(2): 179-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12687508&dopt=Abstract

•

Rapid magnetic resonance imaging for diagnosing cancer-related low back pain. Author(s): Hollingworth W, Gray DT, Martin BI, Sullivan SD, Deyo RA, Jarvik JG. Source: Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine. 2003 April; 18(4): 303-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709099&dopt=Abstract

96

Back Pain

•

Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial. Author(s): Jarvik JG, Hollingworth W, Martin B, Emerson SS, Gray DT, Overman S, Robinson D, Staiger T, Wessbecher F, Sullivan SD, Kreuter W, Deyo RA. Source: Jama : the Journal of the American Medical Association. 2003 June 4; 289(21): 2810-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12783911&dopt=Abstract

•

Rapid MRI no better than X-ray in the treatment of low back pain. Author(s): Rollins G. Source: Rep Med Guidel Outcomes Res. 2003 July 11; 14(13): 1, 6-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12918516&dopt=Abstract

•

Rash on the lower back. History of low-back pain leads to the source of the problem. Author(s): Levine N. Source: Geriatrics. 2003 May; 58(5): 43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756680&dopt=Abstract

•

Re: Hagen KB, Hilde G, Jamtvedt G, et al. The Cochrane review of advice do stay active as a single treatment for low back pain and sciatica. Spine 2002;27:1736-41. Author(s): Werneke M. Source: Spine. 2003 March 1; 28(5): 520. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12616169&dopt=Abstract

•

Risk factors for low back pain among office workers in Ibadan, Southwest Nigeria. Author(s): Omokhodion FO, Sanya AO. Source: Occupational Medicine (Oxford, England). 2003 June; 53(4): 287-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12815127&dopt=Abstract

•

Risk factors for new-onset low back pain amongst cohorts of newly employed workers. Author(s): Harkness EF, Macfarlane GJ, Nahit ES, Silman AJ, McBeth J. Source: Rheumatology (Oxford, England). 2003 August; 42(8): 959-68. Epub 2003 April 16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12730508&dopt=Abstract

•

Risk factors for non-specific low back pain in schoolchildren and their parents: a population based study. Author(s): Kovacs FM, Gestoso M, Gil del Real MT, Lopez J, Mufraggi N, Mendez JI. Source: Pain. 2003 June; 103(3): 259-68. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12791432&dopt=Abstract

Studies

97

•

Schwannoma of the psoas major muscle presenting with abdominal and back pain. Author(s): D'Silva KJ, Dwivedi AJ, Barnwell JM. Source: Digestive Diseases and Sciences. 2003 August; 48(8): 1619-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12924657&dopt=Abstract

•

Secondary prevention of work-related disability in nonspecific low back pain: does problem-solving therapy help? A randomized clinical trial. Author(s): van den Hout JH, Vlaeyen JW, Heuts PH, Zijlema JH, Wijnen JA. Source: The Clinical Journal of Pain. 2003 March-April; 19(2): 87-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12616178&dopt=Abstract

•

Septic discitis: an important cause of back pain. Author(s): Patel P, Olive KE, Krishnan K. Source: Southern Medical Journal. 2003 July; 96(7): 692-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12940323&dopt=Abstract

•

Sickness absence due to low back pain. Author(s): Fishbain DA. Source: Occupational and Environmental Medicine. 2003 April; 60(4): 306. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12660381&dopt=Abstract

•

Side-to-side weight-bearing asymmetry in subjects with low back pain. Author(s): Childs JD, Piva SR, Erhard RE, Hicks G. Source: Manual Therapy. 2003 August; 8(3): 166-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12909437&dopt=Abstract

•

Skeletal scintigraphy of young patients with low-back pain and a lumbosacral transitional vertebra. Author(s): Connolly LP, d'Hemecourt PA, Connolly SA, Drubach LA, Micheli LJ, Treves ST. Source: Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine. 2003 June; 44(6): 909-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12791818&dopt=Abstract

•

Stature loss and recovery in pregnant women with and without low back pain. Author(s): Rodacki CL, Fowler NE, Rodacki AL, Birch K. Source: Archives of Physical Medicine and Rehabilitation. 2003 April; 84(4): 507-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12690588&dopt=Abstract

98

Back Pain

•

The diagnostic contribution of the frontal lumbar spine radiograph in community referred low back pain--a prospective study of 1030 patients. Author(s): Khoo LA, Heron C, Patel U, Given-Wilson R, Grundy A, Khaw KT, Dundas D. Source: Clinical Radiology. 2003 August; 58(8): 606-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12887953&dopt=Abstract

•

The diagnostic contribution of the frontal lumbar spine radiograph in community referred low back pain--a prospective study of 1030 patients. Author(s): Davies AM. Source: Clinical Radiology. 2003 August; 58(8): 604-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12887952&dopt=Abstract

•

The effect of McKenzie therapy as compared with that of intensive strengthening training for the treatment of patients with subacute or chronic low back pain: A randomized controlled trial. Author(s): Petersen T, Kryger P, Ekdahl C, Olsen S, Jacobsen S. Source: Spine. 2002 August 15; 27(16): 1702-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12195058&dopt=Abstract

•

The management of low back pain. Author(s): Rossignol M. Source: Occupational and Environmental Medicine. 2003 September; 60(9): 617. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12937180&dopt=Abstract

•

The relative importance of whole body vibration and occupational lifting as risk factors for low-back pain. Author(s): Palmer KT, Griffin MJ, Syddall HE, Pannett B, Cooper C, Coggon D. Source: Occupational and Environmental Medicine. 2003 October; 60(10): 715-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14504358&dopt=Abstract

•

The value of diagnostic tests for low back pain. Author(s): Ernst E. Source: Jama : the Journal of the American Medical Association. 2003 October 8; 290(14): 1852; Author Reply 1852-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14532308&dopt=Abstract

•

The value of diagnostic tests for low back pain. Author(s): Jarvik L. Source: Jama : the Journal of the American Medical Association. 2003 October 8; 290(14): 1852; Author Reply 1853. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14532307&dopt=Abstract

Studies

99

•

The value of diagnostic tests for low back pain. Author(s): Caplan LR. Source: Jama : the Journal of the American Medical Association. 2003 October 8; 290(14): 1851-2; Author Reply 1852-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14532305&dopt=Abstract

•

Understanding and managing the back pain of pregnancy. Author(s): Carlson HL, Carlson NL, Pasternak BA, Balderston KD. Source: Curr Womens Health Rep. 2003 February; 3(1): 65-71. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12521555&dopt=Abstract

•

Understanding sacroiliac joint movement as a guide to the management of a patient with unilateral low back pain. Author(s): Cibulka MT. Source: Manual Therapy. 2002 November; 7(4): 215-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12481788&dopt=Abstract

•

Unusual occurrence of acute low back pain in a patient with ruptured urachal cyst. Author(s): Ambrozic A, Praprotnik S, Rozman B. Source: British Journal of Rheumatology. 1998 December; 37(12): 1354-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9973166&dopt=Abstract

•

Upper lobe fibrocavitary disease in a patient with back pain and stiffness. Author(s): Thai D, Ratani RS, Salama S, Steiner RM. Source: Chest. 2000 December; 118(6): 1814-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11115477&dopt=Abstract

•

Use of a maternity support binder for relief of pregnancy-related back pain. Author(s): Carr CA. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 2003 July-August; 32(4): 495-502. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12903699&dopt=Abstract

•

Use of back belts to prevent occupational low-back pain. Recommendation statement from the Canadian Task Force on Preventive Health Care. Author(s): Canadian Task Force on Preventive Health Care. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2003 August 5; 169(3): 213-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12900481&dopt=Abstract

100 Back Pain

•

Use of epidural corticosteroids in low back pain. Author(s): Tonkovich-Quaranta LA, Winkler SR. Source: The Annals of Pharmacotherapy. 2000 October; 34(10): 1165-72. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11054986&dopt=Abstract

•

Use of grade membership analysis to profile the practice styles of individual physicians in the management of acute low back pain. Author(s): Maetzel A, Johnson SH, Woodbury M, Bombardier C. Source: Journal of Clinical Epidemiology. 2000 February; 53(2): 195-205. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10729692&dopt=Abstract

•

Using intravenous diphenhydramine to minimize back pain associated with photodynamic therapy with verteporfin. Author(s): Tornambe PE. Source: Archives of Ophthalmology. 2002 June; 120(6): 872. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12049608&dopt=Abstract

•

Using the dallas pain questionnaire to classify individuals with low back pain in a working population. Author(s): Ozguler A, Gueguen A, Leclerc A, Landre MF, Piciotti M, Le Gall S, MorelFatio M, Boureau F. Source: Spine. 2002 August 15; 27(16): 1783-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12195072&dopt=Abstract

•

Validation of the Turkish version of the Roland-Morris Disability Questionnaire for use in low back pain. Author(s): Kucukdeveci AA, Tennant A, Elhan AH, Niyazoglu H. Source: Spine. 2001 December 15; 26(24): 2738-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11740366&dopt=Abstract

•

Validity of MMPI-2 profiles in chronic back pain patients: differences in path models of coping and somatization. Author(s): Riley JL 3rd, Robinson ME. Source: The Clinical Journal of Pain. 1998 December; 14(4): 324-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9874012&dopt=Abstract

•

Validity of the French-language version of the Quebec back pain disability scale in low back pain patients in France. Author(s): Yvanes-Thomas M, Calmels P, Bethoux F, Richard A, Nayme P, Payre D, Laurent B. Source: Joint, Bone, Spine : Revue Du Rhumatisme. 2002 June; 69(4): 397-405. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12184438&dopt=Abstract

Studies

101

•

Values and problems in MR imaging for the evaluation of low back pain (orthopedic surgeon's view). Author(s): Kikuchi S. Source: Seminars in Musculoskeletal Radiology. 2001 June; 5(2): 127-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11500153&dopt=Abstract

•

Vertebroplasty--breakthrough in treatment of back pain. Author(s): Westesson PL. Source: Cranio. 2001 October; 19(4): 225. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11725843&dopt=Abstract

•

Vitamin B12 in low back pain: a randomised, double-blind, placebo-controlled study. Author(s): Mauro GL, Martorana U, Cataldo P, Brancato G, Letizia G. Source: Eur Rev Med Pharmacol Sci. 2000 May-June; 4(3): 53-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11558625&dopt=Abstract

•

Vitamin D deficiency and chronic low back pain in Saudi Arabia. Author(s): Al Faraj S, Al Mutairi K. Source: Spine. 2003 January 15; 28(2): 177-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12544936&dopt=Abstract

•

Vocational rehabilitation of workers with back pain. Author(s): Verbeek JH. Source: Scand J Work Environ Health. 2001 October; 27(5): 346-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11712616&dopt=Abstract

•

What is the prognosis for acute low back pain? Author(s): Bielanski TE, Nashelsky J. Source: The Journal of Family Practice. 2002 May; 51(5): 417. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12019046&dopt=Abstract

•

Work restrictions and outcome of nonspecific low back pain. Author(s): Hiebert R, Skovron ML, Nordin M, Crane M. Source: Spine. 2003 April 1; 28(7): 722-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12671363&dopt=Abstract

•

Working hours spent on repeated activities and prevalence of back pain. Author(s): Guo HR. Source: Occupational and Environmental Medicine. 2002 October; 59(10): 680-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12356929&dopt=Abstract

102 Back Pain

•

Working with low back pain: workplace and individual psychosocial determinants of limited duty and lost time. Author(s): Feuerstein M, Berkowitz SM, Haufler AJ, Lopez MS, Huang GD. Source: American Journal of Industrial Medicine. 2001 December; 40(6): 627-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11757039&dopt=Abstract

•

Workplace factors and care seeking for low-back pain among female nursing personnel. MUSIC-Norrtalje Study Group. Author(s): Josephson M, Vingard E. Source: Scand J Work Environ Health. 1998 December; 24(6): 465-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9988088&dopt=Abstract

•

Workplace risk factors and occupational musculoskeletal disorders, Part 1: A review of biomechanical and psychophysical research on risk factors associated with lowback pain. Author(s): Keyserling WM. Source: Aihaj : a Journal for the Science of Occupational and Environmental Health and Safety. 2000 January-February; 61(1): 39-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10772613&dopt=Abstract

•

Work-related outcomes in occupational low back pain: a multidimensional analysis. Author(s): Pransky G, Benjamin K, Hill-Fotouhi C, Fletcher KE, Himmelstein J, Katz JN. Source: Spine. 2002 April 15; 27(8): 864-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11935111&dopt=Abstract

•

X rays for back pain. Author(s): Esslemont I. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 2002 October; 52(483): 853-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12392133&dopt=Abstract

•

X-rays for back pain? Author(s): Little P. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 2002 July; 52(480): 534-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12120722&dopt=Abstract

•

Zhong Yi acupuncture and low-back pain: traditional Chinese medical acupuncture differential diagnoses and treatments for chronic lumbar pain. Author(s): Birch S, Sherman K. Source: Journal of Alternative and Complementary Medicine (New York, N.Y.). 1999 October; 5(5): 415-25; Discussion 427-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10537241&dopt=Abstract

103

CHAPTER 2. NUTRITION AND BACK PAIN Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and back pain.

Finding Nutrition Studies on Back Pain The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “back pain” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

104 Back Pain

The following information is typical of that found when using the “Full IBIDS Database” to search for “back pain” (or a synonym): •

A 63-year-old woman with back pain. Author(s): Vanderbilt University Medical Center, Nashville, USA. Source: Allen, C L Jirjis, J N Tenn-Med. 1998 January; 91(1): 32-3 1088-6222

•

A randomized double-blind pilot study comparing Doloteffin and Vioxx in the treatment of low back pain. Author(s): Department of Forensic Medicine, University of Freiburg, 79104 Freiburg, Germany. [email protected] Source: Chrubasik, S Model, A Black, A Pollak, S Rheumatology-(Oxford). 2003 January; 42(1): 141-8 1462-0324

•

A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. Author(s): Sansum Medical Clinic, Department of Orthopaedic Medicine, Santa Barbara, CA 93102-1239. Source: Klein, R G Eek, B C DeLong, W B Mooney, V J-Spinal-Disord. 1993 February; 6(1): 23-33 0895-0385

•

A randomized, double-blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Author(s): Rheumatology Unit, Studland Centre, Poole Hospital NHS Trust, Longfleet Road, Poole, Dorset BH15 2JB, Outcomes Research Unit, Kings College Hospital, East Dulwich Grove, London, UK. Source: Dechow, E Davies, R K Carr, A J Thompson, P W Rheumatology-(Oxford). 1999 Dec; 38(12): 1255-9 1462-0324

•

A structured approach to low back pain. Thorough evaluation is the key to effective treatment. Author(s): Fairview Spine Care and Rehabilitation Physicians, Edina, Minnesota 55435, USA. [email protected] Source: Biewen, P C Postgrad-Med. 1999 November; 106(6): 102-7, 111-4 0032-5481

•

Acupuncture as complementary therapy for back pain. Author(s): University of New Mexico Hospital, Albuquerque, New Mexico, USA. Source: Smith Fassler, M E Lopez Bushnell, K Holist-Nurs-Pract. 2001 April; 15(3): 35-44 0887-9311

•

Acupuncture for low back pain in huang di nei jing su wen. (Yellow Emperor's Classic of Internal Medicine Book of Common Questions). Author(s): New York University Dental College, New York. Source: Liao, S J Acupunct-Electrother-Res. 1992 Oct-December; 17(4): 249-58 0360-1293

•

Alternative medicine. Willow bark for low back pain. Source: Anonymous Harv-Health-Lett. 2000 November; 26(1): 3 1052-1577

•

An objective review of consumer books about back pain. Author(s): Spine Program, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, USA. Source: Padiyar, A Pandipati, S Kim, T Haig, A J J-Neurosci-Nurs. 2001 December; 33(6): 326-37 0888-0395

•

Back pain and epidural spinal cord compression. Source: Posner, J B Med-Clin-North-Am. 1987 March; 71(2): 185-205 0025-7125

Nutrition

105

•

Brain chemistry reflects dual states of pain and anxiety in chronic low back pain. Author(s): Department of Anesthesiology, SUNY Upstate Medical University, Syracuse, NY, USA. [email protected] Source: Grachev, I D Fredrickson, B E Apkarian, A V J-Neural-Transm. 2002 October; 109(10): 1309-34 0300-9564

•

CE feature. Part 2. Nontechnologic strategies for coping with chronic low back pain. Source: Smith, I W Airey, S Salmond, S W Orthop-Nurs. 1990 Jul-August; 9(4): 26-34 0744-6020

•

Efficacy and safety of controlled-release versus immediate-release oxycodone: randomized, double-blind evaluation in patients with chronic back pain. Author(s): Park Place Therapeutic Center, Plantation, Florida 33324, USA. Source: Hale, M E Fleischmann, R Salzman, R Wild, J Iwan, T Swanton, R E Kaiko, R F Lacouture, P G Clin-J-Pain. 1999 September; 15(3): 179-83 0749-8047

•

Electro-acupuncture treatment of 55 cases of soft tissue lumbar pain. Source: Wang, Y Y J-Tradit-Chin-Med. 1987 March; 7(1): 72 0254-6272

•

Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain. Author(s): Arthritis and Rheumatism Associates, P.C., Washington, DC, USA. Source: Borenstein, D G Curr-Opin-Rheumatol. 2001 March; 13(2): 128-34 1040-8711

•

Epidural application of cortico-steroids in low-back pain and sciatica. Author(s): University Clinic of Neurosurgery, Rigshospitalet, Copenhagen, Denmark. Source: Andersen, K H Mosdal, C Acta-Neurochir-(Wien). 1987; 87(1-2): 52-3 0001-6268

•

Getting the lowdown on back pain. Author(s): VAHCS Pain Center, Lakeside Division, Northwestern University Medical School, Chicago, Ill., USA. Source: Katz, J A Nursing. 2001 December; 31(12): 24 0360-4039

•

How traditional Chinese medicine acupuncturists would diagnose and treat chronic low back pain: results of a survey of licensed acupuncturists in Washington State. Author(s): Northwest Institute of Acupuncture and Oriental Medicine, Seattle, Washington, USA. [email protected] Source: Sherman K, J Hogeboom C, J Cherkin D, C Complement-Ther-Med. 2001 September; 9(3): 146-53 0965-2299

•

Is prolotherapy safe and effective for back pain? Author(s): Department of Physical Medicine and Rehabilitation, Hennepin County Medical Center, Minneapolis, USA. Source: Britton, K R Postgrad-Med. 2000 August; 108(2): 37-8 0032-5481

•

Ketorolac versus acetaminophen-codeine in the emergency department treatment of acute low back pain. Author(s): Royal Columbian Hospital, New Westminster, BC, Canada. Source: Innes, G D Croskerry, P Worthington, J Beveridge, R Jones, D J-Emerg-Med. 1998 Jul-August; 16(4): 549-56 0736-4679

•

Oral medications in the treatment of acute low back pain. Author(s): Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School, Newark, USA. Source: Lipetz, J S Malanga, G A Occup-Med. 1998 Jan-March; 13(1): 151-66 0885-114X

106 Back Pain

•

Potential economic impact of using a proprietary willow bark extract in outpatient treatment of low back pain: an open non-randomized study. Source: Chrubasik, S. Kunzel, O. Black, A. Conradt, C. Kerschbaumer, F. Phytomedicine. Stuttgart; New York : G. Fischer, c1994-. July 2001. volume 8 (4) page 241-251. 0944-7113

•

Psychosocial and occupational impact of chronic low back pain. Author(s): Department of Rheumatology, Roger Salengro Hospital, Lille, France. Source: Duquesnoy, B Allaert, F A Verdoncq, B Rev-Rhum-Engl-Ed. 1998 January; 65(1): 33-40 1169-8446

•

Short-term outcomes of chronic back pain patients on an airbed vs innerspring mattresses. Author(s): Sister Kenny Institute Chronic Pain Rehabilitation Program, Minneapolis, MN, USA. Source: Monsein, M Corbin, T P Culliton, P D Merz, D Schuck, E A MedGenMed. 2000 September 11; E36 1531-0132

•

Treatment of low back pain with a herbal or synthetic anti-rheumatic: a randomized controlled study. Willow bark extract for low back pain. Author(s): Herbal Medicines Research and Education Centre, University of Sydney, Sydney, NSW 2006, Australia. Source: Chrubasik, S Kunzel, O Model, A Conradt, C Black, A Rheumatology-(Oxford). 2001 December; 40(12): 1388-93 1462-0324

•

Treatment of lower back pain with “pressing and pulling” at Kunlun (UB 60) method. Source: Yu, S Z J-Tradit-Chin-Med. 1988 December; 8(4): 267-8 0254-6272

•

Use of spa therapy to improve the quality of life of chronic low back pain patients. Author(s): School of Public Health, Institute of Hydrology, University Henri Poincare, Faculty of Medicine, Nancy, France. Source: Constant, F Guillemin, F Collin, J F Boulange, M Med-Care. 1998 September; 36(9): 1309-14 0025-7079

•

Validation of the French version of the Dallas Pain Questionnaire in chronic low back pain patients. Author(s): Clinica et Statistica, Montrouge, France. Source: Marty, M Blotman, F Avouac, B Rozenberg, S Valat, J P Rev-Rhum-Engl-Ed. 1998 February; 65(2): 126-34 1169-8446

•

Variation in diagnosis and treatment of chronic low back pain by traditional Chinese medicine acupuncturists. Author(s): Department of Epidemiology & Biostatistics, University of California-San Francisco, 94118, USA. [email protected] Source: Hogeboom C, J Sherman K, J Cherkin D, C Complement-Ther-Med. 2001 September; 9(3): 154-66 0965-2299

•

Vitamin B12 in low back pain: a randomised, double-blind, placebo-controlled study. Author(s): Clinica Ortopedica e Traumatologica con Fisioterapia e Medicina dello Sport, Universita degli Studi di Palermo, Italy. Source: Mauro, G L Martorana, U Cataldo, P Brancato, G Letizia, G Eur-Rev-MedPharmacol-Sci. 2000 May-June; 4(3): 53-8

•

What are the management options for acute and chronic low back pain? Author(s): Corvallis Internal Medicine, Corvallis, Ore., USA. Source: Greene, S Brandon, N JAAPA. 2000 October; 13(10): 74-6, 79, 83-6 passim

Nutrition

107

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

•

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

•

The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

•

The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

•

The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

•

Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

•

Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

•

Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

•

Google: http://directory.google.com/Top/Health/Nutrition/

•

Healthnotes: http://www.healthnotes.com/

•

Open Directory Project: http://dmoz.org/Health/Nutrition/

•

Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

•

WebMDHealth: http://my.webmd.com/nutrition

•

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

108 Back Pain

The following is a specific Web list relating to back pain; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Vitamin B1 Source: Healthnotes, Inc.; www.healthnotes.com Vitamin B12 Source: Healthnotes, Inc.; www.healthnotes.com Vitamin B6 Source: Healthnotes, Inc.; www.healthnotes.com Vitamin C Source: Healthnotes, Inc.; www.healthnotes.com Vitamin D Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,905,00.html

•

Minerals Calcium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,884,00.html Calcium/magnesium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,937,00.html Magnesium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,890,00.html

•

Food and Diet Pain Source: Healthnotes, Inc.; www.healthnotes.com

109

CHAPTER 3. ALTERNATIVE MEDICINE AND BACK PAIN Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to back pain. At the conclusion of this chapter, we will provide additional sources.

The Combined Health Information Database The Combined Health Information Database (CHID) is a bibliographic database produced by health-related agencies of the U.S. federal government (mostly from the National Institutes of Health) that can offer concise information for a targeted search. The CHID database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “back pain” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: •

NIH Consensus Conference: Acupuncture Source: JAMA. Journal of the American Medical Association. 280(17): 1518-1524. November 4, 1998. Summary: This journal article presents the findings of the consensus conference on acupuncture, sponsored by the Office of Alternative Medicine and the Office of Medical Applications of Research, National Institutes of Health. The purpose of the conference was to provide clinicians, patients, and the general public with a reliable assessment of the use and effectiveness of acupuncture for a variety of conditions. A multidisciplinary panel evaluated evidence presented by experts and in the scientific literature, and developed a consensus statement addressing five issues: the efficacy of acupuncture compared with placebo or sham acupuncture, the place of acupuncture in clinical practice, the biological effects of acupuncture, the integration of acupuncture into the health care system, and directions for future research. The panel concluded that many of the efficacy studies of acupuncture provide equivocal results because of design, sample

110 Back Pain

size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls. However, promising results have emerged showing the efficacy of acupuncture for adult postoperative and chemotherapy nausea and vomiting, and in postoperative dental pain. In other conditions such as addiction, stroke rehabilitation, headache, menstrual cramps, fibromyalgia, myofascial pain, osteoarthritis, tennis elbow, low back pain, carpal tunnel syndrome, and asthma, acupuncture may be useful as an adjunct treatment, an acceptable alternative, or part of a comprehensive management plan. This article has 66 references.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to back pain and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “back pain” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to back pain: •

A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Author(s): Flynn T, Fritz J, Whitman J, Wainner R, Magel J, Rendeiro D, Butler B, Garber M, Allison S. Source: Spine. 2002 December 15; 27(24): 2835-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12486357&dopt=Abstract

•

A critical evaluation of the methodology of a low-back pain clinical trial. Author(s): Freeman MD, Rossignol AM. Source: Journal of Manipulative and Physiological Therapeutics. 2000 June; 23(5): 363-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10863257&dopt=Abstract

•

A descriptive study of medical and chiropractic patients with chronic low back pain and sciatica: management by physicians (practice activities) and patients (selfmanagement). Author(s): Nyiendo J, Haas M, Goldberg B, Lloyd C. Source: Journal of Manipulative and Physiological Therapeutics. 2001 NovemberDecember; 24(9): 543-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11753326&dopt=Abstract

•

A nonsurgical approach to low back pain. Author(s): Jermyn RT. Source: J Am Osteopath Assoc. 2001 April; 101(4 Suppl Pt 2): S6-11. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11392208&dopt=Abstract

Alternative Medicine 111

•

A pilot investigation of the hypoalgesic effects of transcutaneous electrical nerve stimulation upon low back pain in people with multiple sclerosis. Author(s): Al-Smadi J, Warke K, Wilson I, Cramp AF, Noble G, Walsh DM, Lowe-Strong AS. Source: Clinical Rehabilitation. 2003 November; 17(7): 742-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14606740&dopt=Abstract

•

A prospective randomized controlled study of VAX-D and TENS for the treatment of chronic low back pain. Author(s): Sherry E, Kitchener P, Smart R. Source: Neurological Research. 2001 October; 23(7): 780-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11680522&dopt=Abstract

•

A randomized clinical trial of three active therapies for chronic low back pain. Author(s): Mannion AF, Muntener M, Taimela S, Dvorak J. Source: Spine. 1999 December 1; 24(23): 2435-48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10626305&dopt=Abstract

•

A randomized double-blind pilot study comparing Doloteffin and Vioxx in the treatment of low back pain. Author(s): Chrubasik S, Model A, Black A, Pollak S. Source: Rheumatology (Oxford, England). 2003 January; 42(1): 141-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12509627&dopt=Abstract

•

A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study. Author(s): Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Belin TR, Yu F, Adams AH; University of California-Los Angeles. Source: Spine. 2002 October 15; 27(20): 2193-204. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12394892&dopt=Abstract

•

A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Author(s): Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG. Source: Annals of Internal Medicine. 2003 June 3; 138(11): 898-906. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12779300&dopt=Abstract

•

A structured approach to low back pain. Thorough evaluation is the key to effective treatment. Author(s): Biewen PC.

112 Back Pain

Source: Postgraduate Medicine. 1999 November; 106(6): 102-7, 111-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10576005&dopt=Abstract •

Acupuncture as complementary therapy for back pain. Author(s): Smith-Fassler ME, Lopez-Bushnell K. Source: Holistic Nursing Practice. 2001 April; 15(3): 35-44. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12120109&dopt=Abstract

•

Acupuncture for back pain in a patient with Forestier's disease (diffuse idiopathic skeletal hyperostosis/DISH). Author(s): Mears T. Source: Acupuncture in Medicine : Journal of the British Medical Acupuncture Society. 2002 August; 20(2-3): 102-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12216596&dopt=Abstract

•

Acupuncture for chronic low back pain in older patients: a randomized, controlled trial. Author(s): Meng CF, Wang D, Ngeow J, Lao L, Peterson M, Paget S. Source: Rheumatology (Oxford, England). 2003 July 30 [epub Ahead of Print] http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12890859&dopt=Abstract

•

Acupuncture for chronic low back pain: a randomized placebo-controlled study with long-term follow-up. Author(s): Carlsson CP, Sjolund BH. Source: The Clinical Journal of Pain. 2001 December; 17(4): 296-305. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11783809&dopt=Abstract

•

Acupuncture for chronic low back pain: diagnosis and treatment patterns among acupuncturists evaluating the same patient. Author(s): Kalauokalani D, Sherman KJ, Cherkin DC. Source: Southern Medical Journal. 2001 May; 94(5): 486-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11372797&dopt=Abstract

•

Acupuncture for low back pain in pregnancy. Author(s): Cummings M. Source: Acupuncture in Medicine : Journal of the British Medical Acupuncture Society. 2003 June; 21(1-2): 42-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12924847&dopt=Abstract

•

Acupuncture for low back pain. Author(s): Tulder MW VA, Cherkin DC, Berman B, Lao L, Koes BW.


Source: Cochrane Database Syst Rev. 2000; (2): Cd001351. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10796434&dopt=Abstract •

Acupuncture in the management of chronic low back pain: a blinded randomized controlled trial. Author(s): Kerr DP, Walsh DM, Baxter D. Source: The Clinical Journal of Pain. 2003 November-December; 19(6): 364-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14600536&dopt=Abstract

•

Acupuncture Randomized Trials (ART) in patients with chronic low back pain and osteoarthritis of the knee - design and protocols. Author(s): Brinkhaus B, Becker-Witt C, Jena S, Linde K, Streng A, Wagenpfeil S, Irnich D, Hummelsberger J, Melchart D, Willich SN. Source: Forschende Komplementarmedizin Und Klassische Naturheilkunde = Research in Complementary and Natural Classical Medicine. 2003 August; 10(4): 185-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12972723&dopt=Abstract

•

Acupuncture treatment of chronic low-back pain -- a randomized, blinded, placebocontrolled trial with 9-month follow-up. Author(s): Leibing E, Leonhardt U, Koster G, Goerlitz A, Rosenfeldt JA, Hilgers R, Ramadori G. Source: Pain. 2002 March; 96(1-2): 189-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11932074&dopt=Abstract

•

Acupuncture: evidence for its use in chronic low back pain. Author(s): Henderson H. Source: British Journal of Nursing (Mark Allen Publishing). 2002 November 28December 11; 11(21): 1395-403. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12514474&dopt=Abstract

•

Alcohol and low-back pain: a systematic literature review. Author(s): Leboeuf-Yde C. Source: Journal of Manipulative and Physiological Therapeutics. 2000 June; 23(5): 343-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10863254&dopt=Abstract

•

An objective review of consumer books about back pain. Author(s): Padiyar A, Pandipati S, Kim T, Haig AJ. Source: The Journal of Neuroscience Nursing : Journal of the American Association of Neuroscience Nurses. 2001 December; 33(6): 326-37. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11776715&dopt=Abstract

114 Back Pain

•

An unexpected outcome in a case of low-back pain with peripheralization. Author(s): DeVore JW. Source: Alternative Therapies in Health and Medicine. 1999 November; 5(6): 128, 126-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10550910&dopt=Abstract

•

Analgesic effectiveness of subcutaneous carbon-dioxide insufflations as an adjunct treatment in patients with non-specific neck or low back pain. Author(s): Brockow T, Dillner A, Franke A, Resch KL. Source: Complementary Therapies in Medicine. 2001 June; 9(2): 68-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11444885&dopt=Abstract

•

Are childhood adversities relevant in patients with chronic low back pain? Author(s): Nickel R, Egle UT, Hardt J. Source: European Journal of Pain (London, England). 2002; 6(3): 221-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12036309&dopt=Abstract

•

Ayurveda in ankylosing spondylitis and low back pain. Author(s): Falkenbach A, Oberguggenberger R. Source: Annals of the Rheumatic Diseases. 2003 March; 62(3): 276-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12594124&dopt=Abstract

•

Back pain and satisfaction with chiropractic treatment: what role does the physical outcome play? Author(s): Breen A, Breen R. Source: The Clinical Journal of Pain. 2003 July-August; 19(4): 263-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12840621&dopt=Abstract

•

Back pain reporting in children and adolescents: the impact of parents' educational level. Author(s): Leboeuf-Yde C, Wedderkopp N, Andersen LB, Froberg K, Hansen HS. Source: Journal of Manipulative and Physiological Therapeutics. 2002 May; 25(4): 216-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12021740&dopt=Abstract

•

Back pain. Author(s): Ehrlich GE. Source: J Rheumatol Suppl. 2003 August; 67: 26-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12926648&dopt=Abstract

•

Back pain. Beyond the backache. Author(s): Cherkin D, Sherman K, Eisenberg D.


Source: Newsweek. 2002 December 2; 140(23): 56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12501512&dopt=Abstract •

Beyond the good prognosis. Examination of an inception cohort of patients with chronic low back pain. Author(s): Carey TS, Garrett JM, Jackman AM. Source: Spine. 2000 January; 25(1): 115-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10647169&dopt=Abstract

•

Bipolar permanent magnets for the treatment of chronic low back pain: a pilot study. Author(s): Collacott EA, Zimmerman JT, White DW, Rindone JP. Source: Jama : the Journal of the American Medical Association. 2000 March 8; 283(10): 1322-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10714732&dopt=Abstract

•

BMA approves acupuncture. Is approval of acupuncture for back pain really evidence based? Author(s): Kovacs FM, Gil del Real MT. Source: Bmj (Clinical Research Ed.). 2000 November 11; 321(7270): 1221. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11073520&dopt=Abstract

•

Can a Back Pain E-mail Discussion Group improve health status and lower health care costs?: A randomized study. Author(s): Lorig KR, Laurent DD, Deyo RA, Marnell ME, Minor MA, Ritter PL. Source: Archives of Internal Medicine. 2002 April 8; 162(7): 792-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11926853&dopt=Abstract

•

Can patient reactions to the first chiropractic treatment predict early favorable treatment outcome in persistent low back pain? Author(s): Axen I, Rosenbaum A, Robech R, Wren T, Leboeuf-Yde C. Source: Journal of Manipulative and Physiological Therapeutics. 2002 September; 25(7): 450-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12214186&dopt=Abstract

•

Capsicum pain plaster in chronic non-specific low back pain. Author(s): Keitel W, Frerick H, Kuhn U, Schmidt U, Kuhlmann M, Bredehorst A. Source: Arzneimittel-Forschung. 2001 November; 51(11): 896-903. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11765591&dopt=Abstract

•

Chiropractic management of mechanical neck and low-back pain: a retrospective, outcome-based analysis. Author(s): McMorland G, Suter E.

116 Back Pain

Source: Journal of Manipulative and Physiological Therapeutics. 2000 June; 23(5): 307-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10863249&dopt=Abstract •

Chiropractic spinal manipulation for back pain. Author(s): Ernst E. Source: British Journal of Sports Medicine. 2003 June; 37(3): 195-6; Discussion 196. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12782542&dopt=Abstract

•

Chronic low back pain management in primary care. Author(s): Phillips K, Ch'ien AP, Norwood BR, Smith C. Source: The Nurse Practitioner. 2003 August; 28(8): 26-31. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12902938&dopt=Abstract

•

Chronic low back pain: a study of the effects of manipulation under anesthesia. Author(s): Palmieri NF, Smoyak S. Source: Journal of Manipulative and Physiological Therapeutics. 2002 October; 25(8): E8E17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12381983&dopt=Abstract

•

Clinical guidelines for the management of low back pain in primary care: an international comparison. Author(s): Koes BW, van Tulder MW, Ostelo R, Kim Burton A, Waddell G. Source: Spine. 2001 November 15; 26(22): 2504-13; Discussion 2513-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11707719&dopt=Abstract

•

Clinical guidelines versus clinical practice in the management of low back pain. Author(s): Armstrong MP, McDonough S, Baxter GD. Source: Int J Clin Pract. 2003 January-February; 57(1): 9-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12587934&dopt=Abstract

•

Combined physiotherapy and education is efficacious for chronic low back pain. Author(s): Moseley L. Source: The Australian Journal of Physiotherapy. 2002; 48(4): 297-302. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12443524&dopt=Abstract

•

Comment on: Molsberger AF, Mau J, Pawelec DB, Winkler J. Does acupuncture improve the orthopedic management of chronic low back pain? Pain 2002; 99:579-87. Author(s): Leibing E, Pfingsten M, Leichsenring F. Source: Pain. 2003 July; 104(1-2): 425-6; Author Reply 426-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12855354&dopt=Abstract


•

Comparing the satisfaction of low back pain patients randomized to receive medical or chiropractic care: results from the UCLA low-back pain study. Author(s): Hertzman-Miller RP, Morgenstern H, Hurwitz EL, Yu F, Adams AH, Harber P, Kominski GF. Source: American Journal of Public Health. 2002 October; 92(10): 1628-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12356612&dopt=Abstract

•

Cost-effectiveness studies of medical and chiropractic care for occupational low back pain. a critical review of the literature. Author(s): Baldwin ML, Cote P, Frank JW, Johnson WG. Source: The Spine Journal : Official Journal of the North American Spine Society. 2001 March-April; 1(2): 138-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14588394&dopt=Abstract

•

Cross-sectional and longitudinal associations of low-back pain and related disability with psychological distress among patients enrolled in the UCLA Low-Back Pain Study. Author(s): Hurwitz EL, Morgenstern H, Yu F. Source: Journal of Clinical Epidemiology. 2003 May; 56(5): 463-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12812821&dopt=Abstract

•

Developing methods for acupuncture research: rationale for and design of a pilot study evaluating the efficacy of acupuncture for chronic low back pain. Author(s): Sherman KJ, Cherkin DC. Source: Alternative Therapies in Health and Medicine. 2003 September-October; 9(5): 5460. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14526711&dopt=Abstract

•

Different views of health care professionals on the treatment of osteoarthritis including low back pain. Author(s): Chrubasik S, Conradt C, Black A. Source: Rheumatology (Oxford, England). 2003 August; 42(8): 1020-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12869679&dopt=Abstract

•

Do cerebral potentials to magnetic stimulation of paraspinal muscles reflect changes in palpable muscle spasm, low back pain, and activity scores? Author(s): Simons DG. Source: Journal of Manipulative and Physiological Therapeutics. 2002 January; 25(1): 778. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11898022&dopt=Abstract

•

Do cerebral potentials to magnetic stimulation of paraspinal muscles reflect changes in palpable muscle spasm, low back pain, and activity scores? Author(s): Zhu Y, Haldeman S, Hsieh CY, Wu P, Starr A.

118 Back Pain

Source: Journal of Manipulative and Physiological Therapeutics. 2000 September; 23(7): 458-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11004649&dopt=Abstract •

Do magnets alleviate chronic low-back pain? Author(s): Wasiak J, Anderson JN. Source: The Medical Journal of Australia. 2001 June 18; 174(12): 659. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11480691&dopt=Abstract

•

Doctor-patient concordance and patient initiative during episodes of low back pain. Author(s): Hermoni D, Borkan JM, Pasternak S, Lahad A, Van-Ralte R, Biderman A, Reis S; Low Back Pain Working Group; RAMBAM Israeli Family Practice Research Network. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 2000 October; 50(459): 809-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11127171&dopt=Abstract

•

Doctor-patient discussions of alternative medicine for back pain. Author(s): Neher JO, Borkan JM, Wilkinson MJ, Reis S, Hermoni D, Hobbs FD. Source: Scandinavian Journal of Primary Health Care. 2001 December; 19(4): 237-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11822647&dopt=Abstract

•

Does acupuncture improve the orthopedic management of chronic low back pain--a randomized, blinded, controlled trial with 3 months follow up. Author(s): Molsberger AF, Mau J, Pawelec DB, Winkler J. Source: Pain. 2002 October; 99(3): 579-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12406534&dopt=Abstract

•

Does acupuncture or massage work in people with persistent back pain? Author(s): Cole C. Source: The Journal of Family Practice. 2001 September; 50(9): 799. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11674914&dopt=Abstract

•

Does spinal manipulative therapy help people with chronic low back pain? Author(s): Ferreira ML, Ferreira PH, Latimer J, Herbert R, Maher CG. Source: The Australian Journal of Physiotherapy. 2002; 48(4): 277-84. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12443522&dopt=Abstract

•

Effective services for the care of patients with back pain. Author(s): Pinnock D. Source: Prof Nurse. 2002 March; 17(7): 422-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11917432&dopt=Abstract


•

Effectiveness and cost-effectiveness analysis of neuroreflexotherapy for subacute and chronic low back pain in routine general practice: a cluster randomized, controlled trial. Author(s): Kovacs FM, Llobera J, Abraira V, Lazaro P, Pozo F, Kleinbaum D; KAP Group. Source: Spine. 2002 June 1; 27(11): 1149-59. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12045510&dopt=Abstract

•

Effectiveness of a selected bedding system on quality of sleep, low back pain, shoulder pain, and spine stiffness. Author(s): Jacobson BH, Gemmell HA, Hayes BM, Altena TS. Source: Journal of Manipulative and Physiological Therapeutics. 2002 February; 25(2): 88-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11896375&dopt=Abstract

•

Effectiveness of four conservative treatments for subacute low back pain: a randomized clinical trial. Author(s): Hsieh CY, Adams AH, Tobis J, Hong CZ, Danielson C, Platt K, Hoehler F, Reinsch S, Rubel A. Source: Spine. 2002 June 1; 27(11): 1142-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12045509&dopt=Abstract

•

Effectiveness of massage therapy for subacute low-back pain: a randomized controlled trial. Author(s): Preyde M. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2000 June 27; 162(13): 1815-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10906914&dopt=Abstract

•

Effects of a mechanical pain stimulus on erector spinae activity before and after a spinal manipulation in patients with back pain: a preliminary investigation. Author(s): Lehman GJ, Vernon H, McGill SM. Source: Journal of Manipulative and Physiological Therapeutics. 2001 July-August; 24(6): 402-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11514817&dopt=Abstract

•

Efficacy and tolerance of Harpagophytum extract LI 174 in patients with chronic nonradicular back pain. Author(s): Laudahn D, Walper A. Source: Phytotherapy Research : Ptr. 2001 November; 15(7): 621-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11746846&dopt=Abstract

120 Back Pain

•

Efficacy of percutaneous electrical nerve stimulation for the treatment of chronic low back pain in older adults. Author(s): Weiner DK, Rudy TE, Glick RM, Boston JR, Lieber SJ, Morrow LA, Taylor S. Source: Journal of the American Geriatrics Society. 2003 May; 51(5): 599-608. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12752833&dopt=Abstract

•

Efficacy of the transcutaneous electrical nerve stimulation for the treatment of chronic low back pain: a meta-analysis. Author(s): Brosseau L, Milne S, Robinson V, Marchand S, Shea B, Wells G, Tugwell P. Source: Spine. 2002 March 15; 27(6): 596-603. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11884907&dopt=Abstract

•

Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain. Author(s): Borenstein DG. Source: Current Opinion in Rheumatology. 2001 March; 13(2): 128-34. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11224737&dopt=Abstract

•

Evaluation of a specific home exercise program for low back pain. Author(s): Descarreaux M, Normand MC, Laurencelle L, Dugas C. Source: Journal of Manipulative and Physiological Therapeutics. 2002 October; 25(8): 497-503. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12381971&dopt=Abstract

•

Evaluation of chiropractic management of pediatric patients with low back pain: a prospective cohort study. Author(s): Hayden JA, Mior SA, Verhoef MJ. Source: Journal of Manipulative and Physiological Therapeutics. 2003 January; 26(1): 1-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12532132&dopt=Abstract

•

Evidence-based clinical guidelines for the management of acute low back pain: response to the guidelines prepared for the Australian Medical Health and Research Council. Author(s): Rosner AL. Source: Journal of Manipulative and Physiological Therapeutics. 2001 March-April; 24(3): 214-20. Review. Erratum In: J Manipulative Physiol Ther 2001 June; 24(5): 355. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11313619&dopt=Abstract

•

Evidence-based clinical guidelines submitted to the Australian National Health and Medical Research Council for the management of acute low back pain: a critical review. Author(s): Giles LG.


Source: Journal of Manipulative and Physiological Therapeutics. 2001 February; 24(2): 131-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11208226&dopt=Abstract •

Forces applied during manual therapy to patients with low back pain. Author(s): Chiradejnant A, Latimer J, Maher CG. Source: Journal of Manipulative and Physiological Therapeutics. 2002 July-August; 25(6): 362-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12183694&dopt=Abstract

•

Getting the lowdown on back pain. Author(s): Katz JA. Source: Nursing. 2001 December; 31(12): 24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11921711&dopt=Abstract

•

Health-related quality of life and somatization in patients with long-term low back pain: a prospective study with 109 patients. Author(s): Nickel R, Egle UT, Eysel P, Rompe JD, Zollner J, Hoffmann SO. Source: Spine. 2001 October 15; 26(20): 2271-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11598519&dopt=Abstract

•

How traditional Chinese medicine acupuncturists would diagnose and treat chronic low back pain: results of a survey of licensed acupuncturists in Washington State. Author(s): Sherman KJ, Hogeboom CJ, Cherkin DC. Source: Complementary Therapies in Medicine. 2001 September; 9(3): 146-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11926428&dopt=Abstract

•

Incidence of foot rotation, pelvic crest unleveling, and supine leg length alignment asymmetry and their relationship to self-reported back pain. Author(s): Knutson GA. Source: Journal of Manipulative and Physiological Therapeutics. 2002 February; 25(2): 110E. Erratum In: J Manipulative Physiol Ther 2002 July-August; 25(6): 425. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11896379&dopt=Abstract

•

Innervation of the human costovertebral joint: implications for clinical back pain syndromes. Author(s): Erwin WM, Jackson PC, Homonko DA. Source: Journal of Manipulative and Physiological Therapeutics. 2000 July-August; 23(6): 395-403. Erratum In: J Manipulative Physiol Ther 2000 October; 23(8): 530. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10951309&dopt=Abstract

122 Back Pain

•

Interobserver reliability of the 24-hour schedule in patients with low back pain: a questionnaire measuring the daily use and loading of the spine. Author(s): Bakker EW, Koning HJ, Verhagen AP, Koes BW. Source: Journal of Manipulative and Physiological Therapeutics. 2003 May; 26(4): 226-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12750656&dopt=Abstract

•

Interventions for preventing and treating pelvic and back pain in pregnancy. Author(s): Young G, Jewell D. Source: Cochrane Database Syst Rev. 2002; (1): Cd001139. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11869592&dopt=Abstract

•

Is it possible to differentiate people with or without low-back pain on the basis of test of lumbopelvic dysfunction? Author(s): Leboeuf-Yde C, Kyvik KO. Source: Journal of Manipulative and Physiological Therapeutics. 2000 March-April; 23(3): 160-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10771500&dopt=Abstract

•

Is low back pain part of a general health pattern or is it a separate and distinctive entity? A critical literature review of comorbidity with low back pain. Author(s): Hestbaek L, Leboeuf-Yde C, Manniche C. Source: Journal of Manipulative and Physiological Therapeutics. 2003 May; 26(4): 243-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12750659&dopt=Abstract

•

Is prolotherapy safe and effective for back pain? Author(s): Britton KR. Source: Postgraduate Medicine. 2000 August; 108(2): 37-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10951744&dopt=Abstract

•

Lessons from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects. Author(s): Kalauokalani D, Cherkin DC, Sherman KJ, Koepsell TD, Deyo RA. Source: Spine. 2001 July 1; 26(13): 1418-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11458142&dopt=Abstract

•

Long-term effectiveness of bone-setting, light exercise therapy, and physiotherapy for prolonged back pain: a randomized controlled trial. Author(s): Hemmila HM, Keinanen-Kiukaanniemi SM, Levoska S, Puska P. Source: Journal of Manipulative and Physiological Therapeutics. 2002 February; 25(2): 99-104. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11896377&dopt=Abstract


•

Low back pain in pregnancy. Author(s): Forrester M. Source: Acupuncture in Medicine : Journal of the British Medical Acupuncture Society. 2003 June; 21(1-2): 36-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12924846&dopt=Abstract

•

Low back pain. Author(s): Van Tulder M, Koes BW. Source: American Family Physician. 2002 March 1; 65(5): 925-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11898967&dopt=Abstract

•

Low back pain. Author(s): Hill PG. Source: The New England Journal of Medicine. 2001 May 24; 344(21): 1644; Author Reply 1644-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11374370&dopt=Abstract

•

Low back pain: Time to get off the treadmill. Author(s): Leboeuf-Yde C, Manniche C. Source: Journal of Manipulative and Physiological Therapeutics. 2001 January; 24(1): 636. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11174697&dopt=Abstract

•

Low back pain--a community-based study of care-seeking and therapeutic effectiveness. Author(s): Jacob T, Zeev A, Epstein L. Source: Disability and Rehabilitation. 2003 January 21; 25(2): 67-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12554381&dopt=Abstract

•

Lower back pain is reduced and range of motion increased after massage therapy. Author(s): Hernandez-Reif M, Field T, Krasnegor J, Theakston H. Source: The International Journal of Neuroscience. 2001; 106(3-4): 131-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11264915&dopt=Abstract

•

Lumbar intraspinal synovial cyst containing gas as a cause for low-back pain. Author(s): Firth RL. Source: Journal of Manipulative and Physiological Therapeutics. 2000 May; 23(4): 276-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10820300&dopt=Abstract

•

Management of acute lumbar disk herniation initially presenting as mechanical low back pain. Author(s): Giles LG.

124 Back Pain

Source: Journal of Manipulative and Physiological Therapeutics. 2000 May; 23(4): 294-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10820306&dopt=Abstract •

Management of back pain. Author(s): Quittan M. Source: Disability and Rehabilitation. 2002 May 20; 24(8): 423-34. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12033997&dopt=Abstract

•

Management of the athlete with low back pain. Author(s): George SZ, Delitto A. Source: Clinics in Sports Medicine. 2002 January; 21(1): 105-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11877865&dopt=Abstract

•

Manual therapy and exercise therapy in patients with chronic low back pain: a randomized, controlled trial with 1-year follow-up. Author(s): Aure OF, Nilsen JH, Vasseljen O. Source: Spine. 2003 March 15; 28(6): 525-31; Discussion 531-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12642755&dopt=Abstract

•

Massage for low back pain. Author(s): Furlan AD, Brosseau L, Imamura M, Irvin E. Source: Cochrane Database Syst Rev. 2002; (2): Cd001929. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12076429&dopt=Abstract

•

Massage for low back pain. Author(s): Furlan AD, Brosseau L, Welch V, Wong J. Source: Cochrane Database Syst Rev. 2000; (4): Cd001929. Review. Update In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11034734&dopt=Abstract

•

Massage for low-back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Author(s): Furlan AD, Brosseau L, Imamura M, Irvin E. Source: Spine. 2002 September 1; 27(17): 1896-910. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12221356&dopt=Abstract

•

Massage is better than acupuncture (and in the short term better than self care) in reducing pain and disability in patients with chronic lower back pain. Author(s): Hurley D. Source: The Australian Journal of Physiotherapy. 2001; 47(4): 299. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11774827&dopt=Abstract


•

Massage treatment for back pain. Author(s): Ernst E. Source: Bmj (Clinical Research Ed.). 2003 March 15; 326(7389): 562-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12637375&dopt=Abstract

•

Motion palpation findings and self-reported low back pain in a population-based study sample. Author(s): Leboeuf-Yde C, van Dijk J, Franz C, Hustad SA, Olsen D, Pihl T, Robech R, Skov Vendrup S, Bendix T, Kyvik KO. Source: Journal of Manipulative and Physiological Therapeutics. 2002 February; 25(2): 80-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11896374&dopt=Abstract

•

Nonoperative treatment of low back pain. Author(s): Malanga GA, Nadler SF. Source: Mayo Clinic Proceedings. 1999 November; 74(11): 1135-48. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10560603&dopt=Abstract

•

One-shot percutaneous electrical nerve stimulation vs. transcutaneous electrical nerve stimulation for low back pain: comparison of therapeutic effects. Author(s): Hsieh RL, Lee WC. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2002 November; 81(11): 838-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12394995&dopt=Abstract

•

One-year trend in pain and disability relief recall in acute and chronic ambulatory low back pain patients. Author(s): Haas M, Nyiendo J, Aickin M. Source: Pain. 2002 January; 95(1-2): 83-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11790470&dopt=Abstract

•

Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Author(s): Licciardone JC, Stoll ST, Fulda KG, Russo DP, Siu J, Winn W, Swift J Jr. Source: Spine. 2003 July 1; 28(13): 1355-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12838090&dopt=Abstract

•

Osteopathic medicine in the treatment of low back pain. Author(s): Newswanger DL, Patel AT, Ogle A. Source: American Family Physician. 2000 December 1; 62(11): 2414-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11130229&dopt=Abstract

126 Back Pain

•

Osteopathic treatment of low back pain. Author(s): Orlando C, Field L. Source: The New England Journal of Medicine. 2000 March 16; 342(11): 819; Author Reply 819-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10722339&dopt=Abstract

•

Osteopathic treatment of low back pain. Author(s): Sweetman BJ. Source: The New England Journal of Medicine. 2000 March 16; 342(11): 818; Author Reply 819-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10722338&dopt=Abstract

•

Osteopathic treatment of low back pain. Author(s): Rogers FJ. Source: The New England Journal of Medicine. 2000 March 16; 342(11): 818; Author Reply 819-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10722337&dopt=Abstract

•

Osteopathic treatment of low back pain. Author(s): Lyon DA. Source: The New England Journal of Medicine. 2000 March 16; 342(11): 818; Author Reply 819-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10722336&dopt=Abstract

•

Osteopathic treatment of low back pain. Author(s): Foster D, Johnson MD, Harrelson A. Source: The New England Journal of Medicine. 2000 March 16; 342(11): 817-8; Author Reply 819-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10722335&dopt=Abstract

•

Osteopathic treatment of low back pain. Author(s): Oppenheim JS. Source: The New England Journal of Medicine. 2000 March 16; 342(11): 817; Author Reply 819-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10722334&dopt=Abstract

•

Osteopathic treatment of low back pain. Author(s): Cherkin D. Source: The New England Journal of Medicine. 2000 March 16; 342(11): 817; Author Reply 819-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10722333&dopt=Abstract


•

Pain, disability, and satisfaction outcomes and predictors of outcomes: a practicebased study of chronic low back pain patients attending primary care and chiropractic physicians. Author(s): Nyiendo J, Haas M, Goldberg B, Sexton G. Source: Journal of Manipulative and Physiological Therapeutics. 2001 September; 24(7): 433-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11562650&dopt=Abstract

•

Patient characteristics and physicians' practice activities for patients with chronic low back pain: a practice-based study of primary care and chiropractic physicians. Author(s): Nyiendo J, Haas M, Goldberg B, Sexton G. Source: Journal of Manipulative and Physiological Therapeutics. 2001 February; 24(2): 92-100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11208221&dopt=Abstract

•

Patient characteristics, practice activities, and one-month outcomes for chronic, recurrent low-back pain treated by chiropractors and family medicine physicians: a practice-based feasibility study. Author(s): Nyiendo J, Haas M, Goodwin P. Source: Journal of Manipulative and Physiological Therapeutics. 2000 May; 23(4): 239-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10820296&dopt=Abstract

•

Patients' satisfaction with osteopathic and GP management of low back pain in the same surgery. Author(s): Pincus T, Vogel S, Savage R, Newman S. Source: Complementary Therapies in Medicine. 2000 September; 8(3): 180-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11068348&dopt=Abstract

•

Perceived and measured levels of exertion of patients with chronic back pain exercising in a hydrotherapy pool. Author(s): Barker KL, Dawes H, Hansford P, Shamley D. Source: Archives of Physical Medicine and Rehabilitation. 2003 September; 84(9): 131923. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13680568&dopt=Abstract

•

Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for low back pain. Author(s): Philadelphia Panel. Source: Physical Therapy. 2001 October; 81(10): 1641-74. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11589642&dopt=Abstract

•

Physical therapy management of low back pain: an exploratory survey of therapist approaches. Author(s): Li LC, Bombardier C.

128 Back Pain

Source: Physical Therapy. 2001 April; 81(4): 1018-28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11276184&dopt=Abstract •

Physiotherapy management of low back pain: a survey of current practice in northern Ireland. Author(s): Gracey JH, McDonough SM, Baxter GD. Source: Spine. 2002 February 15; 27(4): 406-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11840108&dopt=Abstract

•

Planning grant awarded to study CAM in treatment of migraines and lower back pain. /entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12779310
Author(s): Ann Intern Med. 2003 Jun 3;138(11):I33 Source: Alternative Therapies in Health and Medicine. 2003 May-June; 9(3): 22. <Title>Potential economic impact of using a proprietary willow bark extract in outpatient treatment of low back pain: an open non-randomized study. Author(s): Chrubasik S, Kunzel O, Black A, Conradt C, Kerschbaumer F. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2001 July; 8(4): 241-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11515713&dopt=Abstract

•

Prevalence of low-back pain in Lesotho mothers. Author(s): Worku Z. Source: Journal of Manipulative and Physiological Therapeutics. 2000 March-April; 23(3): 147-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10771498&dopt=Abstract

•

Prognostic values of physical examination findings in patients with chronic low back pain treated conservatively: a systematic literature review. Author(s): Borge JA, Leboeuf-Yde C, Lothe J. Source: Journal of Manipulative and Physiological Therapeutics. 2001 May; 24(4): 292-5. Review. Erratum In: J Manipulative Physiol Ther 2001 July-August; 24(6): 377. J Manipulative Physiol Ther 2001 June; 24(5): 355. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11353941&dopt=Abstract

•

Quality of life and cost of care of back pain patients in Finnish general practice. Author(s): Hemmila HM. Source: Spine. 2002 March 15; 27(6): 647-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11884913&dopt=Abstract


•

Randomised controlled trial comparing the effectiveness of electroacupuncture and TENS for low back pain: a preliminary study for a pragmatic trial. Author(s): Tsukayama H, Yamashita H, Amagai H, Tanno Y. Source: Acupuncture in Medicine : Journal of the British Medical Acupuncture Society. 2002 December; 20(4): 175-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12512791&dopt=Abstract

•

Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Author(s): Cherkin DC, Eisenberg D, Sherman KJ, Barlow W, Kaptchuk TJ, Street J, Deyo RA. Source: Archives of Internal Medicine. 2001 April 23; 161(8): 1081-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11322842&dopt=Abstract

•

Re: training primary care physicians to give limited manual therapy for low back pain: patient outcomes. Author(s): Mertz JA. Source: Spine. 2001 June 15; 26(12): 1403. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11426162&dopt=Abstract

•

Recall bias, pain, depression and cost in back pain patients. Author(s): Pincus T, Newman S. Source: The British Journal of Clinical Psychology / the British Psychological Society. 2001 June; 40(Pt 2): 143-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11446236&dopt=Abstract

•

Recovery pattern of patients treated with chiropractic spinal manipulative therapy for long-lasting or recurrent low back pain. Author(s): Stig LC, Nilsson O, Leboeuf-Yde C. Source: Journal of Manipulative and Physiological Therapeutics. 2001 May; 24(4): 288-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11353940&dopt=Abstract

•

Rehabilitation therapy in chronic low back pain. Author(s): Poiraudeau S, Revel M. Source: Joint, Bone, Spine : Revue Du Rhumatisme. 2000; 67(6): 582-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11195329&dopt=Abstract

•

Reliability of chiropractic methods commonly used to detect manipulable lesions in patients with chronic low-back pain. Author(s): Feise RJ.

130 Back Pain

Source: Journal of Manipulative and Physiological Therapeutics. 2001 February; 24(2): 145-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11208233&dopt=Abstract •

Reliability of chiropractic methods commonly used to detect manipulable lesions in patients with chronic low-back pain. Author(s): French SD, Green S, Forbes A. Source: Journal of Manipulative and Physiological Therapeutics. 2000 May; 23(4): 231-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10820295&dopt=Abstract

•

Second Prize: The effectiveness of physical modalities among patients with low back pain randomized to chiropractic care: findings from the UCLA low back pain study. Author(s): Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Belin TR, Yu F, Adams AH, Kominsky GF. Source: Journal of Manipulative and Physiological Therapeutics. 2002 January; 25(1): 1020. Erratum In: J Manipulative Physiol Ther 2002 March-April; 25(3): 183. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11898014&dopt=Abstract

•

Self-care techniques for acute episodes of low back pain. Author(s): Nordin M, Welser S, Campello MA, Pietrek M. Source: Best Practice & Research. Clinical Rheumatology. 2002 January; 16(1): 89-104. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11987933&dopt=Abstract

•

Short-term effects of lumbar posteroanterior mobilization in individuals with lowback pain. Author(s): Goodsell M, Lee M, Latimer J. Source: Journal of Manipulative and Physiological Therapeutics. 2000 June; 23(5): 332-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10863253&dopt=Abstract

•

Short-term outcomes of chronic back pain patients on an airbed vs innerspring mattresses. Author(s): Monsein M, Corbin TP, Culliton PD, Merz D, Schuck EA. Source: Medgenmed [electronic Resource] : Medscape General Medicine. 2000 September 11; 2(3): E36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11104482&dopt=Abstract

•

Silver needle therapy for intractable low-back pain at tender point after removal of nucleus pulposus. Author(s): Yi-Kai L, Xueyan A, Fu-Gen W. Source: Journal of Manipulative and Physiological Therapeutics. 2000 June; 23(5): 320-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10863251&dopt=Abstract


•

SPECT in the management of patients with back pain and spondylolysis. Author(s): Dutton JA, Hughes SP, Peters AM. Source: Clinical Nuclear Medicine. 2000 February; 25(2): 93-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10656640&dopt=Abstract

•

Spinal manipulation for chronic low back pain--where to from here? (Comment on Ferreira et al, Australian Journal of Physiotherapy 48: 277-284). Author(s): Edmondston S. Source: The Australian Journal of Physiotherapy. 2003; 49(1): 63-4; Author Reply 64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12600256&dopt=Abstract

•

Spinal manipulation for low-back pain: a treatment package agreed to by the UK chiropractic, osteopathy and physiotherapy professional associations. Author(s): Harvey E, Burton AK, Moffett JK, Breen A; UK BEAM trial team. Source: Manual Therapy. 2003 February; 8(1): 46-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12635637&dopt=Abstract

•

Spinal manipulative therapy for low back pain. Author(s): Swenson R, Haldeman S. Source: J Am Acad Orthop Surg. 2003 July-August; 11(4): 228-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12889861&dopt=Abstract

•

Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies. Author(s): Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Source: Annals of Internal Medicine. 2003 June 3; 138(11): 871-81. Review. Summary for Patients In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12779297&dopt=Abstract

•

Stiffness and neuromuscular reflex response of the human spine to posteroanterior manipulative thrusts in patients with low back pain. Author(s): Colloca CJ, Keller TS. Source: Journal of Manipulative and Physiological Therapeutics. 2001 October; 24(8): 489-500. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11677547&dopt=Abstract

•

Supplementation with alkaline minerals reduces symptoms in patients with chronic low back pain. Author(s): Vormann J, Worlitschek M, Goedecke T, Silver B. Source: Journal of Trace Elements in Medicine and Biology : Organ of the Society for Minerals and Trace Elements (Gms). 2001; 15(2-3): 179-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11787986&dopt=Abstract

132 Back Pain

•

Systematic review of conservative interventions for subacute low back pain. Author(s): Pengel HM, Maher CG, Refshauge KM. Source: Clinical Rehabilitation. 2002 December; 16(8): 811-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12501942&dopt=Abstract

•

Teasing apart quality and validity in systematic reviews: an example from acupuncture trials in chronic neck and back pain. Author(s): Smith LA, Oldman AD, McQuay HJ, Moore RA. Source: Pain. 2000 May; 86(1-2): 119-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10779669&dopt=Abstract

•

The audible pop is not necessary for successful spinal high-velocity thrust manipulation in individuals with low back pain. Author(s): Flynn TW, Fritz JM, Wainner RS, Whitman JM. Source: Archives of Physical Medicine and Rehabilitation. 2003 July; 84(7): 1057-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12881834&dopt=Abstract

•

The centralization phenomenon in chiropractic spinal manipulation of discogenic low back pain and sciatica. Author(s): Lisi AJ. Source: Journal of Manipulative and Physiological Therapeutics. 2001 NovemberDecember; 24(9): 596-602. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11753334&dopt=Abstract

•

The course of low back pain in a general population. Results from a 5-year prospective study. Author(s): Hestbaek L, Leboeuf-Yde C, Engberg M, Lauritzen T, Bruun NH, Manniche C. Source: Journal of Manipulative and Physiological Therapeutics. 2003 May; 26(4): 213-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12750654&dopt=Abstract

•

The diagnosis and treatment of patients with chronic low-back pain by traditional Chinese medical acupuncturists. Author(s): Sherman KJ, Cherkin DC, Hogeboom CJ. Source: Journal of Alternative and Complementary Medicine (New York, N.Y.). 2001 December; 7(6): 641-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11822612&dopt=Abstract

•

The diagnostic utility of McKenzie clinical assessment for lower back pain. Author(s): Delaney PM, Hubka MJ.


Source: Journal of Manipulative and Physiological Therapeutics. 1999 NovemberDecember; 22(9): 628-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10626707&dopt=Abstract •

The economic burden of back pain in the UK. Author(s): Maniadakis N, Gray A. Source: Pain. 2000 January; 84(1): 95-103. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10601677&dopt=Abstract

•

The effectiveness of physical modalities among patients with low back pain randomized to chiropractic care: findings from the UCLA low back pain study. Author(s): Rupert R. Source: Journal of Manipulative and Physiological Therapeutics. 2002 October; 25(8): 538-9; Author Reply 539-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12381978&dopt=Abstract

•

The effects of shiatsu on lower back pain. Author(s): Brady LH, Henry K, Luth JF 2nd, Casper-Bruett KK. Source: Journal of Holistic Nursing : Official Journal of the American Holistic Nurses' Association. 2001 March; 19(1): 57-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11847714&dopt=Abstract

•

The efficacy and safety of a homeopathic gel in the treatment of acute low back pain: a multi-centre, randomised, double-blind comparative clinical trial. Author(s): Stam C, Bonnet MS, van Haselen RA. Source: Br Homeopath J. 2001 January; 90(1): 21-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11212085&dopt=Abstract

•

The experience of breath as a therapeutic intervention - psychosomatic forms of breath therapy. A descriptive study about the actual situation of breath therapy in Germany, its relation to medicine, and its application in patients with back pain. Author(s): Mehling WE. Source: Forschende Komplementarmedizin Und Klassische Naturheilkunde = Research in Complementary and Natural Classical Medicine. 2001 December; 8(6): 359-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11799304&dopt=Abstract

•

The impact of treatment confidence on pain and related disability among patients with low-back pain: results from the University of California, Los Angeles, low-back pain study. Author(s): Goldstein MS, Morgenstern H, Hurwitz EL, Yu F.

134 Back Pain

Source: The Spine Journal : Official Journal of the North American Spine Society. 2002 November-December; 2(6): 391-9; Discussion 399-401. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14589256&dopt=Abstract •

The prevalence of recalled low back pain during and after pregnancy: a South Australian population survey. Author(s): Stapleton DB, MacLennan AH, Kristiansson P. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2002 November; 42(5): 482-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12495090&dopt=Abstract

•

The relation of race to outcomes and the use of health care services for acute low back pain. Author(s): Carey TS, Garrett JM. Source: Spine. 2003 February 15; 28(4): 390-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12590217&dopt=Abstract

•

The role of radiography in primary care patients with low back pain of at least 6 weeks duration: a randomised (unblinded) controlled trial. Author(s): Kendrick D, Fielding K, Bentley E, Miller P, Kerslake R, Pringle M. Source: Health Technology Assessment (Winchester, England). 2001; 5(30): 1-69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11701101&dopt=Abstract

•

The treatment of neck and low back pain: who seeks care? who goes where? Author(s): Cote P, Cassidy JD, Carroll L. Source: Medical Care. 2001 September; 39(9): 956-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11502953&dopt=Abstract

•

The use of spinal manipulation in the treatment of low back pain: a review of goals, patient selection, techniques, and risks. Author(s): Eck JC, Circolone NJ. Source: Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association. 2000; 5(4): 411-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10982694&dopt=Abstract

•

To seek or not to seek? Care-seeking behaviour among people with low-back pain. Author(s): Mortimer M, Ahlberg G; MUSIC-Norrtalje Study Group. Source: Scandinavian Journal of Public Health. 2003; 31(3): 194-203. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12850973&dopt=Abstract

•

Topical treatment of chronic low back pain with a capsicum plaster. Author(s): Frerick H, Keitel W, Kuhn U, Schmidt S, Bredehorst A, Kuhlmann M.


Source: Pain. 2003 November; 106(1-2): 59-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14581111&dopt=Abstract •

Training primary care physicians to give limited manual therapy for low back pain: patient outcomes. Author(s): Curtis P, Carey TS, Evans P, Rowane MP, Mills Garrett J, Jackman A. Source: Spine. 2000 November 15; 25(22): 2954-60; Discussion 2960-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11074684&dopt=Abstract

•

Transcutaneous electrical nerve stimulation (TENS) for chronic low back pain. Author(s): Milne S, Welch V, Brosseau L, Saginur M, Shea B, Tugwell P, Wells G. Source: Cochrane Database Syst Rev. 2001; (2): Cd003008. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11406059&dopt=Abstract

•

Transcutaneous electrical nerve stimulation and acupuncture-like transcutaneous electrical nerve stimulation for chronic low back pain. Author(s): Gadsby JG, Flowerdew MW. Source: Cochrane Database Syst Rev. 2000; (2): Cd000210. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10796326&dopt=Abstract

•

Treatment of chronic lower back pain with lumbar extension and whole-body vibration exercise: a randomized controlled trial. Author(s): Rittweger J, Just K, Kautzsch K, Reeg P, Felsenberg D. Source: Spine. 2002 September 1; 27(17): 1829-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12221343&dopt=Abstract

•

Treatment of low back pain exacerbations with willow bark extract: a randomized double-blind study. Author(s): Chrubasik S, Eisenberg E, Balan E, Weinberger T, Luzzati R, Conradt C. Source: The American Journal of Medicine. 2000 July; 109(1): 9-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10936472&dopt=Abstract

•

Treatment of low back pain with a herbal or synthetic anti-rheumatic: a randomized controlled study. Willow bark extract for low back pain. Author(s): Chrubasik S, Kunzel O, Model A, Conradt C, Black A. Source: Rheumatology (Oxford, England). 2001 December; 40(12): 1388-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11752510&dopt=Abstract

•

UK Back pain Exercise And Manipulation (UK BEAM) trial - national randomised trial of physical treatments for back pain in primary care: objectives, design and interventions [ISRCTN32683578]. Author(s): UK Back pain Exercise And Manipulation (UK BEAM) Trial Team.

136 Back Pain

Source: Bmc Health Services Research [electronic Resource]. 2003 August 1; 3(1): 16. Epub 2003 Aug 01. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12892566&dopt=Abstract •

Variation in diagnosis and treatment of chronic low back pain by traditional Chinese medicine acupuncturists. Author(s): Hogeboom CJ, Sherman KJ, Cherkin DC. Source: Complementary Therapies in Medicine. 2001 September; 9(3): 154-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11926429&dopt=Abstract

•

Views on radiography use for patients with acute low back pain among chiropractors in an Ontario community. Author(s): Ammendolia C, Bombardier C, Hogg-Johnson S, Glazier R. Source: Journal of Manipulative and Physiological Therapeutics. 2002 October; 25(8): 511-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12381973&dopt=Abstract

•

What are the management options for acute and chronic low back pain? Author(s): Greene S, Brandon N. Source: Jaapa. 2000 October; 13(10): 74-6, 79, 83-6 Passim. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11521645&dopt=Abstract

•

What is the most effective treatment for acute low back pain? Author(s): Harwood MI, Chang SI. Source: The Journal of Family Practice. 2002 February; 51(2): 118. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11978208&dopt=Abstract

•

What is the standard of care for patients with low back pain? Author(s): D'Alonzo GE. Source: J Am Osteopath Assoc. 1999 November; 99(11): 556. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10612947&dopt=Abstract

•

Whose autonomy? Which choice? A study of GPs' attitudes towards patient autonomy in the management of low back pain. Author(s): Rogers WA. Source: Family Practice. 2002 April; 19(2): 140-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11906978&dopt=Abstract

•

Yoga aids in back pain. Author(s): Hudson S.


Source: Australian Nursing Journal (July 1993). 1998 April; 5(9): 27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10568387&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

•


•

Chinese Medicine: http://www.newcenturynutrition.com/

•

drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

•

Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

•

Google: http://directory.google.com/Top/Health/Alternative/

•

Healthnotes: http://www.healthnotes.com/

•

MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

•

Open Directory Project: http://dmoz.org/Health/Alternative/

•

HealthGate: http://www.tnp.com/

•

WebMDHealth: http://my.webmd.com/drugs_and_herbs

•

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

•

Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to back pain; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Bladder Infection Alternative names: Urinary Tract Infection [UTI] Source: Prima Communications, Inc.www.personalhealthzone.com Bone Infection Source: Integrative Medicine Communications; www.drkoop.com Bone Loss Source: Integrative Medicine Communications; www.drkoop.com Cervical Dysplasia Source: Integrative Medicine Communications; www.drkoop.com

138 Back Pain

Endocarditis Source: Integrative Medicine Communications; www.drkoop.com Fibromyalgia Source: Healthnotes, Inc.; www.healthnotes.com High Blood Pressure Source: Integrative Medicine Communications; www.drkoop.com Hypertension Source: Integrative Medicine Communications; www.drkoop.com Low Back Pain Source: Healthnotes, Inc.; www.healthnotes.com Low Back Pain Source: Integrative Medicine Communications; www.drkoop.com Lupus Source: Integrative Medicine Communications; www.drkoop.com Osteoarthritis Source: Healthnotes, Inc.; www.healthnotes.com Osteomyelitis Source: Integrative Medicine Communications; www.drkoop.com Osteoporosis Source: Healthnotes, Inc.; www.healthnotes.com Osteoporosis Source: Integrative Medicine Communications; www.drkoop.com Pms Alternative names: Premenstrual Stress Syndrome Source: Prima Communications, Inc.www.personalhealthzone.com Pregnancy and Postpartum Support Source: Healthnotes, Inc.; www.healthnotes.com Prostate Cancer Source: Integrative Medicine Communications; www.drkoop.com Systemic Lupus Erythematosus Source: Integrative Medicine Communications; www.drkoop.com Warts Source: Integrative Medicine Communications; www.drkoop.com


•

Alternative Therapy Acupressure Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,662,00.html Acupuncture Source: Healthnotes, Inc.; www.healthnotes.com Acupuncture Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,663,00.html Alexander Technique Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,665,00.html Biofeedback Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,675,00.html Chiropractic Source: Healthnotes, Inc.; www.healthnotes.com Chiropractic Source: Integrative Medicine Communications; www.drkoop.com Chiropractic Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,681,00.html Craniosacral Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,685,00.html Feldenkrais Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,695,00.html Hellerwork Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,700,00.html

140 Back Pain

Homeopathy Source: Integrative Medicine Communications; www.drkoop.com Hypnotherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,706,00.html Massage Source: Integrative Medicine Communications; www.drkoop.com Massage Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,716,00.html Myotherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,931,00.html Osteopathy Source: Integrative Medicine Communications; www.drkoop.com Osteopathy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,724,00.html Polarity Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,727,00.html Reflexology Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,730,00.html Rolfing Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,732,00.html Shiatsu Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,733,00.html Traditional Chinese Medicine Source: Integrative Medicine Communications; www.drkoop.com


Traditional Chinese Medicine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10085,00.html Trager Approach Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,741,00.html •

Chinese Medicine Gusuibu Alternative names: Fortune's Drynaria Rhizome; Rhizoma Drynariae Source: Chinese Materia Medica Lurong Alternative names: Hairy Deer-horn (Hairy Antler); Cornu Cervi Pantotrichum Source: Chinese Materia Medica Shayuanzi Alternative names: Flatstem Milkvetch Seed; Semen Astragali Complanati Source: Chinese Materia Medica

•

Herbs and Supplements Arctostaphylos Alternative names: Bearberry; Arctostaphylos uva-ursi (L.) Spreng. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Arnica Alternative names: Arnica montana L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Boswellia Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,759,00.html Bromelain Source: Healthnotes, Inc.; www.healthnotes.com Bromelain Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,760,00.html Cayenne Alternative names: Capsicum annuum, Capsicum frutescens Source: Healthnotes, Inc.; www.healthnotes.com

142 Back Pain

Cranberry Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10019,00.html Crataegus Alternative names: Hawthorn; Crataegus oxyacantha L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Devil’s Claw Alternative names: Harpagophytum procumbens Source: Healthnotes, Inc.; www.healthnotes.com Devil's Claw Source: Prima Communications, Inc.www.personalhealthzone.com Devil's Claw Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,970,00.html Digestive Enzymes Source: Healthnotes, Inc.; www.healthnotes.com Eucalyptus Alternative names: Eucalyptus globulus Source: Healthnotes, Inc.; www.healthnotes.com Ginger Alternative names: Zingiber officinale Source: Healthnotes, Inc.; www.healthnotes.com Glucosamine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,790,00.html Juniper Berry Source: Prima Communications, Inc.www.personalhealthzone.com Kava Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,798,00.html Msm Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,807,00.html


Peppermint Alternative names: Mentha piperita Source: Healthnotes, Inc.; www.healthnotes.com Phenylalanine Source: Healthnotes, Inc.; www.healthnotes.com Same (s-adenosylmethionine) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,818,00.html Siberian Ginseng Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,821,00.html Turmeric Alternative names: Curcuma longa Source: Healthnotes, Inc.; www.healthnotes.com Uva Ursi Source: Prima Communications, Inc.www.personalhealthzone.com White Willow Source: Prima Communications, Inc.www.personalhealthzone.com White Willow Bark Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10069,00.html Willow Alternative names: Salix alba Source: Healthnotes, Inc.; www.healthnotes.com Willow Bark Alternative names: There are several species of willow includingSalix alba, Salix nigra, Salix fragilis, Salix purpurea, Salix babylonica, White Willow, European Willow, Black Willow, Pussy Willow, Crack Willow, Purple Willow, Weeping Willow, Liu-zhi Source: Integrative Medicine Communications; www.drkoop.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

145

CHAPTER 4. DISSERTATIONS ON BACK PAIN Overview In this chapter, we will give you a bibliography on recent dissertations relating to back pain. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “back pain” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on back pain, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Back Pain ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to back pain. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

A Comparison of Measured Personality Characteristics of Chronic Low Back Pain Patients and Multiple Pain Patients (personality, Mmpi) by Arnholt, Larry Edward, Phd from Texas A&m University, 1985, 152 pages http://wwwlib.umi.com/dissertations/fullcit/8528301

•

A Cross-cultural Epidemiological Study of Low Back Pain in American and Yucatec Maya Adult Males by Smerken, David S., Phd from Southern Illinois University at Carbondale, 1994, 152 pages http://wwwlib.umi.com/dissertations/fullcit/9516042

•

A Kinetic and Kinematic Comparison of the Traditional and Sumo Deadlifts (deadlifts, Weightlifting, Back Pain) by Thiebaud, Karla Renee, Phd from Texas A&m University, 1990, 137 pages http://wwwlib.umi.com/dissertations/fullcit/9027281

146 Back Pain

•

A Social Epidemiology of Low Back Pain by El-khiami, Afafe M. Khalil, Phd from The Ohio State University, 1983, 245 pages http://wwwlib.umi.com/dissertations/fullcit/8403512

•

A Study of Self-regulation with Chronic Low Back Pain Patients (disregulation, Behavioral Medicine) by Stephens, Eileen L., Edd from Northern Illinois University, 1986, 306 pages http://wwwlib.umi.com/dissertations/fullcit/8620975

•

Adding Insult to Injury: Cultural Dimensions of Frustration in the Management of Chronic Back Pain (medical Treatment, Conversational Analysis) by Corbett, Kitty King, Phd from Univ. of Calif., San Francisco with the Univ. of Calif., Berkeley, 1986, 422 pages http://wwwlib.umi.com/dissertations/fullcit/8624990

•

An Analysis of Indicators in Predicting Return to Work for Chronic Back Pain Sufferers (pain Management) by Neiders, Regine Ilga, Phd from University of Washington, 1990, 223 pages http://wwwlib.umi.com/dissertations/fullcit/9108504

•

An Investigation of the Role of Social Support in the Rehabilitation of Chronic Low Back Pain (low Back Pain, Pain) by Wilkin, Diane Lynch, Phd from The University of Iowa, 1989, 136 pages http://wwwlib.umi.com/dissertations/fullcit/9004961

•

Association of Psychosocial Work Characteristics with Acute Low Back Pain Outcomes by Mielenz, Thelma Jones; Phd from The University of North Carolina at Chapel Hill, 2002, 160 pages http://wwwlib.umi.com/dissertations/fullcit/3070884

•

Back Pain: the Effect of Physiological and Educational Treatment Modalities on Various Outcome Measures by Udermann, Brian Earl, Phd from Syracuse University, 1999, 202 pages http://wwwlib.umi.com/dissertations/fullcit/9925983

•

Childhood Experiences, Personality Development and Marital Interactional Patterns in Women with Chronic Benign Back Pain by Pecukonis, Edward Vincent, Phd from University of Maryland at Baltimore, 1993, 301 pages http://wwwlib.umi.com/dissertations/fullcit/9319837

•

Cognitive Evaluation of Chronic Low Back Pain: a Pre, Post and Follow-up Assessment (pain Management) by Kuhlman, Bradley William, Phd from The University of Iowa, 1992, 146 pages http://wwwlib.umi.com/dissertations/fullcit/9235863

•

Comparative Effectiveness of Existential and Behavioral Group Counseling in Reducing Pain Apperception in Individuals Experiencing Chronic Low Back Pain by Scott, James Douglas, Edd from University of Southern California, 1972, 144 pages http://wwwlib.umi.com/dissertations/fullcit/7217508

•

Comparison of Evidence-based Medicine to Traditional and Placebo Treatments for Acute Back Pain by Long, Preston H.; Phd from Walden University, 2002, 128 pages http://wwwlib.umi.com/dissertations/fullcit/3049920

•

Comparison of Gait Characteristics between Patients with Low Back Pain and Painfree Individuals by Lee, Christina Ellen; Phd from Texas Woman's University, 2002, 173 pages http://wwwlib.umi.com/dissertations/fullcit/3069365

Dissertations 147

•

Development of a Self-efficacy Instrument for Patients with Chronic Low Back Pain and Its Use As a Predictor of Physical Therapy Outcome by Du Bois, Kimberley Anne; Phd from The University of Connecticut, 2002, 368 pages http://wwwlib.umi.com/dissertations/fullcit/3042900

•

Effectiveness of Patient Education in Providing Therapeutic Care for Low-back Pain Conditions by Buddell, Wilfred, Phd from Southern Illinois University at Carbondale, 1980, 106 pages http://wwwlib.umi.com/dissertations/fullcit/8122623

•

Electromyograph Biofeedback and the Treatment of Chronic Low Back Pain by Bush, Clarissa; Phd from Mcgill University (canada), 1984 http://wwwlib.umi.com/dissertations/fullcit/NK66673

•

Electromyographic Analysis of the Lumbar Erector Spinae Muscles: Influence of Position, a History of Low Back Pain, Gender and Muscle Location on Fatigue and Recovery by Fall, Michael Paul; Phd from The University of Connecticut, 2001, 104 pages http://wwwlib.umi.com/dissertations/fullcit/3030666

•

Epidemiological Study of Low Back Pain: Association with Socio-demographic and Occupational Factors by Adera, Tilahun, Phd from Oregon State University, 1987, 213 pages http://wwwlib.umi.com/dissertations/fullcit/8811947

•

Facial Expressive Behaviour of a Chronic Low Back Pain Population by Hyde, Susan Ann; Phd from The University of British Columbia (canada), 1986 http://wwwlib.umi.com/dissertations/fullcit/NL35014

•

Factors Effecting Outcome in Patients Receiving Physical Therapy for Low Back Pain by Bell, Christine Ann; Ms from Mgh Institute of Health Professions, 2002, 76 pages http://wwwlib.umi.com/dissertations/fullcit/1410035

•

Ligament Laxity and Back Pain during Pregnancy by Cameron, Tracy Leigh; Msc from University of Calgary (canada), 2002, 82 pages http://wwwlib.umi.com/dissertations/fullcit/MQ72142

•

Low Back Pain and Neck Pain: the Impact of Coping Strategies, Negative Life Events, and Health Locus of Control by Higgins, June Eckstein, Phd from York University (canada), 1993, 140 pages http://wwwlib.umi.com/dissertations/fullcit/NN90520

•

Low-back Pain and 'Sciatica' Symptoms - Development of a Clinical Method to Identify the Sources by Personius, Walter J., Phd from The University of Iowa, 1984, 222 pages http://wwwlib.umi.com/dissertations/fullcit/8428279

•

Management of the First Episode of Acute Low Back Pain: a Comparison between Two Treatment Protocols by Ali, Ashraf Ahmed; Phd from Texas Woman's University, 2002, 162 pages http://wwwlib.umi.com/dissertations/fullcit/3046296

•

Marital Adaptation to Illness: a Comparison of Cardiac and Back Pain Patients and Their Spouses (cardiac Patients) by Cockburn, Orbie, Phd from Texas Woman's University, 1991, 138 pages http://wwwlib.umi.com/dissertations/fullcit/9203082

148 Back Pain

•

Measuring Function Behavior and Low Back Pain: Analysis and Prescription by Gur, Vardita, Edd from Boston University, 1994, 269 pages http://wwwlib.umi.com/dissertations/fullcit/9422197

•

Medically Incongruent Back Pain Presentation an Indication of Physical Restriction, Suffering, and Ineffective Coping with Pain by Reesor, Kenneth Alan; Phd from The University of British Columbia (canada), 1986 http://wwwlib.umi.com/dissertations/fullcit/NL36693

•

Nonlinear Analysis of Muscle Fatigue in Low Back Pain Patients before and after Exercise Therapy by Liu, Yiwei; Ms from Loyola University of Chicago, 2003, 56 pages http://wwwlib.umi.com/dissertations/fullcit/1413570

•

Occupational Low Back Pain in Residential Carpenters: Ergonomic Elements of Posture and Strain by Gilkey, David Paige; Phd from Colorado State University, 2002, 238 pages http://wwwlib.umi.com/dissertations/fullcit/3053423

•

Physical and Psychosocial Predictors of Work Retention after a Multidisciplinary Rehabilitation Program for Non-specific Low Back Pain Patients by Campello, Marco Aurelio Amora; Phd from New York University, 2002, 116 pages http://wwwlib.umi.com/dissertations/fullcit/3062794

•

Physician Selection in Low Back Pain Patients by Phillips, Reed B., Phd from The University of Utah, 1987, 169 pages http://wwwlib.umi.com/dissertations/fullcit/8714243

•

Psychologists' Descriptions of Successful and Unsuccessful Chronic Low Back Pain Clients on Compensation a Reconstitutive Hermeneutic Analysis by Faltin, Robert J; Phd from University of Alberta (canada), 1987 http://wwwlib.umi.com/dissertations/fullcit/NL41067

•

Psychologists' Descriptions of Successful and Unsuccessful Chronic Low Back Pain Clients on Compensation: a Reconstitutive Hermeneutic Analysis by Faltin, Robert John, Phd from University of Alberta (canada), 1987 http://wwwlib.umi.com/dissertations/fullcit/f364021

•

Psychophysiological Correlates of Low Back Pain by Wilfling, Francis Joseph; Phd from The University of British Columbia (canada), 1981 http://wwwlib.umi.com/dissertations/fullcit/NK55169

•

Psychophysiological Profile of Nonpatient Nonpsychiatric Women Who Reported Low Back Pain Symptoms. by Johnson, Joyce Germaine, Phd from University of Maryland College Park, 1978, 140 pages http://wwwlib.umi.com/dissertations/fullcit/7917381

•

Sex Differences in Perceived Pain, Pain-related Affective Distress, and Pain-related Disability with Low Back Pain by Inman, Sandra Lee; Dnsc from Rush University, College of Nursing, 2003, 116 pages http://wwwlib.umi.com/dissertations/fullcit/3081373

•

Short-term Effects of Mobilization in Patients with Low Back Pain by Vousboukis, Danielle; Ms from Mgh Institute of Health Professions, 2002, 64 pages http://wwwlib.umi.com/dissertations/fullcit/1407900

Dissertations 149

•

The Contribution of Perceived Control over Muscle Tension to the Mechanism of Biofeedback Training with Back Pain Patients by Biedermann, Heinz-joachim; Phd from Queen's University at Kingston (canada), 1986 http://wwwlib.umi.com/dissertations/fullcit/NL30449

•

The Effect of a Fear-avoidance Based Intervention for Patients with Acute Low Back Pain. a Randomized Clinical Trial by George, Steven Zachary; Phd from University of Pittsburgh, 2002, 144 pages http://wwwlib.umi.com/dissertations/fullcit/3066949

•

The Effect of Correcting Muscle Asymmetry upon Chronic Low Back Pain by Donaldson, Christopher Charles Stuart; Phd from University of Calgary (canada), 1989 http://wwwlib.umi.com/dissertations/fullcit/NL54209

•

The Effect of Posture upon Perceived Back Pain in Recreational Male Golfers by Vining, Cynthia Mary; Ma from California State University, Fresno, 2002, 84 pages http://wwwlib.umi.com/dissertations/fullcit/1412809

•

The Efficacy of Relaxation and Imagery in Chronic Low Back Pain Management by Boon, Brian Joseph, Phd from University of Alberta (canada), 1988 http://wwwlib.umi.com/dissertations/fullcit/f3844900

•

The Efficacy of Relaxation and Imagery in Chronic Low Back Pain Management by Boon, Brian Joseph; Phd from University of Alberta (canada), 1988 http://wwwlib.umi.com/dissertations/fullcit/NL45655

•

The Elderly Back Pain Patient: Discerning Variables That Predict Long-term Adherence to Exercise by Mailloux, Julie Elizabeth; Psyd from Massachusetts School of Professional Psychology, 2002, 159 pages http://wwwlib.umi.com/dissertations/fullcit/3052700

•

The Examination of Specific Personality Subsystems of Surgical Versus Nonsurgical Chronic Low Back Pain Patients by Loranger, Jon Wayne, Edd from Peabody College for Teachers of Vanderbilt University, 1988, 67 pages http://wwwlib.umi.com/dissertations/fullcit/8907926

•

The Experience of Female Spouses of Chronic Low Back Pain Sufferers by Mackay, Anne Marie, Phd from University of Alberta (canada), 1996, 176 pages http://wwwlib.umi.com/dissertations/fullcit/NN18070

•

The Psychological Treatment of Back Pain: a Meta-analysis by Bailey, Gregory W.; Phd from Loyola University of Chicago, 2002, 143 pages http://wwwlib.umi.com/dissertations/fullcit/3039265

•

The Relationship of Affect to Treatment and Outcome in Chronic Low Back Pain (measured Affect, Rehabilitation Outcome) by Delmar, Paul William, Phd from Michigan State University, 1992, 237 pages http://wwwlib.umi.com/dissertations/fullcit/9233873

•

The Relationship of Cognitive Coping Strategies to Pain Behavior and Sickness Impact in Chronic Low Back Pain Patients (coping) by Jorge, Michael Celestino, Phd from University of Miami, 1992, 147 pages http://wwwlib.umi.com/dissertations/fullcit/9239660

150 Back Pain

•

The Relationship of Problem Solving Skills, Barriers to Self Management, and Selfefficacy to Perceived Health Outcomes for Persons with Low Back Pain: the Evaluation of Two Instruments by Berendt, John William, Phd from University of Oregon, 1993, 303 pages http://wwwlib.umi.com/dissertations/fullcit/9405141

•

Using the Illness Representation Model to Characterize How Chronic Low Back Pain Patients Understand Their Condition (pain) by Morris, Katherine Jo, Phd from The University of Iowa, 1990, 318 pages http://wwwlib.umi.com/dissertations/fullcit/9122093

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

151

CHAPTER 5. CLINICAL TRIALS AND BACK PAIN Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning back pain.

Recent Trials on Back Pain The following is a list of recent trials dedicated to back pain.8 Further information on a trial is available at the Web site indicated. •

Effect of Antidepressants on Back Pain Condition(s): Back Pain; Sciatica Study Status: This study is currently recruiting patients. Sponsor(s): Department of Veterans Affairs Medical Research Service Purpose - Excerpt: The purpose of this study is to determine whether different types of antidepressant medicines relieve back pain that has lasted at least six months on a daily basis. Study participants will be assigned to treatment with either a antidepressant acting on the serotonin system in the brain (fluoxetine), one acting on the noradrenoline system (desipramine, or to a control medication not expected to relieve pain (benztropine). Each participant will be seen at least nine times during their 12 weeks on medication. This is a phase 2/3, outpatient study. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00018200

•

Magnets in the Treatment of Sciatica Condition(s): Low Back Pain; Sciatica Study Status: This study is currently recruiting patients.

8

These are listed at www.ClinicalTrials.gov.

152 Back Pain

Sponsor(s): National Institute of Dental and Craniofacial Research (NIDCR) Purpose - Excerpt: This 19-week study will evaluate magnets of very low power to treat sciatica (also referred to as lumbago, sciatica, or lumbar radicular pain). Some evidence suggests that magnets can alleviate pain associated with muscle, bone, and nerve problems. Individuals between 30 and 70 years of age who have had sciatica (sharp, shooting pains in the leg) daily for at least 3 months may be eligible for this study. The pain must be moderate to severe, occur on a daily basis, and be due to either disc problems or degeneration of the spine. Patients with pain in the buttock or posterior thigh without sciatica may also qualify if they have irritation of the lumbar (lower spine) nerve roots or if imaging studies such as magnetic resonance imaging (MRI) reveal a disc compressing the lumbar nerves on the same side as the pain. Candidates will be screened with a medical history, physical and neurological examinations, blood tests, pain evaluation, collection of demographic information, and possibly MRI. They will fill out questionnaires regarding pain, daily function, and psychological well being. The study has two phases, consisting of four 2-week periods in phase 1 and two 5-week periods in phase 2. - Phase 1: During two of the 2-week periods, subjects wear an elastic binder back support device with magnets sewn into them - one with the magnets aligned in the direction of the spine; the other with the magnets placed across the spine. During another period, subjects wear a dummy device that looks like a real magnet but has no actual magnetic force; in another, they wear no device at all. The magnets are worn at least 12 hours a day. - Phase 2: The subject wears the preferred magnet (real or sham) from phase 1 during one of these 5-week periods, and a dummy device during the other. Participants who did not find any of the magnets helpful in phase 1 may continue, nevertheless, with phase 2 and be assigned a magnet and sham device by the investigators. Participants may continue taking their regular pain medicines throughout the study's duration. They will keep a pain log during both phases, rating their pain on a scale of 0 to 10, and a record of side effects experienced with each period of the study. They will also keep a record of procedures, such as injections and manipulations, they undergo during the study to control pain flare-ups. Clinic visits will be scheduled as follows: - Visit 1: for screening and baseline studies before starting phase 1; participants may also come to the clinic after each 2-week period in phase 1 to exchange devices, or the devices may be mailed to the participant - Visit 2: at the end of phase 1 for an interview about the magnet treatments and to indicate the preferred treatment - Visit 3: at the end of the first phase 2 5-week period for a brief neurological examination, interview regarding treatment satisfaction and side effects, and completion of questionnaires - Visit 4: at the end of the second phase 2 5-week period for the same procedures as visit 2 During each visit, participants will have sensory testing, in which a pin is placed on the surface of the skin. This test does not cause any discomfort. At the end of the study, participants will be given the device that helped them, if any. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00044109 •

Spine Patient Outcomes Research Trial- Intervertebral Disc Herniation Condition(s): Herniated Disc; Low Back Pain Study Status: This study is currently recruiting patients.

Clinical Trials 153

Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); National Institute for Occupational Safety and Health (NIOSH/CDC); Office of Research on Women's Health (ORWH) Purpose - Excerpt: This study tests the effectiveness of different treatments for the three most commonly diagnosed lumbar (lower) spine conditions. The purpose of the study is to learn which of two commonly prescribed treatments (surgery and non-surgical therapy) works better for specific types of low back pain. In this part of the study, people with lumbar intervertebral disc herniation (damage to the tissue between the bones of the lower spine, or backbone) will receive either discectomy (surgical removal of herniated disc material) or non-surgical treatment. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000410 •

Spine Patient Outcomes Research Degenerative Spondylolisthesis with Spinal Stenosis Condition(s): Spondylolisthesis; Spinal Stenosis; Low Back Pain Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); National Institute for Occupational Safety and Health (NIOSH/CDC); Office of Research on Women's Health (ORWH) Purpose - Excerpt: This study tests the effectiveness of different treatments for the three most commonly diagnosed conditions of the lower backbone (lumbar spine). The purpose is to learn which of two commonly prescribed treatments-surgery and nonsurgical therapy-works better for specific types of low back pain. Low back pain is one of the most widely experienced health problems in the United States and the world. It is the second most frequent condition, after the common cold, for which people see a doctor or lose days from work. In this part of the study, we will treat patients with spinal stenosis (a narrowing of spaces in the backbone that results in pressure on the spinal cord and/or nerve roots) caused by degenerative spondylolisthesis (a condition in which one vertebra, or spinal bone, slips forward on another) with either surgery or nonsurgical methods. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000409

•

Spine Patient Outcomes Research Spinal Stenosis Condition(s): Spinal Stenosis; Low Back Pain Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); National Institute for Occupational Safety and Health (NIOSH/CDC); Office of Research on Women's Health (ORWH)

154 Back Pain

Purpose - Excerpt: This study tests the effectiveness of different treatments for the three most commonly diagnosed conditions of the lower backbone (lumbar spine). The purpose is to learn which of two commonly prescribed treatments (surgery and nonsurgical therapy) works better for specific types of low back pain. Low back pain is one of the most widely experienced health problems in the United States and the world. It is the second most frequent condition, after the common cold, for which people see a doctor or lose days from work. In this part of the study, we will treat patients with spinal stenosis (a narrowing of spaces in the backbone that results in pressure on the spinal cord and/or nerve roots) with a type of surgery known as posterior decompressive laminectomy or with nonsurgical methods. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000411 •

Usual Care Vs Choice of Alternative Rx: Low Back Pain Condition(s): Acute low back pain Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: This study compares two approaches to the management of acute low back pain: usual care (standard benefit) vs. the choice of: usual care, chiropractic, acupuncture or massage therapy (expanded benefit). 480 subjects with uncomplicated, acute low back pain will be recruited from a health maintenance organization, and randomized to either usual care (n=160) or choice of expanded benefits (n=320). Patients' preferences for individual therapies and expectations of improvement will be measured at baseline and throughout the study. Subjects randomized to the expanded benefits arm who choose chiropractic, acupuncture or massage will receive up to 10 treatments over a five-week period. Additional treatments will be available after the fifth week but will require a copayment. Treatments will be provided by licensed providers who have met strict credentialing criteria. Chiropractic, acupuncture or massage treatments will begin within 48 hours. Chiropractic, acupuncture and massage therapy scope of practice guidelines for the treatment of acute low back pain have been developed as have detailed data tracking procedures to be used at each patient visit. Symptom relief, functional status, restricted activity days, use of health care, and patient and provider satisfaction will be assessed at 2, 5,12, 26 and 52 weeks after initiation of treatment. Primary outcomes will include: 1) change in symptoms; 2) change in functional status; 3) patient satisfaction; and 4) total utilization of services associated with care for low back pain. Medical records and the HMO's cost management information system will identify use of services. It is hypothesized that patients offered their choice of expanded benefits will experience a more rapid improvement in symptoms, a faster return to baseline functional status, a decrease in utilization of conventional medical services, and will be more satisfied with their care. The study is a direct examination of the effectiveness of an insurance eligibility intervention, not a test of the efficacy of specific, non-allopathic treatment regimens. The results of this study will provide valuable information to clinicians, patients and third party payers on the relative benefits and costs of an "expanded benefits" treatment option which incorporates chiropractic, acupuncture and massage services for low back pain. Phase(s): Phase III

Clinical Trials 155

Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00010985 •

The Use of Real Time Ultrasound Feedback in Teaching Abdominal Hollowing Exercises Condition(s): Low Back Pain Study Status: This study is no longer recruiting patients. Sponsor(s): National Center for Research Resources (NCRR) Purpose - Excerpt: Recently, physical therapists have begun treating people who have mechanical low back pain, hypothesized to be caused by segmental instability in the lumbar spine, with a very specific exercise program consisting of trunk stabilization exercises. The theory behind the use of trunk stabilization exercises to treat lower back pain is that active contraction of the trunk local segmental muscles helps to control inter-segmental movement in the spine. The initial trunk stabilization exercise that physical therapists teach patients is an abdominal drawing in maneuver often called an abdominal hollowing exercise (AHE). A challenge for physical therapists is to establish the most effective means of teaching people to contract the relevant muscles needed to perform the AHE. The purpose of this study is to examine if supplementing the typical clinical instruction for teaching the AHE with visual ultrasound feedback to the patient is effective at reducing the length of time it takes an individual to learn to perform an AHE. Three groups of research volunteers will be taught how to do the AHE while receiving different kinds of feedback about their performance in order to determine which type of feedback is most effective in assisting people to learn the AHE. Group 1 will not receive any feedback about performance; Group 2 will receive feedback from palpation and verbal descriptive alone; and Group 3 will receive feedback from palpation, verbal descriptive feedback, and real time ultrasound. For the initial test when subjects are learning the AHE, the number of trials until the subject demonstrates his/her third correct AHE will be the outcome variable. For the retention test, the outcome variable will be the percentage of trials (out of ten) of correctly performed AHEs in the absence of visual, verbal or palpation feedback. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005771

•

A Prospective Cohort Study of MR Abnormalities and Back Pain Risk Condition(s): Low Back Pain Study Status: This study is completed. Sponsor(s): Department of Veterans Affairs; Department of Veterans Affairs Cooperative Studies Program Purpose - Excerpt: Low back pain is a frequent cause of disability and a common reason for outpatient care in veterans. Magnetic resonance imaging (MRI) of the lower back often reveals abnormalities,which may be used to justify expensive and invasive therapy, such as surgery. Yet the link between MRI abnormalities and the risk of developing clinically significant back pain is far from clear. This longitudinal study will

156 Back Pain

determine the prevalence and incidence of MRI abnormalities among veterans and determine the extent to which specific MRI abnormalities predict future development of back pain. The result should help clinicians use MR imaging more efficiently, and they may ultimately help reduce the frequency of unnecessary back surgery. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00011739 •

Efficacy of Acupuncture for Chronic Low Back Pain Condition(s): Low Back Pain Study Status: This study is not yet open for patient recruitment. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: This is a trial to clarify the extent to which acupuncture needling can diminish the effect of chronic back pain on patient functioning and symptoms. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00065585

•

Evaluating Yoga for Chronic Low Back Pain Condition(s): Low Back Pain Study Status: This study is not yet open for patient recruitment. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: This study will compare the effectiveness of yoga classes, exercise classes, and a self-care book in the management of pain and function for people with low back pain. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00056212

•

Low Back Pain Patient Education Evaluation Condition(s): Low Back Pain Study Status: This study is completed. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: Back pain is one of the most common of all symptoms. It is also a great cause of days lost from work and visits to health care providers. This study will develop and evaluate an approach to low back pain that allows subjects to talk with each other and with health professionals via an Internet discussion group. Results we will look at include health behaviors, such as exercise; health status, such as pain and disability; and health care use, such as number of visits to doctors and other health care providers. Anyone 18 years old or older who lives in the United States and has ongoing

Clinical Trials 157

Internet access can take part in the study. All subjects must have back pain and meet the eligibility criteria listed below. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000408 •

Massage, Meditation, and Tai Chi for Chronic Lower Back Pain Condition(s): Low Back Pain Study Status: This study is completed. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: This clinical trial is a preliminary study designed to prepare for a fullscale, randomized clinical trial of the effectiveness of tai chi, mediation, and therapeutic massage for chronic lower back pain in adults. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00070915

•

Physical CAM Therapies for Chronic Low Back Pain Condition(s): Chronic Low Back Pain Study Status: This study is completed. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: This is a pilot randomized trial intended to evaluate the effectiveness of acupuncture, chiropractic and massage for chronic back pain in older and younger adults. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00065975

•

Psychosocial Treatment for Acute Low Back Pain Condition(s): Acute low back pain Study Status: This study is completed. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: Acute low back pain (severe pain that comes on suddenly and lasts a relatively short time) is very common in the United States, and accounts for substantial illness, functional limitations, pain, and health care costs. This study looks at whether a program designed to improve self-efficacy (a person's belief in his or her ability to reach a goal, such as managing one's own disease) and social support improves the health status of people with acute low back pain. Phase(s): Phase II

158 Back Pain

Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000418 •

Redesigning Patient Handling Tasks to Prevent Nursing Back Injuries Condition(s): Back Pain; Back Injuries Study Status: This study is completed. Sponsor(s): Department of Veterans Affairs; Department of Veterans Affairs Health Services Research and Development Service Purpose - Excerpt: The study is one of several initiated by the investigators to reduce musculoskeletal injuries in patient care providers. Nurses have one of the highest incidences of work related back injuries of any profession. Over the past 20 years, efforts to reduce work-related injuries in nursing have been largely unsuccessful. The goal of this study is to reduce the incidence and severity of occupational musculoskeletal injuries in nursing through the redesign of stressful patient handling tasks. This study addresses three objectives: (1) conduct a quantitative, biomechanically based, ergonomic evaluation of the eleven "at risk" tasks in nursing practice; (2) redesign the techniques or equipment needed to perform these tasks safely or with reduced risk of musculoskeletal injury; and (3) conduct laboratory- based assessment of the biomechanical benefit of the proposed intervention strategies. Using a randomized experimental design with a control group, ten "at risk" tasks will be evaluated. The sample included 160 experienced nursing staff. Data were collected using: (1) Caregiver Data Form and Anthropometry Data Sheet; (2) 3-D Electromagnetic Tracking System; (3) EMG; and (4) modified Borg Scale for Perceived Comfort. Include: caregiver characteristics, joint torque, spinal forces, spinal tolerance limit and damage load limit, erector spinae surface EMG, joint angles, percent of population capable of performing each task by gender, velocity of lift, reach, heart rate, and perceived comfort. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00012844

•

Using MRI Scans to Evaluate Spinal Manipulation Condition(s): Lower Back Pain Study Status: This study is completed. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: Lumbar spinal manipulation, or chiropractic adjusting, is thought to separate the surfaces of the spinal joints and thereby relieve lower back pain. This study will use MRI scans to evaluate the spinal joints before and after spinal manipulation. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00070902

Clinical Trials 159

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “back pain” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

•

For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

•

For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

•

For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

•

For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

•

For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

•

For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

•

For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

•

For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

•

For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

•

For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

•

For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

•

For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

160 Back Pain

•

For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

•

For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

161

CHAPTER 6. PATENTS ON BACK PAIN Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “back pain” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on back pain, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Back Pain By performing a patent search focusing on back pain, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We

9Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

162 Back Pain

will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on back pain: •

Apparatus and method for decompressing invertebral discs, relieving back pain, and promoting back healing Inventor(s): Kamerman; Brett (310 Montero Ave., Newport Beach, CA 92661) Assignee(s): none reported Patent Number: 6,648,844 Date filed: May 3, 2002 Abstract: An apparatus and method for decompressing invertebral discs, relieving back pain, and promoting back healing is provided, involving a pelvic harness, elastic member, and foot-pad-pressing unit. The pelvic harness has a back side and a front side. The back side of the pelvic harness is connected to the elastic member's top end. The elastic member's bottom end is connected to the foot-pad-pressing unit. The foot-padpressing unit has a centrally located connector receptacle. The centrally located connector receptacle is used to attach the bottom end of the elastic member to the footpad-pressing unit. Excerpt(s): The present invention relates to an apparatus and method for decompressing intervertebral discs, relieving back pain, and promoting back healing. Because of numerous factors relating to lifestyle and environment, the back and spine tend to wear out faster than other parts of the body. The back and spine injure easily and become a source of pain for a large percentage of people at some point in their lives. The source of the pain can be traced to the intervertebral discs found in the back between the vertebrae. These discs consist of a nonbone, cartilage-type material shaped somewhat like a donut, the center of which is filled with a viscous, fluid-like, gelatinous material. The purpose of the disc is to act as a shock absorber between the hard bony vertebrae. If the discs did not exist, the bony vertebra would rest directly upon one another, and any shock to the body would result in a fracture when one vertebra hit another. Web site: http://www.delphion.com/details?pn=US06648844__

•

Apparatus and methods for enhanced exercises and back pain relief Inventor(s): Vatti; Bala R. (152 Wason Rd., Hudson, NH 03051) Assignee(s): none reported Patent Number: 6,450,923 Date filed: October 14, 1999 Abstract: People suffering from back pain would be able to use the apparatus more effectively to relieve the pain. This apparatus can also be used by common users for strengthening and stretching exercises that conventional exercising equipment such as treadmills do not provide. Combinations of a general frame along with multiple attachments form an effective exercising apparatus. The user of the apparatus shifts weight from the spine or lower back to hands while performing exercises. Ordinary upright position causes more stress on the lower back, and the weight of the upper body in motion may make the situation worse. By suitable placement of hands and selectively distributing upper body weight to hands, the user would be able to control the amount

Patents 163

of weight reduction on the lower back or spine as needed to achieve the best results and comfort. Excerpt(s): The invention relates to an apparatus for exercises that relieve back pain and enhance strength and stretching in both lower and upper body. In general, most occupations involve either sitting, standing, walking or even worse, carrying weights while in motion. In these situations the lower part of the spine or lower back carries a person's upper body weight most of the time. All these activities add stress to the lower back constantly, and hence most people suffer from lower back pain one time or an another. This invention is a result of my personal experience. I have had lower back pain for the past several years. I have taken physical therapy and performed various exercises to relieve my back pain. All my attempts failed to produce satisfactory results because of their unsuitability for my back pain or due to inconvenience. Web site: http://www.delphion.com/details?pn=US06450923__ •

Apparatus for relieving back pain Inventor(s): Bachar; Avraham (23 Brande Street, Petach Tikva, IL), Volk; Raanan (Ramat Gan, IL) Assignee(s): Bachar; Avraham (Petach Tivka, IL) Patent Number: 5,848,984 Date filed: September 9, 1996 Abstract: A seat supportable device for relieving lower back pressure is provided. The device includes a seat portion arranged to be supported on a seat and to be sat upon by a user, a rib cage engagement portion arranged to removably engage the rib cage of the user when he is sitting on the seat portion and user controlled tensioning apparatus for selectably applying tension between the rib cage engagement portion and the seat portion, thereby to relieve lower back pressure on the user. Excerpt(s): The present invention relates to apparatus for relieving lower back pressure. Various devices are known for relieving lower back pressure. These include devices for transferring stress to the rib cage of a person. The state of the art as reflected in the U.S. Patent literature is represented by the following U.S. Pat. Nos. 5,224,924; 5,195,949; 4,996,978; 4,715,362; 4,565,409; 3,029,810; 2,886,031; 2,667,913; 1,722,205; and 1,650,650. The present invention seeks to provide improved apparatus for relieving lower back pressure. Web site: http://www.delphion.com/details?pn=US05848984__

•

Apparatus for therapeutic treatment of low back pain Inventor(s): Becerra; Carlos (Atlanta, GA), Martin; Charity (Douglasville, GA), Medeiros; Joseph (Lantana, FL), Shealy; C. Norman (Fairgrove, MO) Assignee(s): Cluster Technology Corp. (Tampa, FL) Patent Number: 6,152,950 Date filed: March 31, 1998 Abstract: A therapeutic traction table for the treatment of low back pain includes a bed pivotable from a vertical to a horizontal position for facilitating the placement of a

164 Back Pain

person in a horizontal position on the bed. An upper body harness and underarm supports anchor the upper body of the person to the bed. A lower body harness is attached to the lower body pelvic portion of the person, and includes an inflatable air bladder for positioning within the posterior cavity of the lumbar spine formed between the lower back of the person and the bed for relaxing low back muscles during a pulling force on the spine. A traction unit includes a strap connected to the lower body harness for providing a pulling force between the upper body and the lower body. The traction unit is vertically movable from a position generally along an axis of the spine to a vertically displaced position for pulling at a pre-selected and measurable angle to the axis of the spine and isolating the pulling force to a preselected portion of the spine during a programmable back treatment protocol. Excerpt(s): The present invention generally relates to the therapeutic treatment of the back and more particularly to treatment of low back pain. Pain in the lumbosacral spine is the most common of all pain complaint. It causes loss of work and is the single most common cause of disability in persons under 45 years of age. Such is described in various well-known references directed to acute low back problems and in particular articles addressing pain management. Traction-like methods are well known for pain relief. Although pelvic traction has been used to treat patients with low back pain for hundreds of years, most neurosurgeons and orthopedists have not been enthusiastic about it secondary to concerns over inconsistent results and cumbersome equipment. Simple traction has been known to be highly effective. However, few pain clinics ever include traction as part of their approach. Various authors have reported varying techniques which widen disc spaces, decompress the discs, unload the vertebrate, reduce disc protrusion, reduce muscle spasm, separate vertebrate, and lengthen and stabilize the spine. As addressed by C. Norman Shealy et al in the Fifth Edition of Pain Management, a Practical Guide for Clinicians, St. Lucie Press 1998, C. Norman Shealy et al addresses concepts in back pain management that include decompression, reduction and stabilization. Four broad categories of low back pain syndrome are identified as acute muscular low back paid which is usually self-limiting, acute low back pain involving sciatic radiation, chronic low back pain which has recurring symptoms modified by therapy, and neoplastic low back pain syndrome which is recurring, but eventually becoming progressive, constant, and intractable. Each type of low back pain syndrome has common features which vary with the intensity of the syndrome. Typically they will include regional pain, impairment and mechanical dysfunction exacerbated by activities of daily living, and mood and behavioral changes. It is agreed generally that all need to be addressed for overall successful outcome. Web site: http://www.delphion.com/details?pn=US06152950__ •

Apparatus to provide relief for back pain Inventor(s): Neeley; Michael Joseph (2039 Rose Hill, Carrollton, TX 75007) Assignee(s): none reported Patent Number: 5,653,665 Date filed: August 24, 1995 Abstract: According to the present invention, at least one adjustable resilient elastic cable interconnects a generally flat lower elongated rigid member and an upper elongated rigid member. The resilient elastic cable is attached to the lower elongated rigid member by at least one retention structure and is attached to the upper elongated rigid member by at least one connection member. Use of the back exercising apparatus

Patents 165

in conjunction with selected exercises subjects the user's spine to vertical compression and, if desired, rotation, thereby placing traction on the spine. One or more masses may be optionally attached to the upper elongated rigid member to further increase the compression of the spine. Following termination of exercise, decompression of the user's spine yields relief of back pain. Excerpt(s): The present invention relates to a compact exercise apparatus and method for providing relief for back pain, and more specifically to an apparatus and method which enables a user to exercise specific muscles along the spinal column using compression and rotation in order to obtain relief from back pain. By some estimates, Americans spend more than $16 billion per year in their quest for relief from back pain. At any given time, approximately 31 million Americans, or about one in eight people, suffer from back pain. According to the Liberty Mutual Insurance Company, the largest single payer of workers' compensation claims in the United States, approximately $1 million are paid every working day to cover claims by injured workers. Back pain is one of the most common, most expensive, and most litigious forms of on-the-job injuries. The National Council on Compensation Insurance reports that the cost to treat the average back strain or sprain is nearly $6,000 and the average cost to treat a herniated disc is nearly $23,500. The group of back muscles thought to be the most probable source of muscular spasms and pain is the erector spinae group. This group consists of the spinalis, longissimus, and iliocostalis muscles which run the entire length of the back. Their points of insertion originate at individual vertebrae and ribs at the base of the neck and terminate at the end of the spine. Web site: http://www.delphion.com/details?pn=US05653665__ •

Back injury recovery method Inventor(s): Eckman; Walter W. (408 Council Cir., Tupelo, MS 38803) Assignee(s): none reported Patent Number: 5,954,056 Date filed: June 16, 1997 Abstract: The early care of low-back pain using a series of stretching exercises that include knee to chest stretching, straight leg rising stretching, sitting toe touches and lumbar flexion stretching aid the gradual healing of low-back pain without the need for medical treatment. With such stretching, sufficient ability to bend the body in flexion is achieved. Further, the strengthening of the lumbar muscles with graded weight lifting continues a path to recovery and control over what would otherwise be immobilizing low-back pain. Excerpt(s): The present invention relates to the treatment of low back pain through a structured exercise protocol, and in particular to on-site early care methods employing stretching and graded weight lifting for minimizing the role of surgery in treatment of low-back pain and maximizing the benefits of natural recovery of the injured back. The management of degenerative diseases of the spine, particularly low-back pain, represents a major challenge in the development of efficient and cost-effective healthcare systems for the future. Low-back pain is the most common medical condition in the Western World and affects about eighty per cent of the population within their lifetime. At any given time, it is estimated that over thirty million Americans are affected. In particular, there is an increasing incidence of low-back pain affecting the working industrial population and it is a major cause of industrial disability. Second

166 Back Pain

only to the common cold, low-back pain results in more time lost from work than other illnesses. An average of 1.4 lost days per worker per year has been estimated. Further, chronic back problems are the number one cause for disability below the age of 45 and the third major cause over the age of 45. Back problems commonly affect the work population and have made and continue to make a profound impact on our society including financial impacts amounting to billions of dollars annually. Thousands of workers are on the payroll, but not on the job as a result of low back injuries and disabilities. Extensive bed rest, medication and even surgery are typically offered as methods for recovery form such back pain. In an article of SPINE, Vol. 12, No. 7, 1987, titled "A New Clinical Model for the Treatment of Low-Back Pain" by Gordon Waddell, the author concluded with a statement that modern medicine can successfully treat many serious spinal diseases and persisting nerve compression but has completely failed to cure the vast majority of patients with simple low-back pain. Further, the author further stated that bed rest is unanimously taught in all standard textbooks as the first line of treatment for acute attacks, yet it is difficult to discover when or why bed rest became the conservative accepted treatment. Web site: http://www.delphion.com/details?pn=US05954056__ •

Back rehab exercise table Inventor(s): Mayes; Billy Jack (95 Deerwoode Lane, Brevard, NC 28712) Assignee(s): Mayes; Billy Jack (Brevard, NC) Patent Number: 6,592,501 Date filed: September 10, 2001 Abstract: An exercise table and exercise routine useful in treatment of low back pain is disclosed. The table design permits a users to apply low levels of traction to the lower back by pushing lightly on adjustable arm support posts. The table design permits the users to have complete control of the level of traction applied to the lower back. An exercise routine uses the methodology of relaxing the user and applying very low levels of traction to the lower back. The low level of traction is alternated every few seconds and utilizes deep breaths to keep the user in a relaxed condition. Excerpt(s): The present invention generally relates to the therapeutic treatment of the back and more particularly to the treatment of the lower back. Back troubles affect millions of people each year. Pain in the lower lumbar area of the back is the most common back difficulty. In response to this frequent problem, numerous treatments have been developed, recommended, and practiced. These treatments involve exercise therapy, specialized equipment, and even surgery to relieve the discomfort associated with lower back trauma. Procedures that use the patient's weight and suspend the person in an inverted, head-down position have been and are currently being used to stretch and decompress the back. Using gravity and the individual's body weight to stretch the back in this fashion has several disadvantages. In order for the back to properly decompress the person must be relaxed and hanging in an inverted state is not a relaxed position due to fear and to discomfort from being inverted. Supporting body weight with arms or elbows or being suspended in an inverted position may give a feeling of relief initially but after a short time muscles tighten and reduce and even eliminate the spinal relaxation required to alleviate the pain. When muscles become tense, the spine is prevented from decompressing and the relief is limited. Web site: http://www.delphion.com/details?pn=US06592501__

Patents 167

•

Belt and method for increasing comfort and reducing back pain while lying down Inventor(s): Pearcey; Mary Annette (2646 22nd St., Sarasota, FL 34234) Assignee(s): none reported Patent Number: 6,427,697 Date filed: December 8, 1998 Abstract: The invention comprises a flexible padded belt adapted to be worn by a person when in a substantially horizontal position. The invention further comprises a method of reducing back pain and increasing comfort by wearing a flexible padded belt while lying down. The belt encircles the wearer's lower lumbar, side and abdominal regions, and fastens over the wearer's stomach. Padding in the portions of the belt contacting the wearer's sides and lower back support the wearer's spine and reduce spinal curvature when the wearer lies on his or her side, thereby promoting comfort and reducing pain. When the wearer lies on his or her back, the belt supports the lower lumbar region. Excerpt(s): During or after sleep, or other periods of lying in a horizontal position, some individuals experience discomfort in the lower back area. This invention relates to device and method for comfortably supporting the lower back and reducing spinal curvature when the wearer is lying in a substantially horizontal position on his or her side, thereby promoting wearer comfort and preventing back pain. There are numerous prior art examples of belts designed to provide lower back support during lifting or other strenuous activity. For example, Gates, U.S. Pat. No. 5,651,763, discloses a belt with an incorporated stiff orthopedic pad that is intended to support the lower back. Rise, U.S. Pat. No. 5,421,809, discloses a two-piece belt for supporting the lower back and related muscles during activity. However, these belts rely, at least in part, upon intra-abdominal pressure within the belts (such as may be generated during lifting or other activity) to provide back and muscle support, and would not be suitable for supporting the lower back when the wearer is relaxed and in a substantially horizontal position. Racz, U.S. Pat. No. 4,552,135, discloses a belt designed to provide lower back support while the wearer is sitting (driving), but does not suggest back support while lying down and turned on one's side. A padded belt is worn around an individual's midsection. The belt is filled with cushioning material in the portions contacting the user's lower back and sides. In the preferred embodiment, the thickness of said padding is approximately equal throughout most of the belt, but is substantially reduced or absent in the ends of the belt that fasten over the wearer's stomach. Normal filling thickness is approximately 1 inch per 72 pounds of body weight of the intended wearer, but belts can be manufactured with differing thicknesses to accommodate differing personal preferences and body types. The belt is widest in the portion that contacts the user's lower back, and the widths of the belt portions encircling the user's sides taper towards the front, where the belt is fastened over the user's stomach with hook and pile fastening material. Web site: http://www.delphion.com/details?pn=US06427697__

168 Back Pain

•

Centrifugal force device and method for treatment of orthopedic spinal disorders Inventor(s): Brummer; Eric (67 Jefferson Ave., Jersey City, NJ 07306) Assignee(s): none reported Patent Number: 6,123,680 Date filed: April 16, 1998 Abstract: A centrifugal force device and method for treating neck and back pain associated with intervertebral disc disorders is described. The patient is secured to a table in vertical position with the table being oriented about its vertical axis so as to maximize the delivery of centrifugal force along an appropriate vector. The patient is then rotated about the vertical axis of the device in a speed and time duration controlled manner so as to subject the patient's spinal column to a predetermined level of centrifugal force. Under these conditions intervertebral discs and/or disc material pathologically displaced in a manner to cause the patient signs or symptoms will be forced away from the pathological positions within the spinal column toward a more desirable position as determined by an appropriate clinician. The table can be made with a top section movable upwards in relation to a fixed bottom section. A pulley and cable system and movable weights within the device cause the top section of the table to move upwards due to centrifugal force. Standard pelvic and occiput-chin harnesses attached to various parts of the table and/or patient and the pulley--cable--weight system permit adding lumbar-sacral or cervical traction forces simultaneously with centrifugal force to ameliorate disc derangements. Excerpt(s): This invention relates to the treatment of orthopedic spinal disorders, and in particular to the use of centrifugal force to ameliorate intervertebral disc associated pathology. The human spinal column consists of 26 bony segments and 23 intervertebral discs (IVDs). From top to bottom, the spine consists of 7 cervical vertebra, 12 thoracic vertebra, 5 lumbar vertebra, the sacrum which is 5 vertebra fused together, and the coccyx which is several vertebra fused together. Each of the bony segments except the first two (C1 and C2) and the last two (sacrum and coccyx), are separated from each other by an IVD. The IVDs are cartilaginous and are comprised of an outer annulus fibrosis and an inner nucleus pulposus. The annulus is a cartilaginous disc and the nucleus is a semisolid gelatinous material situated within the annulus at the center of the disc. Because the IVDs are somewhat flexible, they give the spine mobility. They also attenuate force when external loads are placed on the spine. Acute or chronic injury to the IVD, can result in severe neck, back or limb pain, necessitating medical intervention. If a disc or disc material deviates from its proper position centrally between the vertebral bodies to a more posterior position it can encroach on the spinal canal. The annular or nuclear material can press against and cause irritation of several tissues, including the spinal cord, spinal nerve roots, and the posterior longitudinal ligament. Also, because the annulus fibrosis is innervate with pain fibers, it can be a source of pain as a result of tearing, bulging, or herniation. If disc material presses against the cord or spinal nerve roots, a radiculopathy may result, which may cause signs and/or symptoms to be experienced somewhere along the distribution of the involved neural tissue. Web site: http://www.delphion.com/details?pn=US06123680__

Patents 169

•

Composition for relief of arthritis-induced symptoms Inventor(s): Hersh; Theodore (Atlanta, GA) Assignee(s): Thione International, Inc. (Atlanta, GA) Patent Number: 5,827,886 Date filed: May 7, 1997 Abstract: A composition and method of using it for ameliorating inflammatory reactions and painful and other symptoms of the diseases of arthritis, lumbago, low back pain, myalgias and neuralgias. The composition includes reduced glutathione, a selenoamino acid and an anesthetic, such as capsaicin, in a suitable carrier for topical application. Excerpt(s): The present invention deals with the combinations of several synergistic antioxidants, including enzymatic co-factors with analgesics such as capsaicin or the local caine anesthetics and anti-inflammatory agents in appropriate delivery vehicles employed in topical carriers as a means of ameliorating the inflammatory reactions and painful symptoms of a variety of arthritis syndromes, spinal pain, lumbago, myalgias and neuralgias and exercise and sport injuries. These clinical entities result primarily or secondarily from free radical damage to particular surfaces (joints and associated musculo-skeletal structures) resulting from a variety of inflammatory pathologies. A classic example is the process of "hypoxic-reperfusion injury" of rheumatoid arthritis where the etiologic factor is unknown but the free radical species and other products derived from the neutrophils "oxygen burst reaction" contribute to the joint's injury. All of these etiologies engender free radicals in joint spaces and contiguous cutaneous and musculo-skeletal tissues, requiring additional local antioxidant compositions to the therapeutic armamentarium of each disease state to aid in the amelioration of signs and symptoms and repair of the affected tissues. The synergistic locally applied antioxidants plus capsaicin as a depletor of substance P which is the major neuronal chemomediator of painful stimuli are thus adjuncts in the management of inflammation and pain in these clinical entities. There are a number of rheumatologic and neurologic disorders as well as clinical musculo-skeletal syndromes where free radicals play a primary or secondary role in the clinical signs and symptoms of these distinct entities. Exercise, whether as calisthenics, weight lifting, swimming, running or jogging, generates free radical species. Exercise may be followed by muscle strain and aches or sprains, or result in painful sport injuries. The most common diseases affecting joints are rheumatoid arthritis and osteoarthritis. The former is an autoimmune disease where the articular inflammation in part leads to the generation of free radicals causing further inflammation and damage to the lining (synovium) of the affected joints. Free radicals also arise in rheumatoid arthritis and the other autoimmune related diseases, as periarteritis, lupus and scleroderma, through the mechanism of ischemia-reperfusion, similar to that in myocardial damage from coronary artery disease. The common syndromes of low back pain, fibrositis, and other neuro-muscular entities cause chronic pain from local inflammation. Thus, locally administered synergistic antioxidants play a role as adjuvant therapy alone or in combination with anti-inflammatory and analgesic medications, including topical capsaicin. To follow first are some definitions of free radicals, the clinical conditions and the antioxidant defense system which the body utilizes to scavenge and neutralize the deleterious free radicals. The present invention utilizes the synergistic and complementary antioxidants most similar to those endogenous human defense mechanisms. Web site: http://www.delphion.com/details?pn=US05827886__

170 Back Pain

•

Cover assembly for mattresses of the type used in medical facilities Inventor(s): Erickson; Tomiko (10100 E. Calusa Club Dr., Miami, FL 33186) Assignee(s): none reported Patent Number: 6,631,529 Date filed: March 6, 2001 Abstract: A cover assembly designed and structured to protectively enclose a mattress of the type used in medical facilities such as on hospital beds, stretchers, gurneys, etc. A casing is formed from a flexible, high strength, water impermeable material which is resistant to rupture or abrasion and which has characteristics which facilitates its use in the environment of a hospital or other medical facility. The casing includes a reinforcement assembly in the form of one or more flexible material panels, which may be formed from a material similar or identical to that from which the casing is formed and which are attached to different elongated outer walls of the casing so as to extend over a mid-portion thereof and be aligned substantially with a mid-portion of a body supported on the mattress, thereby providing supplementary support to the body so as to resist the mid-portion of the body sinking excessively into the mattress. The underlying, supported position of the one or more reinforcement panels therefore significantly reduces the tendency of the patient to develop back pain from prolonged bed rest. Excerpt(s): The present invention relates to a cover assembly that is structured to removably enclose mattresses, and in particular, but not exclusively, the type designed for use in hospitals or like medical treatment facilities. The cover assembly includes a casing formed of a high strength, liquid impermeable material and having a variety of other structural or performance features which are preferred for use in medical facilities. The casing preferably includes a reinforcement assembly including one or more panels secured to predetermined portions of the casing so as to more reliably support portions of the user's body in a manner which will resist the heavier portion of the torso from sinking into the mattress. As such, the present invention is structured to significantly reduce, if not eliminate back pain or other discomfort commonly associated with prolonged bed rest. In virtually all hospitals, clinics or like medical facilities designed to provide health care on an "in-patient" basis, the mattress is an indispensable piece of equipment which is often overlooked, at least in terms of providing the patient with comfortable and recuperative health care. A large number of mattresses, of the type which are structurally adapted for use on adjustable hospital beds, are typically required, dependent of course upon the intended patient capacity for any given medical facility. Because of the large number of mattresses utilized in hospitals, nursing homes, clinics, etc., the cost associated with the initial purchase of mattresses in medical facilities consumes a significant portion of an institution's budget. Therefore, there may be a tendency for such institutions to accept mattresses that are manufactured to technically come within the physical and operational parameters required of medical type mattresses, but which are designed and manufactured to be simple and to be sold at a sufficiently low price so as to at least partially relieve the financial burden of initially stocking a medical facility and/or of periodically replacing mattresses over a period of time. Accordingly, it is generally well accepted that mattresses of the type used on hospital beds, gurneys, stretchers, etc. could be constructed to provide significantly more support to a patient's body than are routinely offered by such mattresses. More in particular, mattresses intended for use in the medical field oftentimes do not provide adequate support for all or at least the major portions of a patient's body, particularly in situations where the patient is required to undergo a long

Patents 171

period of bed rest. In fact, and as noted above, there is probably a tendency for hospitals and like medical facilities to accept mattresses which are less than optimal in terms of offering adequate, prolonged support to a patient's body in order to obtain a lower and more economical price. While such mattresses are assumed to be functional for their general intended purposes, it is believed by the inventor hereof that most, if not all hospital mattresses do not provide sufficient support of the patient's body, particularly in the general area of the trunk of the body or mid-body portion where the majority of the patient's weight is concentrated. It is understandable that one goal in the construction of mattresses is to produce a less firm or softer feel to the patient, which frequently results in the aforementioned heavier portions of the patient's body sinking or receding into the mattress. While the softer feel may initially seem to be more comfortable or even luxurious to a patient, if the patient is required or instructed to rest for long periods of time in a reclined orientation on such a mattress, it frequently results in at least some discomfort to that area of the patient's body which sinks into the mattress and/or to adjacent areas. It is believed by the inventor hereof that such patients will experience discomfort most often in the aforementioned mid-body region which normally comprises the heaviest overall portion of the patient's body. To at least some extent, some patient discomfort will likely be associated with a prolonged period of bed rest, which cannot be avoided. Even if hospital mattresses were made to be more firm, there would likely be some significant reduction in the patient's comfort, and further, the mattress would still not be likely to offer adequate support to those areas where the majority of a patient's body weight is concentrated. Web site: http://www.delphion.com/details?pn=US06631529__ •

Diagnosis of neuromuscular dysfunction Inventor(s): Hodges; Paul William (Taringa, AU), Richardson; Carolyn Anne (St. Lucia, AU) Assignee(s): The University of Queensland (Queensland, AU) Patent Number: 5,916,172 Date filed: December 30, 1997 Abstract: A diagnostic apparatus for diagnosis of lower back pain (LBP) caused by neuromuscular dysfunction, said diagnostic apparatus comprising:a monitoring means for monitoring an anticipatory muscle signal resulting from one or more electrodes associated with an anticipatory muscle and a prime mover muscle signal resulting from one or more electrodes associated with at least one prime mover muscle associated with a limb; anda processing means for detecting a variation in the time of onset of the anticipatory muscle signal relative to the time of onset of the prime mover muscle signal for providing diagnosis of presence or absence of LBP.There is also provided a method for diagnosis of LBP caused by neuromuscular dysfunction said method including the steps of:(i) initiating a voluntary movement of a limb;(ii) electrically monitoring activation of at least one anticipatory muscle relative to activation of at least one prime mover muscle associated with the limb, and(iii) comparing time of onset of activation of the at least one anticipatory muscle relative to time of onset of activation of the at least one prime mover muscle to diagnose presence or absence of LBP. Excerpt(s): Low back pain (LBP) produces major societal, industrial, and personal problems, resulting in substantial annual health care costs, lost productivity, and disability (Flicker et al., 1993, Spine, 18, 582-586). Only a small percentage of low back complaints can be diagnosed definitively (Nachemson, 1975, NINCDS, Monograph No.

172 Back Pain

15, US Department of Health, Education and Welfare) because current techniques are effective only for diagnosis of LBP associated with damage or abnormality of the skeleton. However, a substantial percentage of these complaints can not be diagnosed because existing techniques are ineffective for diagnosis of LBP associated with muscular dysfunction. The importance of the muscular system in stabilising the lumbar spine is summarised in an article by Goel et al., (1993, Spine, 18, 1531-1541). The paraspinal muscles, in particular, have been shown to play a vital role in the stability and functional movement of the vertebral column but their role in spinal dysfunction is unclear. In this respect, reference may be made to studies in which it was determined that the lumbar multifidus (Kalimo et al., 1989, Ann. Med., 21, 353-359; Punjabi et al., 1989, Spine, 14, 194-200; Wilke et al., 1995, Spine, 20, 192-198) and the lumbar erector spinae (McGill, 1991, Spine, 16, 809-815; Soderberg and Barr, 1993, Spine, 8, 79-85; Sullivan, 1989, Phys. Ther., 69, 38-45) are important in stabilisation of the lumbar spine. Instability of the lumbar motion segment which often manifests in the neutral zone motion, is implicated as an important factor in the development of recurrent and chronic LBP (Punjabi, 1992, J. Spinal Disord., 5, 383-389; Panjabi, 1992, J. Spinal Disord., 5, 390397). In an article by Hides et al. (1994, Spine, 19, 165-172) reference is made to unilateral wasting of paraspinal muscles localised to one vertebral level in patients with acute/subacute LBP. Paraspinal muscle wasting also has been documented in postoperative patients (Laasonen, 1984, Neuroradiology, 26, 9-13; Mayer et al., 1989, Spine, 14, 33-36; Sihvonen et al., 1993, Spine, 18, 575-581) and in subjects with chronic LBP (Cooper et al., 1992, Br. J. Rheumatol., 31, 389-394; Tertti et al., 1991, Radiology, 180, 503507). Web site: http://www.delphion.com/details?pn=US05916172__ •

Disposable elastic thermal back wrap Inventor(s): Cramer; Ronald Dean (Cincinnati, OH), Davis; Leane Kristine (Milford, OH), Ouellette; William Robert (Cincinnati, OH) Assignee(s): The Procter & Gamble Company (Cincinnati, OH) Patent Number: 5,925,072 Date filed: December 31, 1996 Excerpt(s): The present invention relates to disposable thermal back wraps having one or more thermal packs comprising a plurality of heat cells, wherein heat is applied to specific areas of the user's lower back, for pain relief. More particularly, the present invention relates to disposable elastic thermal back wraps having good conformity to user's back which provides consistent, convenient and comfortable heat application. A common method of treating temporary or chronic pain is by application of heat to the afflicted area. Such heat treatments are used as a means of therapy for conditions which include aches, stiffness in muscles and joints, nerve pain, rheumatism and the like. Chronic back pain is one of the most common complaints found in modem society. Heating pads and elastic compression bands are common devices used to relieve chronic back pain. More recently, combinations of elastic back wraps and heating pads have been available. Many of these combination devices, however, utilize thermal packs which are reusable via the replenishment of thermal energy including heated water and/or microwaveable gels. Such therapeutic devices are inconvenient to use on a regular basis. Web site: http://www.delphion.com/details?pn=US05925072__

Patents 173

•

Endocoupler system Inventor(s): Biggs; Robert C. (1005 Alderman Dr., Suite 101, Alpharetta, GA 30202) Assignee(s): none reported Patent Number: 5,868,665 Date filed: December 30, 1996 Abstract: An endocoupler system having an endocoupler (110) and a myeloscope (210). The present invention relates to an endocoupler system. More particularly, the present invention relates to an endocoupler system consisting of an endocoupler connected to a myeloscope. The present invention is a system to directly view the pathology of the epidural space in the lower spine region using a miniature endoscopic catheter device. This device is currently used by physicians to diagnose and treat patients who suffer from chronic low back pain. The present invention consists of a developed medical procedure, disposable procedure access kit, multi-lumen steerable catheter (Video Guided Catheter), small fiber optic endoscope (Myeloscope), endocoupler (Endocoupler), light source, and camera system. A major feature of the invention is the ability to orientate the viewing plane with respect to the image transmitted through the image fiber bundle by rotation of the image fiber coupler in a plane that is normal to the central optical axis of the objective lens assembly and image fiber coupler. This is accomplished in the present invention which is designed permitting the endocoupler to rotate allowing the image fiber coupling to be oriented at the connection point to the endocoupler. This is accomplished by means of a collet assembly which allows the user to loosen the collet and rotate the image fiber coupler to the desired orientation as viewed on the monitor and re-tighten the collet. Excerpt(s): The present invention relates to an endocoupler system. More particularly, the present invention relates to an endocoupler system consisting of an endocoupler connected to a myeloscope. The endocoupler system was developed to satisfy a need that every pain practitioner has faced for the last 60 years. The need to directly visualize the pathology in-situ in and around the nerve roots as they make their way out of neural forming along the axis of the spinal cord. Other means of visualizations such as Fluoroscopy, MRI and CAT Scans cannot produce real time images of the pathology or disease and cannot clearly differentiate soft tissue pathology. Epidural endoscopy was practically impossible if performed utilizing ridged optics and the paramedian or lumbar approach. This is due to the fact that the spinal cord is encased by an articulating bone structure with minimal access possibilities. Any device with the capability to access the epidural space would have to be flexible and very small. Using miniature fiberoptic endoscopes and miniature multi lumen steerable catheters the inventor has developed a medical device that introduces epidural space. The present invention allows physicians to directly visualize the epidural space of the spine and treat patients for related diseased in a minimally invasive manner. Numerous innovations for an endoscope system have been provided in the prior art that are described as follows. Even though these innovations may be suitable for the specific individual purposes to which they address, they differ from the present invention as hereinafter contrasted. Web site: http://www.delphion.com/details?pn=US05868665__

174 Back Pain

•

Ergonomically designed chair Inventor(s): Knapp; Herbert A. (272 Elm St., Norwich, VT 05055-9444) Assignee(s): none reported Patent Number: 6,244,659 Date filed: March 10, 2000 Abstract: A chair ergonomically designed to cause its occupant to assume a sitting posture that acts to distribute the load imposed by the sitter's upper body weight so as to relieve stress on the musculature of the lower back, thereby obviating lower back pain. The seat of the chair is slidable along a track that is upwardly inclined at a fixed angle relative to the structure on which the chair is supported. Hinged to the seat is a backrest that is supported at the rear of the chair. When an individual sits down to place his buttocks on the seat, he then slides the seat along the track until the backrest assumes an angle with respect to the seat at which it is comfortable to the sitter, and the seat is then latched to maintain this orientation. The resultant sitting posture of the individual is such that the load imposed by his upper body weight is to a substantial degree transferred away from the ischeal tuberosities and toward the lower back, where the weight is borne by the vertebral spinous processes, and to the thighs. Additionally, the iliopsosas and other musculature that normally maintains support when standing but is stressed when sitting in a conventional chair or bench is not stressed. Excerpt(s): This invention relates generally to chairs adapted to accommodate an individual in a manner avoiding adverse physical side effects; and more particularly to a chair ergonomically designed to cause its occupant to assume a sitting posture which obviates undue stress on the lower back and hence avoids lower back pain. Human factors engineering, also known as ergonomics, deals with interaction which take place between an individual and a device or machine he uses or operates. The objective of ergonomic design is to attain an optimum relationship between this individual and the machine or device. Thus in designing a kitchen utensil having a handle, an ergonomic design is one making it possible for an individual who is handicapped to be able to firmly grasp the handle despite the weakness of his grip. In the ergonomic design of a chair, the objective is not only to provide its occupant with a comfortable seat, for its main goal is to avoid impairment of the occupant's well being. Of primary concern in this regard is the avoidance of lower back pain, a condition which though widespread in a chair-sitting society, is difficult to treat effectively. Web site: http://www.delphion.com/details?pn=US06244659__

•

Exercise method and apparatus for relieving hip and back pain Inventor(s): Bertolucci; Joan M. (Citrus Heights, CA), Bertolucci; Lawrence E. (Citrus Heights, CA) Assignee(s): Woodside Biomedical, Inc. (Carlsbad, CA) Patent Number: 6,179,756 Date filed: September 23, 1993 Abstract: An exercise device and method are provided for relieving hip and back pain. The device is a firm solid block with side surfaces contoured to fit between a patient's inner thighs. The device is placed between a seated patient's inner thighs just above the knees. By compressing the knees inwardly against the device, the adductor muscles are

Patents 175

activated in isometric contractions. By pulling the knees outwardly, the piriformis muscles are activated in isometric contractions. Both actions relieve specific joint and soft tissue dysfunctions in the pelvic girdle and lumbar region thereby relieving hip and back pain. Excerpt(s): This invention relates generally to exercise equipment and exercise therapy. More specifically, this invention relates to an exercise apparatus to relieve or eliminate hip and back pain and a method for its use. Back pain can be a chronic, very painful, frustrating experience for its sufferers. It also is a costly problem for society, causing millions of dollars to be expended annually in worker's compensation claims, lost time, etc. (1) Ligament structures in the anterior pelvic region such that the pubic symphysis ends up elevated or depressed. Web site: http://www.delphion.com/details?pn=US06179756__ •

Guitar pick with gripping means Inventor(s): Chance; Allen (Marina Del Rey, CA), Gray; William T. (Topanga, CA) Assignee(s): Big Rock Engineering (Topanga, CA) Patent Number: 6,054,643 Date filed: October 5, 1998 Abstract: An ergonomic musician's pick or pick holder for use with string instruments, such as a guitar, mandolin, bass guitar, or ukelele, has a curved finger grip portion on one side adapted to form a finger cradle for either the thumb or index finger of a user and has a flat generally planar area on another side against which the other fingers of a user may be pressed to allow the user to securely and comfortably grasp the pick for playing. The grip portion positively locates the fingers in a generally predetermined angular relationship to the string engaging pick tip. Different individual picks of the invention may have different angular relationships. The pick functions in the same way to bring the same advantages of the invention to any conventional and some nonstandard or custom picks. Holder provides the added advantage that various picks may be used and the angular relationship may be more easily varied through various arrangements for attaching the pick to the holder. The simplicity of construction allows use of various materials in various thicknesses, sizes, and hardnesses, and materials to satisfy a wide range of playing conditions and preferences. The pick and holder have a folded configuration which is efficiently manufactured and allows convenient storage on the instrument strap or stings. The ergonomic grip design allows a more relaxed, and low pressure grip which is less likely to cause physical problems such as carpal tunnel syndrome and arm and back pain. Excerpt(s): The present invention relates generally to a pick for stringed instruments, and more particularly to a pick and pick holder device having an improved ergonomic grip that allows a more comfortable, less tense grip that avoids physical tension and stress related problems and facilitates improved playing. Stringed instruments have been known since at least the Middle Ages and means for plucking these strings evolved from the use of pieces of sea shell and tortoise shells. As the stringed instruments, and particularly guitars, evolved and the intensity of the music increased to that now being played by rock bands on electric guitars, the requirement for improved gripping capabilities has similarly increased. With the faster, more intense playing, it is important that the conventional pick be gripped tightly and securely to achieve the proper pick alignment and possession. It has been found that with the tight gripping of the prior art

176 Back Pain

picks, there has been a tendency for the picks to move in the user's finger and to cause stress and fatigue for the user. The problem of providing adequate gripping capability for musical picks has been approached in many different ways in the prior art From the inventors' experience, picks have been made from various materials and in a variety of different shapes--some have been made with holes or with crosshatch non-slip patterns embossed into the plastic--but this never really achieved the positive grip that was sought. Some users put tape on a pick in order to achieve better gripping or have even taped or glued the pick to their thumbs. Web site: http://www.delphion.com/details?pn=US06054643__ •

Head support device Inventor(s): Towlen; Paul Raymond (30 Berkshire Heights Rd., Great Barrington, MA 01230) Assignee(s): none reported Patent Number: 5,832,926 Date filed: December 27, 1995 Abstract: A device for restraining and supporting the head of a user at a given forward angle while alleviating resultant neck, shoulder, and back pain comprises an angularly adjustable upper section contacting the head of a user, a fixed intermediate section for transmitting the force applied by the head of a user to the device to the user's upper back and shoulders, and a lower section contacting the lower back of a user. The device is attached to the body of a user by a back support belt. The device may optionally support a removable mirror from its upper section to enable a user to view his or her surroundings while the user's head is restrained and supported by the device. Excerpt(s): This invention relates to the stabilizing devices to be worn by individuals after surgery or in other situations and, more particularly, to head supports and restraints to fix the head of a person during healing after vitrectomy surgery or in other situations. In certain persons, a hole develops in the macula lutea retinae, a depression on the retina. Retinal detachment around the rim of the macular hole from the underlying retinal pigment epithelium and a loss of visual acuity is associated with the macular hole. Until recently thought untreatable, macular holes are now treated with eye surgery comprising pars plana vitrectomy, removing any cortical portions of the vitreous body of the eye adhering to the retina and any epiretinal membranes, and a total gas-fluid exchange (the eye surgery hereinafter being referred to as "vitrectomy" for the sake of brevity). At the end of surgery, sulfur hexaflouride gas is injected to lengthen intraocular tamponade. Vitrectomy attempts to reattach the portion of the retina around the rim of the macular hole. In many of the cases where such reattachment is successfully effected, an improvement in visual acuity has been reported. The head must be held down for a minimum of one week after this surgery according to the relevant medical literature. The information presented herein on macular holes and vitrectomy was drawn from Kelly, N. E., Wendel, R. T., "Vitreous Surgery for Idiopathic Macular Holes Results of a Pilot Studt", Arch Ophthalmol. 1991;109:654-659 and Wendel, R. T., Patel, A. C., Kelly, N. E., Salzano, T. C., Wells, J. W., Novack, G. D., "Vitreous Surgery for Macular Holes", Ophthalmology 1993;100:1671-1676. Further information on macular holes may be found in Gass, J. D. M., "Idiopathic Senile Macular Hole Its Early Stages and Pathogenesis", Arch Ophthalmol. 1988;106:629-639 and Johnson, R. N., Gass, J. D. M., "Idiopathic Macular Holes Observations, Stages of Formation, and Implications for Surgical Intervention", Ophthalmology 1988;95:917-924.

Patents 177

Web site: http://www.delphion.com/details?pn=US05832926__ •

Hyperextension orthotic apparatus useful for treating pain associated with spinal disorders Inventor(s): Beczak, Sr.; Terry A. (Wichita, KS), Szymke; Thomas E. (Savannah, GA) Assignee(s): Peach U.S., Inc. (Wichita, KS) Patent Number: 5,599,287 Date filed: October 3, 1995 Abstract: A hyperextension orthotic device is provided for treatment of back pain by causing uniform abdominal compression and hyperextension of the spinal column. The device includes a rigid brace having upper and lower pads for exerting pressure against the sternum and pubic area of an individual and a strap for causing a counterbalancing force to be applied to the back of the individual. The brace is coupled with a corset which causes abdominal compression to provide a stable base for the rigid brace. Excerpt(s): The invention is directed to braces or orthotic devices used in the treatment of spinal disorders and, more particularly, to hyperextension back braces used in the treatment of spinal disorders. Hyperextension back braces are used to reposition the spine in a hyperextended position to alleviate the pain often associated with various types of spinal disorders. These braces may also serve to correct or prevent deformation of the spinal column, such as may result from the multiple compression fractures frequently experienced by women suffering from osteoporosis. Conventional hyperextension back braces, such as disclosed in U.S. Pat. No. 4,173,973 to Hendricks, typically apply pressure at the pelvis and sternum of a patient. This pressure applied at the front of the thoracic region of the patient is then counterbalanced by pressure applied with straps and a posterior pad positioned at the desired location along the spine. By applying pressure in this three-point arrangement, the spinal column can be moved from a hyperflexed or slumped posture to a hyperextended position. When the spinal column is placed in the hyperextended position, the joint space between adjacent vertebra is increased, thereby relieving compressive pressure and associated pain along the spinal column. Web site: http://www.delphion.com/details?pn=US05599287__

•

Leg support pillow Inventor(s): Stokes; Lowell (440 Country La., Louisville, KY 40207) Assignee(s): none reported Patent Number: 5,878,453 Date filed: December 5, 1997 Abstract: A pillow for alleviating lower back pain includes an under-knee portion, which holds an individual's knee in flexion when he is lying on his back, and a betweenknee portion, which holds the individual's knees a spaced distance apart when he is lying on his side. The under-knee and between-knee portions are connected by a flexible web that permits automatic adjustment of the relative positions of the two pillow portions to accommodate different sizes of users.

178 Back Pain

Excerpt(s): The present invention relates to pillows constructed to alleviate lower back pain. There have been many different pillows and cushions that have been designed to alleviate lower back pain. Many of these pillows serve to hold an individual's legs in a flexed position when the individual is lying on his back (supine position). Other pillows hold an individual's knees apart while he is lying on his side (lateral decubitus position). A conventional pillow may be used below the knees to maintain flexion or between the knees to maintain spacing, but the pillow must be re-positioned whenever an individual rolls from his back onto his side, or vice versa. Moreover, a conventional pillow is easily displaced as an individual moves and turns while he is sleeping. Thus, it would be desirable to have a dual-function pillow that provides the necessary support regardless of whether the individual is lying on his back or on his side and that does not have to be re-positioned when the individual moves. There have been a few attempts in the prior art to construct such a dual-function pillow. For example, U.S. Pat. No. 4,910,818, issued to Grabill et al., describes a dual-function pillow that includes three lobes, two of which form a base that is positioned below an individual's knees, and a third lobe which extends from the base between the individual's knees. This device provides support below the knees when an individual is in a supine position, and between the knees when the individual is lying on his side. The construction of this pillow, however, does not allow for adjustment of the position of the center lobe relative to the base lobes. The position of the center lobe is fixed relative to the base lobes. Thus, if the width of the pillow is not precisely tailored to the individual, the center lobe will not be at the correct height when the individual is lying on his side. The width of the pillow should be at least the width of a user's hips to prevent the user's legs from slipping off. However, if the pillow is made wide enough for a majority of users, a user with narrower hips has difficulty using the pillow while lying on his side because the center lobe of the pillow will cause his upper leg to be held up in the air. As for users with wider hips, the fixed center lobe prevents the pillow from resting on the bed while the user is lying on his side, resulting in the user supporting the full weight of the pillow. These difficulties prevent a single pillow from accommodating different sizes of people. This pillow must be custom fit to the user. In short, the prior art design, with the center lobe fixed relative to the base lobes, has several disadvantages that make the pillow impractical for common usage. The present invention is a dual-function pillow that includes an underknee portion that holds an individual's knees in a flexed position when he is lying on his back and a between-knee portion that holds an individual's knees a spaced distance apart when he is lying on his side. The two portions of the pillow are connected by a flexible web that allows for the shifting of the relative positions of the two portions. Because of this adjustability, the under-knee portion can be made amply wide so that the user's legs do not slip off the pillow without creating problems when the user rolls to his side. Web site: http://www.delphion.com/details?pn=US05878453__ •

Lower back heater mat with a leg support Inventor(s): Kiefer; John Steven (8410 Ferndale Cutoff, Little Rock, AR 72211) Assignee(s): none reported Patent Number: 5,718,722 Date filed: September 11, 1996 Abstract: A lower back heater mat with a leg support comprising a ladder shaped leg support and an electrical heater mat pivotally connected to the leg support. A person

Patents 179

with lower back pain lying on the electrical heater mat is forced to elevate his or her legs on the leg support. The leg support and the electrical heater mat fold making allowing for easy transportation. Excerpt(s): The invention relates to a lower back heater mat with a leg support. More particularly, the invention relates to a cushioned mat with a lower back heater having a ladder shaped leg support which allows a person to elevate his or her legs while laying on the mat. Lower back pain is a common and an extremely painful ailment. Second only to work-related injuries, lower back pain has the highest incidence of disability and economic loss in the United States. Approximately 21 million Americans experience lower back pain. The total annual cost (health care plus indirect costs) attributable to low back pain is about $20 billion. However, the cost of human suffering is truly inestimable. Nearly everyone has experienced lower back pain at least once. Unfortunately, for many people lower back pain is chronic. Chiropractors and doctors provide generic advice to relieve the pain: elevating your legs to take the pressure of the vertebrae of your spine and apply heat to facilitate the healing process by increasing the blood circulation in the lower back area. Web site: http://www.delphion.com/details?pn=US05718722__ •

Lumbar extension machine Inventor(s): Pierra; Eric A. (701 W. Imperial Highway, Unit 308, La Habra, CA 90631), Robertson; Virgil L. (28 Rancho Naviato Dr., Philips Ranch, CA 91766), Verna; Joe L. (2628 Presidio La., Corona Hills, CA 91719) Assignee(s): none reported Patent Number: 5,971,902 Date filed: October 7, 1998 Abstract: The present invention resides in an exercise apparatus for individuals with chronic back pain. The apparatus comprises an elongated base frame that is rectangular in configuration and has a U-shaped front portion and a T-shaped back portion. An inverted Y-shaped, lower support shaft having three members with rectangular configurations is removably attached to the base frame. An elongated, rectangular shaped upper support shaft attached to an angle adjustment cam is attached to the inverted Y-shaped lower support shaft with rotation and locking means. The upper support shaft contains, near the bottom portion thereof, a restraint stand having foot boards and lower extremity restraint. The upper support shaft is hollow on the inside and is slidably connected to a telescoping pelvic restraint stand, which contains hip pads, pelvic restraints and bicycle like handle bars near the top portion thereof. The upper support shaft also contains locking and stabilizing means for securing the telescoping pelvic restraint stand. Excerpt(s): The present invention resides in a Lumbar Extension Machine which is a trunk extension exercise device for the human body. It should be noted that the LUMBAR EXTENSION MACHINE is a new and improved version of the VARIABLE ANGLE ROMAN CHAIR. The device is especially helpful in alleviating chronic low back pain of individuals suffering from severe disability and deconditioning syndrome. In the past, devices for exercising individuals suffering from chronic low back pain were stationary at approximately 0.degree. and 45.degree. angles at the restrained pelvic portion of the device. These angles are very difficult for the initial use of such a device by some individuals. Through continued research by the inventors herein, it was

180 Back Pain

determined that by varying the angle of the restrained pelvic portion of this invention from 0.degree. to 75.degree. from horizontal, that a severely disabled individual suffering from chronic low back pain could exercise at a more vertical angle where resistance is lower (i.e. 75.degree.) and progressively move to more difficult angles (i.e. 0.degree.) by virtue of a progressive resistance exercise program utilizing this device. Numerous exercise devices exist for strengthening the various muscles of the human body. It should be noted, however, that exercises to strengthen a particular group of muscles have limitations because of the various muscle interactions. In particular, exercises for the muscles of the trunk are especially difficult to accomplish because of interaction of the back muscles with other quite powerful muscles, particularly those of the legs. Thus, stabilization of the pelvic region during the exercise is quite important. In particular, stabilization of the pelvis to prevent rotation of said pelvis during an exercise routine is needed to isolate the lumbar region of the trunk and provide for an acceptable exercise device. Web site: http://www.delphion.com/details?pn=US05971902__ •

Maternity brace Inventor(s): Alberts; Gina (5 North Villas, London NW1 9BJ, GB) Assignee(s): none reported Patent Number: 6,537,132 Date filed: October 26, 2000 Abstract: A maternity brace for providing support to the vulval and abdominal regions of a pregnant woman. The maternity brace has a central vulval panel and a pair of front and rear straps attached thereto. A body-encircling adjusting belt is in communication with the front and rear straps. An abdominal panel positioned between the two front straps applies a supporting force to the abdomen. A back panel along the back of the adjusting belt imparts stability to the lower back. The front and rear straps may be nonlinear to add comfort and support. Wearing the maternity brace improves the overall well-being of an expectant mother and helps to prevent varicose veins, stretch marks, back pain, cystocele, rectocele, hemorrhoids, increased wear on knee and hip joints, reduced blood circulation, and overall fatigue. Excerpt(s): The present invention relates to a support brace for providing support to the vulval and abdominal regions of a pregnant woman and for reducing or eliminating the deleterious effects of the increased body weight of pregnancy. The additional size and weight of the fetus in a pregnancy often impact negatively on several body parts and the overall well-being of an expectant mother. Varicose veins may develop. Hemorrhoids may form. Conditions such as cystocele and rectocele may occur. The additional weight of the fetus places a strain on the lower back and may cause poor posture and back pain. Knee and hip joints may fatigue from the extra stress. Stretch marks may appear in the abdominal region. Thus there is a need for therapies and other means to alleviate or prevent these conditions. Various types of supportive garments and girdles have been proposed to help reduce the deleterious effects of both fetal weight and additional body weight of the expectant mother. For example, Alberts U.S. Pat. No. 3,116,736 discloses a body support having both a vulval support for supporting the vulval region of the wearer and a girdle for providing beneficial support to the abdominal region. Castiglia U.S. Pat. No. 4,195,640 discloses a lower torso support appliance having both an inelastic front panel for engaging the abdominal region of the wearer and a rigid sheet-like member for engaging the lower back.

Patents 181

Web site: http://www.delphion.com/details?pn=US06537132__ •

Method and apparatus for measuring pelvic symmetry Inventor(s): Horvath; Laura (164 Osner Dr., Atlanta, GA 30342), Jirmenez; David (145 Copeland Rd. F-9, Atlanta, GA 30342) Assignee(s): none reported Patent Number: 5,966,827 Date filed: May 6, 1996 Abstract: A method and apparatus for measuring pelvic symmetry to aid in diagnosing and treating lower back pain. A first angle is measured between the horizon and a axis extending between a left ASIS and a left PSIS and simultaneously compared against a second angle corresponding to the angle between the horizon and an axis extending between a right ASIS and a right PSIS. The angle of a line extending through points bisecting each of the axis and the horizon is also measured. The angles are then compared against prior measurements or norms to assess posture and pelvic position in order to document progress of lower back pain treatment. Excerpt(s): This invention relates to a method and apparatus for aiding in the diagnosing and treating lower back pain by measuring the relationship between two sides of the bodies' pelvic bone, and more particularly to a method for measuring the symmetry of these two bones along the sacroiliac joint. Distortions of the spine are principally the result of faulty postural habits, trauma or injury of some sort, or congenital deformities. These distortions and particularly distortion of the pelvic structure can result in displacement of the innominate bones and sacrum from the norm, which is believed to be the source of some lower back pain. When diagnosing and treating lower back pain, it has been observed that there is a relationship between the asymmetry of the pelvic bone and symptoms of such pain. This asymmetry is possibly caused by incorrect shurling of the muscle groups in the lower back and mechanical problems in joints around the pelvic bone. Examples of mechanical problems include one muscle group being shorter or longer than the other resulting in the pelvis being askew. When the pelvis is askew, problems have been noticed in the lumbar vertebrae which disrupt mechanics of the skeleton. Web site: http://www.delphion.com/details?pn=US05966827__

•

Method and composition for topical therapy of back pain and muscle tension Inventor(s): Liedtke; Rainer K. (Munich, DE) Assignee(s): American Pharmed Labs, Inc. (New York, NY) Patent Number: 5,776,952 Date filed: July 17, 1996 Abstract: A composition for topical therapy for symptoms of back pain, muscle tension or myofascial pain or a combination thereof, which comprises a topical carrier system for intact skin of the back or outer synovial membranes or both, which comprises a therapeutic dose of a local anesthetic, and which applies the local anesthetic to a region of skin lying beneath the topical carrier system.

182 Back Pain

Excerpt(s): The present invention relates to a method and composition for topical therapy of back pain and muscle tension. It is known that back pain, muscle tension, and myofascial pain predominantly have neurological and muscular causes, however, psychosomatic stress factors, physical environmental factors, nonfunctional, active or passive fixation in body posture, deficient movement, functional or organic dysfunction of the spinal column due to stress, for example, intervertebral disk damage, are also implicated. Approximately 80% of the population with varying frequency, experiences back pain. Back pain is also one of the most important causes of lost work time with all of the attendant economic results. Presently, the symptoms of back pain are predominantly treated pharmacologically with systemically active, nonopiate, oral or injectable analgesics and antiphlogistics, and, in part, in combination with psychosomatic or physical therapy, sometimes also in combination with other methods, such as, acupuncture. The last resort for diseases of the intervertebral disk is surgery. Web site: http://www.delphion.com/details?pn=US05776952__ •

Method for pain relief using low power laser light Inventor(s): Wong; Edmund (Honolulu, HI) Assignee(s): DioLase Corporation (Berkeley, CA) Patent Number: 5,640,978 Date filed: November 6, 1991 Abstract: The invention comprises a method for treatment of chronic and referred pain such as chronic headaches and migraine headaches, as well as pain of the upper back, neck and shoulders, and lower back pain using low power laser light. The source of such referred pain involves microscopic and macroscopic tears in the periosteal-osseous junctions of the upper vertebrae, the scapula, and the skull. These lesions stimulate the generation of histamines, kinins, bradykinins, prostaglandin, proteolytic enzymes, seratonin, and other substances which cause numerous localized autonomic reactions, such as muscle spasm, ischemia, local inflammation, edema, as well as generalized reactions such as increased blood pressure, photophobia, nausea, blurred vision, copious mucous flow of the nose and sinus, and the like. The muscle spasms are responsible for transmitting the pain sensation to other portions of the body, and the systemic reactions are often associated with migraine-type headaches. The sites of the periosteal-osseous lesions can be correlated directly with the distant locus of the referred pain sensation. The laser energy is directed to the sites of the lesions to cause an increase in lymphatic circulation at the site of the causative lesion in response to the laser energy. Laser energy delivered to the site results in increased blood circulation and cellular metabolism in the area, which promotes more rapid healing of the lesion. Excerpt(s): Although it is often said that the common cold is the most prevalent disease among humankind, it is also true that chronic pain is an affliction that is almost as prevalent. Chronic headaches, muscle pain, joint pain, and the like are experienced by most individuals, and many persons have such chronic pain on a daily or weekly basis. It is interesting to note that most forms of chronic pain often are not traceable to a specific causative factor. The term "referred pain" has been used to describe pain that is experienced at a locus removed from the cause or lacking an identified cause. From the perspective of a treating physician, this situation leads to skepticism concerning the patient's complaints, and a tendency to dismiss the complaints as psychosomatic, neurological, or imagined. From the perspective of the patient, there is real suffering experienced on a regular basis, and often there is no medical treatment to relieve the

Patents 183

pain. Frequently, medical treatment consists of drugs such as analgesics or muscle relaxers. These substances are systemic, and can have adverse side effects such as kidney toxicity, liver inflammation, gastrointestinal symptoms, and the like. Alternative treatments consist of chiropractic manipulations, acupuncture, physical therapy, stress relief regimens, and the like. These approaches to treatment have had limited success for most chronic pain sufferers. Research conducted 40 to 50 years ago indicated that referred pain could be emulated in test subjects by injecting hypertonic saline solution into the interspinous ligaments and causing temporary inflammations of the periosteum at the points where muscle tissue extends from the upper spinal vertebrae to the skull and the scapula. Referred pain was produced at various sites remote from the injection points, and was virtually indistinguishable from the sensations described by chronic pain sufferers. Moreover, it was clear that induced inflammation of specific sites along the spinous processes resulted in pain sensation at corresponding specific sites throughout the body far removed from the cause, and that the pain sensation could also be induced in the form of headaches similar to migraine headaches. This research also established that the pain referral mechanism did not involve mere neural transmission. However, this promising early work apparently was not followed, and did not result in effective treatment modalities. Web site: http://www.delphion.com/details?pn=US05640978__ •

Method of and means for providing force feedback in continuous passive motion systems Inventor(s): Hazard; Rowland G. (Burlington, VT), Reinecke; Steven M. (Hinesburg, VT) Assignee(s): Ergomedics, Inc. (Winooski, VT) Patent Number: 5,624,383 Date filed: February 22, 1994 Abstract: Method and apparatus for providing force feedback in continuous passive motion systems for use in treating or preventing low back pain. A mechanism adjacent to a static back support is provided to initiate continuous passive motion for the lumbar area in order to produce substantial lordotic motion for the spine. A force measuring apparatus is provided for continuously measuring the force exerted by the mechanism on an individual's lumbar area and a system controls the force exerted by the mechanism in order to build up to and then maintain a predetermined force on the lumbar area of the user. Thereafter, a predetermined time is selected to allow the lordotic position of the spine to be returned to its original state. Excerpt(s): Back pain is a very widespread malady in the United States. Lower back pain can be caused by disease, injury or congenital defect. There are many different types of relevant therapeutic machines on the market today. There have been a number of patents issued in the continuous passive motion field including the U.S. Pat. No. 4,981,131, issued to the applicant Rowland G. Hazard for a Passive Motion Back Support. This patent shows a pneumatic based apparatus for providing continuous passive motion in treating or preventing back pain. A number of devices provide mechanical apparatus for the same purpose. The key difficulty inherent in these designs and requiring solution in order to optimize the user's comfort is the need for integrated automatic force feedback to control the support devices. Without such feedback, devices cannot accommodate variations in the user's spinal compliance, posture and position while providing the desired spinal mobilization comfortably and safely. What is needed is a method and means that will provide force feedback for mechanical and pneumatic

184 Back Pain

devices that deliver back support and/or continuous passive spinal motion. A type of device related to providing massage is shown by the U.S. Pat. No. 5,083,552 issued to Lipowitz for a device that provides vertical compression for the user very rapidly giving a massage effect. The high and low pressure limits of Lipowitz are continuously cycling in the very fast cycle time of half a second to two seconds in order to provide massage. As opposed to the type of control, which is only adequate for massage, safe and comfortable spinal mobilization through a continuous passive motion support requires a pressure feedback system with operating characteristics which vary between phases of the motion cycles. What is also needed is a device and a method which builds up to a preset force range and then holds the force constant for a minimum of five seconds or more during which time movement may or may not occur. It is the object of this invention to teach a method of and means for providing force feedback in continuous passive motion systems which avoids the disadvantages and limitations, recited above. Another object of this invention is to provide force feedback for producing spinal motion using a prolongation of certain phases of cycle time in order to have the user remain comfortable and safe. Particularly, it is the object of this invention to teach a method for providing force feedback in continuous passive motion systems, for use in treating and preventing low back pain and providing back comfort in an individual, comprising the steps of providing at least one static back support; providing a mechanism adjacent to said static back support to initiate continuous passive motion for the lumbar area in order to produce significant lordotic motion for the spine; providing a timer for the basic control of the mechanism; providing a system for measuring the force exerted by the mechanism on an individual's lumbar area; providing a system for continuous and automatic controlling the force exerted by the mechanism on the individual's lumbar area in order to build up and then maintain a predetermined force on the lumbar area of the user for a predetermined period of time; and providing a predetermined period of time to allow the lordotic position of the spine to be returned to its original state. It is also the object of the invention to teach a method for providing force feedback in continuous passive motion systems, for use in treating or preventing low back pain and providing back comfort in an individual, comprising the steps of providing at least one static back support; providing a mechanism adjacent to said static back support to initiate continuous passive motion for the lumbar area in order to produce significant lordotic motion for the spine; providing a system for continuous measuring the force exerted by the mechanism on an individual's lumbar area; providing a system for continuously and automatically controlling of the force exerted by the mechanism on an individual's lumbar area; and providing a predetermined period of time to allow the lordotic position of the spine to be returned to its original state. It is also the object of this invention to teach means for providing force feedback in continuous passive motion systems, for use in treating or preventing low back pain and providing back comfort in an individual, comprising back support means; said back support means comprising at least one static back support; said back support means having a continuous force applying section adjacent to said static back support; said force applying section having a mechanism for initiating continuous passive motion to an individual's lumbar area by said force applying section in order to produce significant lordotic motion for the spine; continuous force measuring means; logic system means for continuous and automatic controlling of the operation of said force applying section based upon the measurements obtained from said force measurement means; and said continuous force measuring means comprising transducers that continuously monitor values below, equal to and above the predetermined levels and submit those values to said logic system in order to maintain a predetermined force on the lumbar area of the user for a predetermined period of time. Finally, it is the object of this invention to teach means for providing force feedback in back support systems for

Patents 185

use in treating and preventing back pain and providing back comfort in an individual, comprising back support means; said back support means comprising at least one static back support; said back support means having a continuous force applying section adjacent to said static back support; continuous force measurement means; and logic system means for continuous and automatic controlling of the operation of said force applying section based upon the measurements obtained from said continuous force measurement means. Web site: http://www.delphion.com/details?pn=US05624383__ •

Methods for electrosurgical treatment of intervertebral discs Inventor(s): Eggers; Philip E. (Dublin, OH), Ellsberry; Maria B. (Fremont, CA), Hovda; David C. (Mountain View, CA), Thapliyal; Hira V. (Los Altos, CA) Assignee(s): Arthrocare Corporation (Sunnyvale, CA) Patent Number: 6,264,650 Date filed: May 21, 1999 Abstract: Systems, apparatus and methods for ablation, resection, aspiration, collagen shrinkage and/or hemostasis of tissue and other body structures in open and endoscopic spine surgery. In particular, the present invention includes a channeling technique in which small holes or channels are formed within spinal discs, and thermal energy is applied to the tissue surface immediately surrounding these holes or channels to cause thermal damage to the tissue surface, thereby stiffening the surrounding tissue structure and for reducing the volume of the disc to relieve pressure on the surrounding nerves. High frequency voltage is applied between one or more active electrode(s) and one or more return electrode(s) to volumetrically remove or ablate at least a portion of the disc tissue, and the active electrode(s) are advanced through the space left by the ablated tissue to form a channel, hole, divot or other space in the disc tissue. In addition, the high frequency voltage effects a controlled depth of thermal heating of the tissue surrounding the hole to thermally damage or create a lesion within the tissue surrounding the hole to debulk and/or stiffen the disc structure, thereby relieving neck or back pain. Excerpt(s): The present invention relates generally to the field of electrosurgery, and more particularly to surgical devices and methods which employ high frequency electrical energy to treat tissue in regions of the spine. The present invention is particularly suited for the treatment of herniated discs. The major causes of persistent, often disabling, back pain are disruption of the disc annulus, chronic inflammation of the disc (e.g., herniation), or relative instability of the vertebral bodies surrounding a given disc, such as the instability that often occurs due to a degenerative disease. Intervertebral discs mainly function to cushion and tether the vertebrae, providing flexibility and stability to the patient's spine. Spinal discs comprise a central hydrostatic cushion, the nucleus pulposus, surrounded by a multi-layered fibrous ligament, the annulus fibrosis. As discs degenerate, they lose their water content and height, bringing the adjoining vertebrae closer together. This results in a weakening of the shock absorption properties of the disc and a narrowing of the nerve openings in the sides of the spine which may pinch these nerves. This disc degeneration can eventually cause back and leg pain. Weakness in the annulus from degenerative discs or disc injury can allow fragments of nucleus pulposis from within the disc space to migrate into the spinal canal. There, displaced nucleus or protrusion of annulus fibrosis, e.g., herniation, may impinge on spinal nerves. The mere proximity of the nucleus pulposis or a

186 Back Pain

damaged annulus to a nerve can cause direct pressure against the nerve, resulting in numbness and weakness of leg muscles. Often, inflammation from disc herniation can be treated successfully by non-surgical means, such as rest, therapeutic exercise, oral anti-inflammatory medications or epidural injection of corticosteroids. In some cases, the disc tissue is irreparably damaged, thereby necessitating removal of a portion of the disc or the entire disc to eliminate the source of inflammation and pressure. In more severe cases, the adjacent vertebral bodies must be stabilized following excision of the disc material to avoid recurrence of the disabling back pain. One approach to stabilizing the vertebrae, termed spinal fusion, is to insert an interbody graft or implant into the space vacated by the degenerative disc. In this procedure, a small amount of bone may be grafted from other portions of the body, such as the hip, and packed into the implants. This allows the bone to grow through and around the implant, fusing the vertebral bodies and alleviating the pain. Web site: http://www.delphion.com/details?pn=US06264650__ •

Multi-purpose thoracic sac Inventor(s): Theodore; Dean Anthony (26821 West Sage Ct., Calabasas Hills, CA 91301) Assignee(s): none reported Patent Number: 5,950,896 Date filed: July 28, 1998 Abstract: A multi-purpose thoracic sac for carrying personal belongings or the like is disclosed. The multi-purpose thoracic sac or front pack with its unique and versatile structures, such as a removable padded seat cushion, bilateral insulated pouch with velcro closure, therapeutic and strategically placed padded shoulder supports, personal safety devices, and a removable lumbar roll facilitate and improve energy conservation, comfort, and sitting posture. The front pack of the present invention enhances overall posture which in turn alleviates lordosis, scoliosis, kyphosis, back-packer's palsy, chronic back pain or strain and provides the user with a sense of security and comfort. Excerpt(s): The present invention generally relates to shouldered, carrying bags for holding personal items. More specifically, the invention relates to a multi-purpose pack that is worn over the chest of a wearer so as to improve a user's overall posture. Various packs, especially the back packs, are well known in the related art. However, the back packs promote poor posture because a wearer is normally hunched forward in an attempt to compensate for the weight on the wearer's back. The wearer's shoulders are internally rotated asymmetrically and elevated abnormally. The wearer's neck is flexed and protracted forward. The wearer's vision is limited because of the position of the back pack forces the wearer to focus downwardly, instead of looking straight ahead. All of these problems place a tremendous pressure onto the spinal column, specifically the lumbar region, which is overly exaggerated when a back pack is worn. This over exaggeration of the lumbar region exacerbates spinal column pain by causing the spinal column to impinge on the spinal nerves. Another disadvantage of the traditional back pack is that the position of the back pack causes the wearer's chest cavity to flex and the lungs to compress, thus creating an energy loss and decreasing the wearer's endurance level. The effect of poor posture causes many people to suffer from chronic lower back pain and discomfort. Accordingly, there is a need for a shouldered pack that is worn on the front of a wearer so as to enhance and maintain a proper posture for conserving the wearer's energy. An added benefit of such pack involves the increased sense of safety and security of one's belongings inside the pack by the ability to see the pack. Yet

Patents 187

another benefit of such pack is to incorporate beneficial principles of a therapeutic neurodevelopmental technique which brings the wearer's pelvis into an anterior tilt, as compared to the traditional back packs which bring the pelvis into a posterior tilt. The posterior tilt of the pelvis places increased pressure onto the wearer's lumbar spine. Web site: http://www.delphion.com/details?pn=US05950896__ •

Orthotic apparatus useful for treating pain associated with spinal disorders Inventor(s): Beczak, Sr.; Terry A. (Wichita, KS), Szymke; Thomas E. (Savannah, GA) Assignee(s): Peach, U.S., Inc. (Wichita, KS) Patent Number: 5,634,891 Date filed: April 14, 1995 Abstract: A corset-type orthotic device is provided for treatment of lower back pain by causing uniform abdominal compression. The corset utilizes vertically spaced apart straps which overlap at the front of the corset to cause tightening of the corset about the torso of the wearer to increase the abdominal compression. The straps are connected at one end to lateral margins of a front panel of the corset and extend rearwardly through metal rings fixed to lateral margins of a rear panel of the corset. The straps then extend forwardly for joinder at the front panel. Upper and lower ones of the straps are also coupled and extend through another metal ring which allows the straps to vary in length to accommodate the variations in circumference of the lower ribs, waist and hips. Excerpt(s): The invention is directed to braces or orthotic devices used in the treatment of spinal disorders and, more particularly, to an abdominal corset-type orthotic which is used in the treatment of lumbar spine disorders. It has long been recognized that certain types of lower back pain in humans can be treated by wearing corset type devices. These devices are applied around the torso of the individual and are tightened to cause an increase in the intra-abdominal pressure in the wearer. The increased intraabdominal pressure in turn functions to reduce the compression force on the individual's spine by creating a semi-rigid hydra-pneumatic cylinder surrounding the spinal column. The load normally carried by the spine is distributed across this cylinder and the pressure on the lumbar inter-vertebral discs is correspondingly reduced. In many cases, the reduction in pressure also serves to provide dramatic relief in the pain associated with the spinal disorder. One problem associated with many corsets of the type described above is the difficulty in achieving the proper tensioning of the corset about the individual's torso. Typically, the corsets comprise front and back panels which are laced together along their lateral edges by at least one and often several laces. Tensioning of the corset is accomplished by pulling tightly and then securing the laces after the corset has been applied to the torso. It can be appreciated that the use of both hands is generally necessary to pull the ends of the laces to achieve the desired tensioning and then secure them together. The positioning of the laces at the sides of the individual also makes it difficult, particularly for the elderly and infirm, to reach the laces with both hands, let alone manipulate and pull the laces with the force necessary to achieve satisfactory abdominal compression. Web site: http://www.delphion.com/details?pn=US05634891__

188 Back Pain

•

Passenger bus cargo handling system Inventor(s): Leonard; Bruce E. (6300 W. 10th St., Sioux Falls, SD 57107), Wolterstorff; Niclas E. (P.O. Box 29, Renville, MN 56284) Assignee(s): Leonard; Bruce E. (Sioux Falls, SD), Wolterstorff; Niclas E. (Renville, MN) Patent Number: 6,022,181 Date filed: August 21, 1997 Abstract: A new Passenger Bus Cargo Handling System for offering a top loading extendable and retractactable cargo handling system. The inventive device includes a support rail, a moveable tray, axle spindles, load carrying wheels, and a retaining latch. In use, a passenger bus is equipped with the present invention and the user can more easily load cargo into the bus, saving back pain and other exasperating energies. Excerpt(s): The present invention relates to touring buses luggage compartments and more particularly pertains to a new Passenger Bus Cargo Handling System for offering a top loading extendable and retractactable cargo handling system. The use of touring buses luggage compartments is known in the prior art. More specifically, touring buses luggage compartments heretofore devised and utilized are known to consist basically of familiar, expected and obvious structural configurations, notwithstanding the myriad of designs encompassed by the crowded prior art which have been developed for the fulfillment of countless objectives and requirements. Known prior art touring buses luggage compartments include those used by well known bus lines such as Greyhound, Jackrabbit, etc. Web site: http://www.delphion.com/details?pn=US06022181__

•

Pillow with adjustable neck support Inventor(s): Martin; Charles N. D. (Ottawa, CA), Stanfield; Judith J. (Hull, CA), Veilleux; Alain C. (Hull, CA) Assignee(s): S.V.M. Orthopedic Solutions Inc. (Hull, CA) Patent Number: 6,327,725 Date filed: December 14, 1999 Abstract: An orthopaedic pillow, including an adjustable neck support. The body of the pillow is comprised of pre-formed visco-elastic foam, which has an interior cavity, longitudinally disposed near the edge of the pillow on which a user's neck is intended to rest. An inflatable airtight chamber is disposed within the cavity or slot, for providing adjustable support to the user's neck. The level of neck support can be quickly and easily adjusted using a hand-operated pump. The pump can be neatly stored within a contoured cavity at one end of the pillow. The pillow has a removable cloth cover with an opening on the end, which enables the user to access the pump, and a closure device for closing the opening. The pillow increases user comfort levels, and assists in reducing neck and back pain. Excerpt(s): This invention relates to orthopaedic pillows with adjustable: neck support. The vertebrae of an individual's spine should be in neutral alignment while sleeping, in order to increase the individuals comfort, and reduce neck and back strain. If the neck support in a pillow is too high or too low, the vertebrae in the neck will be out of alignment with the vertebrae in the rest of the spine. This may reduce the restfulness of the individual's sleep, and aggravate neck and back problems. The level of neck support

Patents 189

required will vary according to body size and sleeping position. Accordingly, it is desirable to have an adjustable neck support which can be quickly and easily adjusted by the individual, while lying down. It is also desirable for the pillow to distribute the body weight of the individual to decrease compression on compression points. These features will increase comfort levels, and reduce neck and back strain. The development of visco-elastic foam has introduced a technology that revolutionizes sleeping systems. Visco-elastic foam may be preformed into an orthopaedically designed contour pillow, which provides improved support for a user's head and neck. Visco-elastic foam provides comfort and health benefits because it is heat and pressure sensitive and thereby responds to body weight and temperature by molding to the individual. This provides more evenly distributed support and decreases compression on compression points. However, this technology suffers from at least two limitations. First, because the ideal level of neck support varies depending on the user's body size and sleeping position, a pre-formed visco-elastic pillow will not provide adequate neck support for all users in all sleeping positions. Secondly, because the visco-elastic foam molds to the individual, the support in the neck region may not be sufficiently firm. Accordingly, there is a need for a preformed visco-elastic pillow with a neck support which can be custom-adjusted to suit the user's individual needs and sleeping patterns. Web site: http://www.delphion.com/details?pn=US06327725__ •

Portable, adjustable, pneumatic, lumbar support Inventor(s): Daggett; Jonathan G. (111 S. A St., Madera, CA 93638), Daggett; Ronald R. (111 S. A St., Madera, CA 93638) Assignee(s): none reported Patent Number: 6,117,095 Date filed: December 4, 1998 Abstract: A portable, adjustable, pneumatic, lumbar support is provided, designed to allow a user with chronic or acute back pain to select and lie in a neutral lumbar position so as to decrease the pain in the lumbar area. When a user is positioned on the present invention, the inflatable bladder extends from the upper portion of the hamstring region of the leg to approximately the L-5 vertebrae, and is constructed such that inflation in the hamstring region causes a displacement greater than that of the buttocks region, allowing for more tilt of the lower spine. Excerpt(s): The present invention was first disclosed in the Disclosure Document filed on Apr. 9, 1998. There have been no previously filed, nor any co-pending applications, anywhere in the world. The present invention relates generally to orthopedic supports, and, more particularly, to a portable, adjustable, pneumatic lumbar support. There are a great deal of people who suffer from lower back pain that is derived from a number of sources. Many people suffer from residual pain that began as a result of a previous injury that never completely heals or is easily aggravated. Others suffer from pain that stems from an aggregation of years of improper posturing and insufficient exercise practices. Web site: http://www.delphion.com/details?pn=US06117095__

190 Back Pain

•

Posture aid apparatus Inventor(s): Toole; James Patrick (9621 Baskerville, Rockwall, TX 75087) Assignee(s): none reported Patent Number: 6,315,747 Date filed: July 24, 2000 Abstract: A therapeutic posture aid apparatus designed to properly align all three curves of the spine, hold the shoulder girdle in a proper posture position, allow full range of motion of all joints in the back, neck, shoulders and arms, reminding the wearer to move his/her back, neck and shoulders into a proper posture to eliminate/relieve, back pain, stress and muscle fatigue. Excerpt(s): The present invention relates orthopedic type braces, and more particularly, to a posture aid apparatus that can be worn comfortably, all the time, by an individual and will remind the wearer to move his/her back, neck and shoulders into the proper position to eliminate/relieve, back pain stress and muscle fatigue. The art abounds with inventions relating to devices for preventing the movement of the clavicle (collar bone) in a splint. One example of these devices is U.S. Pat. No. 3,382,868 issued to Henry K Stiefel on May 14, 1968. Another device for providing a clavicle brace is disclosed in U.S. Pat. No. 4,570,619 issued to Paul B. Gamm on Feb. 18, 1986. The device disclosed therein includes adjustable straps and links in order to adjust the tension thereof for the comfort of the wearer thereof. Web site: http://www.delphion.com/details?pn=US06315747__

•

Sciatic exercise bench Inventor(s): Minor; Patsy A. (617 Evergreen St., Okawville, IL 62271) Assignee(s): none reported Patent Number: 5,938,576 Date filed: August 6, 1998 Abstract: A exercise bench particularly suitable for persons with lower back pain wherein the bench comprises a hard foam ridged mat hinged to an upper body support and head rest at one end thereof and having an adjustable angular support for supporting the upper body and head rest at a desired angle by the user. A pair of arched padded knee rails extends outwardly from the far side ends of the hard foam mat providing locations for depressing one's knees while performing legs raising exercises. A pair of padded hand rails extends up and over the padded knee rails and provides the locations for supporting oneself while performing exercises and exiting or entering the exercise bench. An adjustable height foot rest support extends between the pair of hand rails and at opposite ends of the hard foam mat from the upper body support and head rest. The height of the foot rest support is adjustable by the user to a desired height. Excerpt(s): The present invention relates to devices and methods for exercising and more particularly to devices and methods for a sciatic exercise bench which is for use by people with lower back pain comprising a hard foam center hinged to an upper body support and head rest at one end thereof having an adjustable angular support for supporting the upper body and head rest at a desired angle, a pair of padded knee rails extending outward from the far side ends of the hard foam mat, a pair of padded hand rails extending up and over the padded knee rail and an adjustable height foot rest pad

Patents 191

support extending between the pair of hand rails at the opposite end of the hard foam mat. The height of the foot rest support is adjustable by the user to a desired height. Persons who suffer from lower back pain, sciatica, sometime find relief from performing several exercises that relieve the pain, however most of these exercises require the use of a table and chair in combination. The present invention provides a useful exercise bench which takes the place of the table and chair method and provides a better way to exercise a persons lower body. Prior to the present invention there has never been an exercise bench which is specifically directed toward persons with lower back pain and which comprises the elements described herein. Rifas, U.S. Pat. No. 5,647,829 which discloses an abdominal exercise apparatus and methods. Web site: http://www.delphion.com/details?pn=US05938576__ •

Split seat pelvic mobilizing chair Inventor(s): Robertshaw; Richard C. (12255 Red Dog Rd., Nevada City, CA 95959) Assignee(s): none reported Patent Number: 6,139,095 Date filed: December 31, 1998 Abstract: A split-seat chair includes a mechanism for stimulation of a person's hips while seated in the chair, by generally simulating the hip motion which occurs during walking, or by allowing such movement by the user. Two platforms under the respective buttocks of the person preferably move in orbital motions about a horizontal axis transverse to the chair, the two pads orbiting 180.degree. out of phase relative to one another. The speed of orbital motion is preferably coordinated with the rate of circulation of cerebrospinal fluid in the skull as it travels down into the sacrum. The chair moves the pelvis in a gliding motion that partially mimics walking while the person is seated, thus reducing posturally caused lower back pain and stiffness. Excerpt(s): This invention is concerned with an ergonomic chair which provides for stimulation of the hips while the user is seated, to at least partially simulate the hip motion involved in walking, thus reducing posturally caused lower back pain and stiffness. Sitting for long hours, whether driving, working at a computer, traveling or other activities, has become a contributing factor to lower back pain, stiffness, and degenerative disk disease. The problem with sitting in a standard single seat chair is that after a few minutes, the pressure of the torso's gravitational weight on the sacrum, the triangular shaped bone between the two iliac bones, begins to lock not only the sacroiliac joint, but also the acetabular joint which houses the femur bone of the leg. Once the sacrum beings to lock, or fixate, at the sacroiliac joints, the lower lumbar spine also beings to immobilize. The results of this occurrence include the stasis of cerebral spinal fluid in the sacral reservoir of the sacrum, as well as the loss of vital motion of both the ligaments and musculature, therefore causing increased pressure on the lumbar disks. Cerebral spinal fluid originates in the central ventricles of the skull. The fluid is then pumped out of the skull, into the spinal column and down into the sacral reservoir in the center of the sacral bone in the pelvis. The full cycle of the flow of cerebral spinal fluid takes twelve to fifteen seconds. In osteopathy, this cycle is known as the primary respiratory motion. Web site: http://www.delphion.com/details?pn=US06139095__

192 Back Pain

•

Stretching method for preventing or relieving lower back pain Inventor(s): Ilan; Daniel (24 Hamatmid, Even Yehuda, IL) Assignee(s): none reported Patent Number: 5,772,612 Date filed: June 17, 1996 Abstract: A therapeutic method, for simultaneously stretching and lifting a user's lower back while the user is lying on his back on the ground, thereby relieving and preventing lower back pain. The device includes a frame which features a horizontally extending upper cross frame for accommodating the back of the user's knees. In use, the lower end of the frame contacts the ground and serves as a fulcrum. The device further includes a foot rest for accommodating the user's feet. The foot rest is mounted to the frame at a convenient point between the cross frame and the lower end. Excerpt(s): The present invention relates to a stretching device, particularly useful for the relieving or preventing of lower back pains. It is well known that lower back pains affect a very large portion of adults, especially middle aged adults and older. As a consequence, a great deal of suffering and disability is experienced by a large fraction of the population resulting, among other things, in a large number of lost work days and greatly diminished quality of life. A brief physiological analysis will help illustrate the cause of back pains and give an insight as to possible remedies. Web site: http://www.delphion.com/details?pn=US05772612__

•

Support pillow for pregnant women, obese people, people who suffer from various forms of back pain and people who suffer from sleep apnea, snoring and sciatica Inventor(s): Friedman; Loretta (9269 Shore Rd., Apt. B1, Brooklyn, NY 11209) Assignee(s): none reported Patent Number: 6,044,505 Date filed: August 27, 1998 Abstract: A pillow (10) for pregnant, over weight, back-pain suffering, sleep apnea suffering, and sciatica suffering persons lying in a prone position, is provided. The pillow has an aperture (90) extending through it, and is sized for receipt of a portion of the abdomen of the user. The aperture is defined by at least first (20), second (30) and third (40) support structures, and is of a substantially uniform thickness (T). The first support structure extends substantially traversely across the lower-chest and upperabdominal regions of the user, the second support structure extends along a first sideabdominal region of the user to end proximate to the person's pelvic region, and the third support structure extends along a second side-abdominal region of the user to also end proximate to the pelvic region of the user. Excerpt(s): This invention relates to the field of pillows, and more particularly, to the field of abdominal support pillows for pregnant women, over weight people and otherwise regular people who suffer from back pain. Citizens of the United States spend eleven percent of the nation's gross national product on hospital and medical care. The United States has more doctors and hospitals that nearly any other industrialized nation, and yet the United Nations World Health Organization continually rates the population of the United States as having one of the lowest general health indexes in the world. The symptoms of bad health and poor physical condition are the end result of

Patents 193

the body's inability to function properly. Currently, if you are a pregnant woman, an obese person, an athlete, an individual who suffers from back pain, sleep apnea, snoring or sciatica, your ability to lay on your stomach is greatly diminished. The posture that is assumed during pregnancy, or in the obese, creates hyper-extension in the low back region, causing jamming of the thoracolumbar facets, posterior narrowing of the disc space and myospasms in the erector spinae muscles. Sciatica, and lower back pain, are usually caused by misalignment of bones, nerve interference and vertebral subluxation. Web site: http://www.delphion.com/details?pn=US06044505__ •

System for diagnosing medical conditions using a neural network Inventor(s): Bishop; Jeffrey B. (1221 Sheridan Ave., Iowa City, IA 52240), Pope; Malcolm H. (1983 Highview Cir., Coralville, IA 52241) Assignee(s): none reported Patent Number: 6,090,044 Date filed: December 10, 1997 Abstract: A system for diagnosing medical conditions, such as low back pain (LBP), is provided, whereby a neural network is trained by presentation of large amounts of clinical data and diagnostic outcomes. Following training, the system is able to produce the diagnosis from the clinical data. While the present invention may be useful in diagnosing LBP in one embodiment, other applications of the present invention, both in the medical field and in other fields, are also envisioned. This intelligent diagnostic system is less expensive and more accurate than conventional diagnostic methods, and has the unique capability to improve its accuracy over time as more data is analyzed. Excerpt(s): The present invention generally relates to a system for diagnosing medical conditions using a neural network trained from clinical data. While the present invention may be adapted for a variety of medical conditions, in one embodiment it may be used for the diagnosis of low back pain. Low back pain (LBP) is one of the most frequent and most disabling health problems affecting our society, and its incidence appears to be increasing. It has been estimated that, in the United States and Great Britain, this complaint will affect 80% of the population at some point during their lifetime. In Sweden in a 10 year period, 1% of all workdays were lost annually because of low back conditions. The average sickness absence period was 36 days, which is quite similar to the 24 days for the United States and the 33 days for Great Britain. Forty percent of the workers affected with low back pain were disabled for less than one week, while 9.9% were disabled for more than six months. No other disease category was responsible for a greater number of days lost from work. Approximately 2.4 million Americans are disabled because of LBP disorders, the major cause of disability under the age of 45. Although sophisticated diagnostic means have been developed, it has been estimated that in 80% of cases there is no obvious source of nociception. Furthermore, the relationships between abnormal radiological findings and low back complaints are highly inconsistent. In the wide majority of cases, low back pain is considered as mechanical or functional. Therefore, functional assessment may be considered as useful to investigate those low back troubles. Functional assessment has been used to differentiate between different types of non-specific low back troubles and to prescribe and follow up specific rehabilitation. Differentiate between non-specific back troubles and specific pathologies in basic low back pain screening has also been used before going to more sophisticated and expensive investigation techniques (CT scan, MRI, etc.). In addition many researchers show positive findings in asymptomatic subjects by CT

194 Back Pain

and plain mylography. Degenerate discs, bulging discs and even herniated discs are part of the aging process for the spine and may be irrelevant findings; they are seen on imaging tests of the lumbar spine in a significant percentage of subjects with no history of low back problems. Therefore, abnormal imaging findings seen in a patient with acute low back problems may not be related to that individual's symptoms. Web site: http://www.delphion.com/details?pn=US06090044__ •

Therapeutic back belt and related method of manufacture Inventor(s): Hopwood; Sandra K. (Grand Rapids, MI), Pearson; David P. (Thousand Oaks, CA), Smith; Mark C. (Rockford, MI) Assignee(s): Access Business Group International LLC (Ada, MI) Patent Number: 6,623,419 Date filed: April 25, 2002 Abstract: A back belt including magnets, and a thermally active gel material to provide magnetic and thermal induced lower back pain relief. The magnets are arranged in multiple quadrapolar pods, which are secured to a contour-conforming, resilient support web. Preferably, an interior sheet sandwiches the pods and gel material between it and an exterior sheet in a cross-shaped array within the support web. In a more preferred embodiment, the belt includes a fastening strap that neatly secures excess belt by wrapping around the excess belt and drawing that excess against the remainder of the belt. In a preferred process of manufacturing the back belt, multiple quadrapolar magnet pods and the gel material are secured to a support web. Belt straps are secured to the support web. More preferably, a fastening strap is secured to at least one of the belt straps. Excerpt(s): The present invention relates to a therapeutic back belt, and more particularly to a back belt including magnets that address pain originating in the lower back. The application of magnetic fields to areas of the human body experiencing pain has become a widely accepted method of treating that pain. Such treatment is sometimes preferred over other conventional methods, such as surgery or administration of drugs, because, among other reasons, it is less invasive. It is believed that when a magnetic field is applied to an area of localized pain, it blocks chemical channels in nerve cells in the area of pain. As a result, the generation of pain impulses from the nerve cells, and subsequent transmission along the nerve cell fibers to the brain is reduced, thereby relieving the pain. Magnetic therapy has proven to be particularly helpful in reducing lower back pain, that is, pain originating in the sacral or lumbar regions of the back. One device used to provide magnetic therapy to the lower back is disclosed in U.S. Pat. No. 4,480,596 to Shumiyashu. In Shumiyashu, an array of magnets is positioned on a belt so that all the magnets exert either a positive or a negative magnetic field toward the lower back when the belt is worn around the waist of a user. The magnets are maintained in fixed positions relative to one another with a rigid plastic support sheet so that they do not attract one another and collapse the belt into a ball. Web site: http://www.delphion.com/details?pn=US06623419__

Patents 195

•

Transdermal therapeutic formulation Inventor(s): Davis; Roosevelt (27 Lullwater Estate Rd., Atlanta, GA 30307), Primo-Davis; Susan A. (27 Lullwater Estate Rd., Atlanta, GA 30307) Assignee(s): none reported Patent Number: 5,665,378 Date filed: November 21, 1995 Abstract: The present invention relates to a transdermal therapeutic formulation comprising capsaicin, a nonsteroidal anti-inflammatant and pamabrom. The formulation is used to alleviate pain or discomfort in a mammal by being applied to the skin of the mammal thereby causing the active ingredients in the formulation to pass into and/or through the skin of the mammal. In a preferred embodiment of the present invention, the formulation is used in patch form for the treatment of the pain and discomfort associated with menstrual cramps, water retention (e.g., "bloating") and/or muscular pain (e.g., muscular back pain). Excerpt(s): The present invention relates to a transdermal therapeutic formulation comprising capsaicin, a nonsteroidal anti-inflammatant and pamabrom. In a preferred embodiment of the present invention, the formulation is used in patch form for the treatment of menstrual cramps and/or muscular back pain. In general, analgesics fall into two broad categories. The simple analgesics, such as aspirin, are most effective against pain of integumental origin, headache, and muscle ache; the narcotics are more useful for deep or visceral pain. Narcotic analgesics such as morphine produce more profound effects than simple analgesics, and are potentially addicting, with the development of tolerance and physical dependence. The morphine-like analgesics appear to work through interaction with the endorphin/enkephalin system of the central nervous system; many, if not all of the simple, non-narcotic analgesics appear to work by inhibition of prostaglandin synthetase. The effect of narcotics is to elevate the pain threshold above the normal level; the non-narcotic analgesics act to raise an abnormally low pain threshold to the normal level. The narcotic analgesics are antagonized by compounds such as naloxone; the non-narcotic analgesics are not. Capsaicin (8-methyl-N-vanillyl-6-nonenamide), which is the pungent component of paprika, is a potent analgesic. However, it appears to be largely unrelated to the two known classes of analgesics. In certain tests, it produces a level of analgesia comparable to morphine, yet it is not antagonized by classical narcotic antagonists, such as naloxone. It effectively prevents the development of cutaneous hyperalgesia, but appears to have minimal effects on normal pain responses at moderate doses. At high doses capsaicin also exerts analgesic activity in classical models of deep pain, elevating the pain threshold above the normal value. Web site: http://www.delphion.com/details?pn=US05665378__

Patent Applications on Back Pain As of December 2000, U.S. patent applications are open to public viewing.10 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take

10

This has been a common practice outside the United States prior to December 2000.

196 Back Pain

several years.) The following patent applications have been filed since December 2000 relating to back pain: •

Apparatus and method for decompressing intervertebral discs, relieving back pain, and promoting back healing Inventor(s): Kamerman, Brett Kamerman; (Newport Beach, CA) Correspondence: THOMPSON & KNIGHT, L.L.P.; PATENT PROSECUTION GROUP; 1700 PACIFIC AVENUE, SUITE 3300; DALLAS; TX; 75201; US Patent Application Number: 20030009121 Date filed: May 3, 2002 Abstract: An apparatus and method for decompressing invertebral discs, relieving back pain, and promoting back healing is provided, involving a pelvic harness, elastic member, and foot-pad-pressing unit. The pelvic harness has a back side and a front side. The back side of the pelvic harness is connected to the elastic member's top end. The elastic member's bottom end is connected to the foot-pad-pressing unit. The foot-padpressing unit has a centrally located connector receptacle. The centrally located connector receptacle is used to attach the bottom end of the elastic member to the footpad-pressing unit. Excerpt(s): The present invention relates to an apparatus and method for decompressing intervertebral discs, relieving back pain, and promoting back healing. Because of numerous factors relating to lifestyle and environment, the back and spine tend to wear out faster than other parts of the body. The back and spine injure easily and become a source of pain for a large percentage of people at some point in their lives. The source of the pain can be traced to the intervertebral discs found in the back between the vertebrae. These discs consist of a nonbone, cartilage-type material shaped somewhat like a donut, the center of which is filled with a viscous, fluid-like, gelatinous material. The purpose of the disc is to act as a shock absorber between the hard bony vertebrae. If the discs did not exist, the bony vertebra would rest directly upon one another, and any shock to the body would result in a fracture when one vertebra hit another. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Apparatus and method of massaging back and alleviating back pain using suction cup Inventor(s): Horst, Patricia J.; (Rockford, IL) Correspondence: LEYDIG VOIT & MAYER, LTD; 6815 WEAVER ROAD; ROCKFORD; IL; 61114-8018; US Patent Application Number: 20020002346 Date filed: June 28, 2001 Abstract: A pain relieving device that includes a suction cup adapted to be applied to the body of a person. The suction cup is affixed to a handle that allows the suction cup to be manually manipulated by a massager to massage the body of a massagee. The suction cup may be pushed, rolled or pulled to facilitate a massaging effect. The method of using the device includes applying the suction cup to the back of a person and then moving the suction cup to change the suction effect of the suction cup while applied to the back. Additionally, a pump system may be operatively connected to the suction cup

Patents 197

to adjust the suction effect. The pump can be controlled to modulate the pressure within the pressure chamber. Excerpt(s): This patent application is a "continuation-in-part," of copending U.S. patent application Ser. No. 09/607,035, filed Jun. 29, 2000, hereby incorporated by reference it its entirety. The present invention generally relates to pain relieving devices and more particularly to a pain relieving device that produces a lifting action. A common aggravation and source of discomfort to many persons is back soreness, back pain, pinched nerves, and muscle fatigue. A common way of alleviating such aggravation and discomfort is through massage. There are a variety of massage techniques and massage devices in existence that are used as remedies to such problems. A drawback with some certain devices or techniques is that they can cause muscle damage or back injury when used improperly. In addition, people respond differently and prefer different forms of massage and massage devices. As such, certain massage techniques and massage devices are not as effective for everyone, and there continues to be a desire for alternatives and/or better forms of massage techniques and pain relieving devices. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Article and method for self-administered physical therapy to alleviate back pain Inventor(s): Pecora, Ralph R.; (Baltimore, MD) Correspondence: ROYAL W. CRAIG; A PROFESSIONAL CORPORATION; SUITE 153; 10 NORTH CALVERT STREET; BALTIMORE; MD; 21202; US Patent Application Number: 20020193714 Date filed: June 13, 2002 Abstract: A therapeutic device for alleviating mid-to-upper back pain. The device comprises a hard cylindrical body wrapped in a cushioning sleeve. The sleeve is sufficiently firm to resist deforming, thereby maintaining its round shape and enabling it to roll easily along the ground. At the same time, the sleeve comfortably supports the user and transfers the force of the hard inner element to the user's back muscles and joints without causing pain or injury. The device can be used by individuals suffering from mid-to-upper back pain associated with muscle spasms, soreness, or injury. The device enables the individual to self-administer therapy to the back muscles and joints to relieve back pain and reduce the likelihood of future incidences of pain. Excerpt(s): The present application derives priority from U.S. Provisional Patent Application 60/297,803, filed: Jun. 13, 2001. The present invention relates to physical therapy devices, and, more particularly, to a therapeutic device for alleviating mid-toupper back pain resulting from muscle spasms or tired, stiff muscles. Worldwide back pain is estimated to afflict 60-80% of the human population at some point in their lives, and it afflicts 2-5% of the population at any given time. Anatomically, the back is divisible into three regions defined by the vertebrae of the spinal column. Beginning at the neck, the first 7 descending vertebrae are the cervical vertebrae. Next, the thoracic region consists of 12 vertebrae, and finally the lumbar region comprises five vertebrae of the lower back. The trapezius and the latissimus dorsi represent two large muscle groups in the back most commonly associated with muscular back pain. The present invention is directed to alleviating the discomfort and debilitating effects of mid-toupper back pain, generally corresponding to regions of the thoracic and cervical vertebrae. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

198 Back Pain

•

Back rehab exercise bench Inventor(s): Mayes, Billy Jack; (Brevard, NC) Correspondence: Billy Jack Mayes; 95 Deerwooded Lane; Brevard; NC; 28712; US Patent Application Number: 20020128576 Date filed: March 9, 2001 Abstract: An exercise table and exercise routine usefull in the treatment of low back pain is disclosed. The table design permits a user to apply low levels of traction to the lower back by pushing lightly on adjustable arm support posts. The table design permits the user to have complete control of the level of traction applied to the lower back. An exercise routine uses the methodology of relaxing the user and applying very low levels of traction to the lower back. The low level of traction is alternated every few seconds and utilizes deep breaths to keep the user in a relaxed condition. Excerpt(s): The present invention generally relates to the therapeutic treatment of the back and more particularly to the treatment of the lower back. Back troubles affect millions of people each year. Pain in the lower lumbar area of the back is the most common back difficulty. In response to this frequent problem, numerous treatments have been developed, recommended, and practiced. These treatments involve exercise therapy, specialized equipment, and even surgery to relieve the discomfort associated with lower back trauma. Lower back therapy usually involves procedures that stretch or elongate the spine and decompress the vertebrae that contribute to back pain. Common procedures use various forms of traction using weights and even the individuals own body weight to stretch the back and provide pain relief. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Belt-like corset Inventor(s): Toda, Yoshitaka; (Osaka, JP) Correspondence: Nancy Lord Johnson, Ltd.; 361 South Frontage Rd.; Pahrump; NV; 89048; US Patent Application Number: 20030050584 Date filed: August 22, 2002 Abstract: This present invention relates to a novel belt-like extension corset providing for anterior to posterior traction from the sides to the back at waist level comprising two longitudinally expandable front and back belt members each having an inner and outer surface, means to attach said belt members at their longitudinal centers, means for attaching the longitudinal ends of the front belt member, two direction changing means for said back belt member located on the outer surface of the front belt member positioned so as to be present on the left and right side when worn, and means for attaching the longitudinal ends of the back belt member to the outer surface of the back belt member lateral to its middle portion. The corset can shorten a number of days of treatment, for example, a number of days required for treatment of muscular low back pain. Excerpt(s): This application claims priority based on Japanese application number 2001253516, filed Aug. 23, 2001. The present invention relates to a belt-like corset for use in

Patents 199

the treatment of low back pain (hereinafter "LBP"). Conservatively, low back pain is treated with joint manipulation, myofascial therapy, a combination of both, or "back school." Back school is a program that teaches patients the recommended sitting and standing neutral postures, body mechanics, and exercises. In a randomized, assessorblinded clinical trial of 206 patients, the only significant difference between these treatments after three weeks was a higher pain score with myofascial therapy alone compared with combined therapy. Back school was shown to be as effective as the other procedures. Hsieh, Cj et al, 27(11) SPINE 1142-8 (2002). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Cytokine antagonists for neurological and neuropsychiatric disorders Inventor(s): Tobinick, Edward Lewis; (Los Angeles, CA) Correspondence: EZRA SUTTON, ESQ.; EZRA SUTTON, P.A.; Plaza 9; 900 Route 9; Woodbridge; NJ; 07095; US Patent Application Number: 20030049256 Date filed: October 9, 2002 Abstract: Methods for treating neurological or neuropsychiatric diseases or disorders in humans by administering to the human a therapeutically effective dose of specific biologics are presented. The biologics of consideration include antagonists of tumor necrosis factor or of interleukin-1. The administration of these biologics is performed by specific methods, most, but not all of which fall into the category of anatomically localized administration designed for perispinal use. Anatomically localized administration involving perispinal use includes, but is not limited to the subcutaneous, intramuscular, interspinous, epidural, peridural, parenteral or intrathecal routes. Additonally, intranasal administration is discussed as a method to provide therapeutic benefit.The clinical conditions of consideration include, but are not limited to the following: diseases of the brain, including neurodegenerative diseases such as Alzheimer's Disease and Parkinson's Disease; migraine headache; spinal radiculopathy associated with intervertebral disc herniation, post-herpetic neuralgia, reflex sympathethic dystrophy, neuropathic pain, vertebral disc disease, low back pain, amyotrophic lateral sclerosis, chronic fatigue syndrome; and neuropsychiatric diseases, including bipolar affective disorder, anorexia nervosa, nicotine withdrawal, narcotic addiction, alcohol withdrawl, postpartum depression, and schizoaffective illness. Excerpt(s): This is a continuation-in-part of application Ser. No. 10/236,097, filed on Sep. 6, 2002, which is a continuation-in-part of application Ser. No. 09/841,844, filed on Apr. 25, 2001, which is a continuation-in-part of application Ser. No. 09/826,976, filed on Apr. 5, 2001, now U.S. Pat. No. 6,419,944, which is a continuation-in-part of application Ser. No. 09/563,651, filed on May 2, 2000, which is a continuation-in-part of application Ser. No. 09/476,643, filed on Dec. 31, 1999, now U.S. Pat. No. 6,177,077, which is a continuation-in-part of application Ser. No. 09/275,070, filed on Mar. 23, 1999, now U.S. Pat. No. 6,015,557, which is a continuation-in-part of application Ser. No. 09/256,388, filed on Feb. 24, 1999, now abandoned. The present invention relates to novel methods of use of specific cytokine antagonists for the treatment of neuropsychiatric and neurological disorders in humans. More particularly, these cytokine antagonists are used in a new treatment of neuropsychiatric and neurologic diseases and disorders, including, but not limited to affective disorders, including unipolar and bipolar affective disorders; schizoaffective illness, schizophrenia, autism, depression, anorexia nervosa, obsessive-compulsive disorders, narcotic addiction, and smoking cessation/nicotine

200 Back Pain

withdrawal; diseases and disorders of the brain; neurodegenerative disorders, including but not limited to Parkinson's Disease and Alzheimer's Disease; spinal cord injury, amyotrophic lateral sclerosis; headache syndromes, including, but not limited to migraine headaches and cluster headaches; neurologic disorders associated with neuropathic pain, including, but not limited to lumbar and cervical radiculopathy, low back pain, vertebral disc disease, fibromyalgia, post-herpetic neuralgia, and reflex sympathetic dystrophy; and chronic fatigue syndrome; utilizing specific anatomic methods of administration of these specific biologics. The delivery of these cytokine antagonists is performed by specific methods, most of which fall into the categories of perispinal administration or intranasal administration. Perispinal administration involves an anatomically localized injection performed so as to deliver the therapeutic molecule directly into the vicinity of the spine. Perispinal administration includes, but is not limited to the subcutaneous, intramuscular, interspinous, epidural, peridural, parenteral, or intrathecal routes, and may be perilesional or alternatively, particularly when treating diseases of the brain, remote from the ultimate site of pathology. Intranasal administration includes the delivery of these particular cytokine antagonists by instillation into the nasal passages, either by nasal spray or nasal inhaler. The cytokine antagonists of consideration are those designed to block the action of, inhibit, or antagonize the biologic effects of tumor necrosis factoralpha (TNF) or interleukin-1 (IL-1). These antagonists may take the form of a fusion protein (such as etanercept); a monoclonal antibody (such as infliximab); a binding protein (such as onercept; Serono); an antibody fragment (such as CDP 870, Pharmacia); or other types of molecules which are potent, selective, and specific inhibitors of the action of these proinflammatory cytokines and are capable of being used by parenteral injection. Localized administration for the treatment of localized clinical disorders has many clinical advantages over the use of conventional systemic treatment. Locally administered medication after delivery diffuses through local capillary, venous, arterial, and lymphatic action to reach the anatomic site of pathology, or, alternatively, to reach the cerebrospinal fluid (CSF). In addition local administration of a biologic in the vicinity of the spine (perispinal administration) has the key advantage of improved delivery of the agent to the central nervous system (CNS). Local intranasal administration of a biologic is another method to improve delivery of the biologic to the CNS, and is discussed here as a method to treat neuropsychiatric disorders, including disorders of mood (depression, bipolar disorder) utilizing TNF antagonists or IL-1 antagonists. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Devices and methods for the treatment of spinal disorders Inventor(s): Atkinson, Robert E.; (Falcon Heights, MN), Keith, Peter T.; (Saint Paul, MN) Correspondence: Robert E. Atkinson; CROMPTON, SEAGER & TUFTE, LLC; Suite 895; 331 Second Avenue South; Minneapolis; MN; 55401-2246; US Patent Application Number: 20020095154 Date filed: March 7, 2002 Abstract: Devices and methods for treating a damaged intervertebral disc to reduce or eliminate associated back pain. Dynamic bias devices and reinforcement devices are disclosed, which may be used individually or in combination, to eliminate nerve impingement associated with the damaged disc, and/or to reinforce the damaged disc, while permitting relative movement of the vertebrae adjacent the damaged disc.

Patents 201

Excerpt(s): The present invention generally relates to spinal implants. Specifically, the present invention relates to implantable devices and methods for the treatment of spinal disorders associated with the intervertebral disc. Back pain is one of the most common and often debilitating conditions affecting millions of people in all walks of life. Today, it is estimated that over ten million people in the U.S. alone suffer from persistent back pain. Approximately half of those suffering from persistent back pain are afflicted with chronic disabling pain, which seriously compromises a person's quality of life and is the second most common cause of worker absenteeism. Further, the cost of treating chronic back pain is very high, even though the majority of sufferers do not receive treatment due to health risks, limited treatment options and inadequate therapeutic results. Thus, chronic back pain has a significantly adverse effect on a person's quality of life, on industrial productivity, and on heath care expenditures. Some forms of back pain are not chronic and may be simply treated by rest, posture adjustments and painkillers. For example, some forms of lower back pain (LBP) are very common and may be caused by unusual exertion or injury. Unusual exertion such has heavy lifting or strenuous exercise may result in back strain such as a pulled muscle, sprained muscle, sprained ligament, muscle spasm, or a combination thereof. An injury caused by falling down or a blow to the back may cause bruising. These forms of back pain are typically nonchronic and may be self-treated and cured in a few days or weeks. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Ergonomic seating cushion Inventor(s): Loomos, Melanie; (Miami, FL) Correspondence: Michael C. Cesarano; Suntrust International Center, 28th Floor; 1 S.E. 3rd Avenue; Miami; FL; 33131-1714; US Patent Application Number: 20020124318 Date filed: March 9, 2001 Abstract: An ergonomic seating cushion has a central cavity whose interior boundaries form an oscillating waveform. This feature reduces the pressure gradient on skin pressing against the cushion, promoting blood flow to the region while maintaining a central area of little or no pressure upon the perineum area. The cushion may have a dimpled surface to further lower pressure gradients, and may be tilted forward to assist in increasing lordosis and reducing lower back pain, or rearward when used by pregnant women to assist in compensating for the weight of an unborn child during pregnancy. Excerpt(s): Modern society tends to promote sedentary lifestyles, in which office workers and others must perform their daily work while seated. Long periods of sitting are increasingly being identified as a major cause of lower back pain. Studies directed to that phenomenon have concluded that changes in the curvature of the spine that occur when a person sits down and remains seated for long lengths of time, are one cause of lower back pain. One such study is entitled Ergonomics in the Design of Office Furniture, by Kroemer, Ing, and Robinette, and published in Industrial Medicine, Vol. 38, No. 4 (Apr., 1969). Additional studies have been conducted to determine the extent of changes to spinal curvature that result from moving from a standing position to a seated position, and the effect upon the spine of seating posture and angle of recline when seated. Two typical studies are Posture of the Trunk When Sitting on Forward Reclining Seats, by Bendix and Biering-Sorensen, published in Scandinavian Journal of Rehabilitative Medicine, Vol 15 (1983); and The Influence of Different Sitting Positions

202 Back Pain

on Cervical and Lumbar Posture, by Black, McClure and Polansky, published in SPINE, Vol. 21, No. 1 (1996). Lumbar lordosis is the term commonly used to refer to the forward curve of the lumbar spine. In one study (Lumbar Lordosis--Effects of Sitting and Standing, by Lord, Small, Dinsay and Watkins, published in SPINE, Vol. 22, No. 21 (1997)), lordosis was measured as an angle between various identifiable points within the spine, with "total lordosis" being measured from the cephalad endplate of L1 to the cephalad endplate of S1. Other measurements from L2 and S1, from L4 to S1, and from L5 to S 1 were also taken to determine the amount of curvature at each of the L1 locations, and the difference in curvature from standing to sitting. The results from that study are that lordosis increases by almost 50 percent when the patient moves from a sitting to a standing position, representing an angular change in total lordosis from 34.+.15 degrees when sitting to 49.+-.15 degrees when standing. Since lower back pain and increased intradiscal pressure are associated with sitting over long periods of time, there has been an interest in alleviating or mitigating the problem by increasing lordosis when a subject is seated. Various attempts to do this have been proposed, and have led to ergonomically designed chairs having backs that provide lower back support for the lumbar spine. Another proposal has been that seats should be sloped forward to increase the forward tilt of the pelvis when seated. The Kroemer study, however, indicates that, while tilting the seat may increase forward pelvic tilt, also increasing lordosis, it also causes the body to slide forward. Such forward thrust must then be counterbalanced by action of the leg muscles, which ultimately becomes uncomfortable and fatiguing. Other problems associated with sitting for long periods of time are documented in Sitting Posture and Prevention of Pressure Ulcers, by Defloor and Grypdonck, published in Applied Nursing Research, Vol. 12, No. 3 (Aug., 1999), Shear vs Pressure as Causative Factors in Skin Blood Flow Occlusion by Bennett, Kavner, Lee and Trainor, published in Arch Physical Medical Rehabilitation, Vol 60 (Jul., 1979), and Hemorrhoids by Nussain, published in Primary Care, Vol. 26, No. 1 (Mar., 1999), and include pressure ulcers, decreased blood flow, and aggravation of pre-existing hemorrhoids. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Exercise apparatus and method Inventor(s): Weitzman, Bernard; (New York, NY) Correspondence: DARBY & DARBY P.C.; Post Office Box 5257; New York; NY; 101505257; US Patent Application Number: 20030096685 Date filed: November 15, 2002 Abstract: This invention relates to health and fitness, and more particularly to exercise methods and devices. More particularly, the invention is directed to stretching exercises and physical therapy, for example an apparatus and exercises for lower back pain. The exercise apparatus comprises at least three cells abutting each other on a common base or frame. Each cell can be independently inflated and deflated to provide an adjustable support cushion having a range of shapes and firmness. An articulated frame is optionally provided for additional independent movement of the cells. Users lie down on the cushion and produce precise stretches and exercises by controlling the rate and degree of inflation or deflation of each cell or group of cells, and optionally, articulated movement of the frame. Stretching can occur passively, as when the body conforms to

Patents 203

the shape of the cushion, or actively by exercising in concert with the conformation of the cushion. Excerpt(s): This application claims priority from Provisional Application No. 60/335,854 filed on Nov. 16, 2001. This invention relates to health and fitness, and more particularly to exercise methods and devices. More particularly, the invention is directed to stretching exercises and physical therapy, for example an apparatus and exercises for lower back pain. Lower back pain is widespread in our civilization. It has been estimated, for example by the US government, that its cost to the economy is second only to upper respiratory infection. Many forms of treatment are employed. These include verbal, psychotherapeutic or educational interventions, massage, exercise, physical therapy, and surgery. The usefulness of all of these approaches is real, but limited. Some people are helped by each of them; many are not. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Human vanilloid receptor-like proteins Inventor(s): Shinjo, Katsuhiro; (Chita-gun, JP), Yabuuchi, Hikaru; (Yokohama, JP) Correspondence: Gregg C. Benson; Pfizer Inc.; Patent Department, MS 4159; Eastern Point Road; Groton; CT; 06340; US Patent Application Number: 20030017527 Date filed: May 30, 2001 Abstract: This invention relates to human vanilloid receptor-like protein 2 (VRL-2) polypeptides, polynucleotides encoding such polypeptides, polynucleotide probes or primers, expression vectors and host cells comprising such DNA molecules. This invention further relates to a process for producing the polypeptides; an antibody immunospecific for the polypeptide; a diagnostic kit for diagnosing the VRL-2 receptor related disease; a method for screening to identify modulators which modulate the polypeptides; modulators identified by the screening method; a pharmaceutical composition for treatment of conditions associated with biological function of the polypeptides; and a non-human transgenic animal model for vanilloid receptor-like gene. The polypeptides and the DNA molecules of the present invention can be used to identify agonists, antagonists or the like. These agonists and antagonists are useful for treatment of diseases such as pain, nociceptive pain, chronic pain, neuropathic pain, postoperative pain, cancer pain, rheumatoid arthritic pain, osteoarthritis, diabetic neuropathies, neuralgia, neuropathies, algesia, nerve injury, muscle-skeletal pain, low back pain, neurodegeneration, stroke, inflammatory disorders, athma, allergy, urogenital disorders, incontinence, hypertension, hypotension, perivasular disease and the like. Excerpt(s): The analgesic properties of capsaicin and capsaicinoides are known for their uses in the treatment of a variety of disorders such as pain, chronic pain, neuropathic pain, postoperative pain, rheumatoid arthritic pain, neuralgia, neuropathies, algesia, nerve injury, ischaemia, neurodegeneration stroke incontinence and inflammatory disorders (e.g., Campbell et al. "Clinical Applications of Capsaicin and Its Analogues" in Capsaicin in the Study of Pain, Academic Press pgs. 255-272 (1993)). Capsaicin receptors are believed to be members of the ion channel family of polypeptides. These receptors are believed to be associated with the mechanism of action of capsaicin (a vanilloid compound). Capsaicin elicits a senstation of burning pain by selectively activating sensory neurons that convey information about noxious stimuli to the central nervous

204 Back Pain

system (e.g, Caterina, M. J. eta al., "The Capsaicin Receptor: A Heat Activated Ion Channel In the Pain Pathway", Nature 389, 816-824 (1997) and Caterina, M. J. et al., "A Capsaicin-Receptor Homologue with A High Threshold For Noxious Heat", Nature 398, 436-441 (1999)). The channels are permeable to cations and exhibit a notable preferance for divalent cations, particularly calcium ions. The level of calcium ion permeability exceeds that observed for most non-selective cation channels and is similar to values observed for NMDA-type glutamate receptors and alpha-7 nicotinic acetylcholine receptors. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Methods and apparatus for treating back pain Inventor(s): Hovda, David C.; (Mountain View, CA), Martini, Brian E.; (Menlo Park, CA), Sanders, Norman R.; (Hillsborough, CA), Woloszko, Jean; (Mountain View, CA) Correspondence: ARTHROCARE CORPORATION; 680 VAQUEROS AVENUE; SUNNYVALE; CA; 94085-3523; US Patent Application Number: 20030158545 Date filed: February 26, 2003 Abstract: Apparatus and methods for treating back pain of a patient by denervation of an intervertebral disc or a region of the posterior longitudinal ligament by the controlled application of heat to a target tissue. In one embodiment, the invention may include a procedure combining both decompression of a disc, and denervation of the annulus fibrosus. In one embodiment, a method of the invention includes positioning an active electrode of an electrosurgical instrument in at least close proximity to an intervertebral disc, and applying at least a first high frequency voltage between the active electrode and a return electrode, wherein nervous tissue within the annulus fibrosus is inactivated, and discogenic pain of the patient is alleviated. In one embodiment, the invention includes positioning a first electrode of a dual-shaft electrosurgical instrument at a first location in relation to a target disc, positioning a second electrode of the instrument at a second location, and applying a high frequency voltage between the first and second electrodes, wherein the first and second electrodes are disposed on separate shafts of the instrument. Excerpt(s): The present invention is related to U.S. patent application Ser. No. 09/026,851, filed Feb. 20, 1999 (Attorney Docket No. S-2), which is a continuation-in-part of U.S. patent application Ser. No. 08/690,159, filed Jul. 18, 1996 (Attorney Docket No. 16238-001610), the complete disclosure of which is incorporated herein by reference for all purposes. The present invention is also related to commonly assigned co-pending U.S. patent application Ser. No. 09/181,926, filed Oct. 28, 1998 (Attorney Docket No. S-12), U.S. patent application Ser. No. 09/130,804, filed Aug. 7, 1998 (Attorney Docket No. S-4), U.S. patent application Ser. No. 09/058,571, filed on Apr. 10, 1998 (Attorney Docket No. CB-2), U.S. patent application Ser. No. 09/248,763, filed Feb. 12, 1999 (Attorney Docket No. CB-7), U.S. patent application Ser. No. 09/026,698, filed Feb. 20, 1998 (Attorney Docket No. S-3), U.S. patent application Ser. No. 09/074,020, filed on May 6, 1998 (Attorney Docket No. E-6), U.S. patent application Ser. No. 09/010,382, filed Jan. 21, 1998 (Attorney Docket A-6), U.S. patent application Ser. No. 09/032,375, filed Feb. 27, 1998 (Attorney Docket No. CB-3), U.S. patent application Ser. Nos. 08/977,845, filed on Nov. 25, 1997 (Attorney Docket No. D-2), 08/942,580, filed on Oct. 2, 1997 (Attorney Docket No. 16238-001300), U.S. patent application Ser. No. 08/753,227, filed on Nov. 22, 1996 (Docket 16238-002200), U.S. patent application Ser. No. 08/687792, filed on Jul. 18,

Patents 205

1996 (Docket No. 16238-001600), and PCT International Application, U.S. National Phase Serial No. PCT/US94/05168, filed on May 10, 1994, now U.S. Pat. No. 5,697,909 (Attorney Docket 16238-000440), which was a continuation-in-part of U.S. patent application Ser. No. 08/059,681, filed on May 10, 1993 (Attorney Docket 16238-000420), which was a continuation-in-part of U.S. patent application Ser. No. 07/958,977, filed on Oct. 9, 1992 (Attorney Docket 16238-000410) which was a continuation-in-part of U.S. patent application Ser. No. 07/817,575, filed on Jan. 7, 1992 (Attorney Docket 1623800040), the complete disclosures of which are incorporated herein by reference for all purposes. The present invention is also related to commonly assigned U.S. Pat. No. 5,697,882, filed Nov. 22, 1995 (Attorney Docket 16238-000700), the complete disclosure of which is incorporated herein by reference for all purposes. The present invention relates generally to the field of electrosurgery, and more particularly to surgical devices and methods which employ high frequency electrical energy to treat tissue in regions of the spine. The present invention also relates to the treatment of intervertebral discs, ligaments, cartilage, tendons, and other tissue within the vertebral column. The invention further relates to apparatus and methods for the inactivation of nervous tissue in and around the spine to alleviate pain associated with defects of the spine or intervertebral discs. The major causes of persistent, often disabling, back pain are disruption of the disc annulus, chronic inflammation of the disc (e.g., herniation), or relative instability of the vertebral bodies surrounding a given disc, such as the instability that often occurs due to a degenerative disease. It is thought that discogenic pain may account for up to 85% of cases of back pain. Disc degeneration appears to be almost universal, occurring as part of the aging process. Intervertebral discs mainly function to cushion and tether the vertebrae, providing flexibility and stability to the patient's spine. Spinal discs comprise a central hydrophilic cushion, the nucleus pulposus, surrounded by a multi-layered fibrous ligament, the annulus fibrosus. As discs degenerate, they lose their water content and height, bringing the adjoining vertebrae closer together. This results in a weakening of the shock absorption properties of the disc and a narrowing of the nerve openings (foramina) of the spine which may pinch these nerves or nerve roots. This disc degeneration can eventually cause back and leg pain. Weakness in the annulus from degenerative discs or disc injury can allow fragments of nucleus pulposus from within the disc space to migrate into the spinal canal. There, displaced nucleus pulposus or protrusion of annulus fibrosus, e.g., herniation, may impinge on spinal nerve roots. The mere proximity of the nucleus pulposus or a damaged annulus to a nerve or nerve root can cause direct pressure against the nerve, resulting in pain, as well as sensory and motor deficit. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Methods and compositions for treating back pain Inventor(s): Yeomans, David C.; (Los Altos, CA) Correspondence: TOWNSEND AND TOWNSEND AND CREW, LLP; TWO EMBARCADERO CENTER; EIGHTH FLOOR; SAN FRANCISCO; CA; 94111-3834; US Patent Application Number: 20030104085 Date filed: December 5, 2001 Abstract: The present invention provides methods and kits for treating back pain, especially chronic back pain. The methods comprise administering a vanilloid receptor agonist, preferably a capsaicin.

206 Back Pain

Excerpt(s): Current analgesic therapies often fall short of therapeutic goals and typically have unacceptable side effects. In many chronic pain syndromes, such as those subsequent to neuropathic injury, pain is not well controlled by any currently available method. The sensation of pain is transduced in the periphery by pain-sensing, i.e. nociceptive, C- and A-delta primary afferent neurons. These neurons have a peripheral nerve ending in the skin or deep tissues and a central terminal that makes synaptic contact with second order neurons in the spinal cord dorsal horn. The impulse is processed locally for activation of withdrawal reflexes and relayed to the brain for conscious perception and contextually relevant integrated responses. Vanilloid receptor1 (VR1) is a multimeric cation channel prominently expressed in nociceptive primary afferent neurons (see, e.g., Caterina et al., Nature 389:8160824, 1997; Tominaga et al., Neuron 531-543, 1998). Activation of the receptor typically occurs at the nerve endings via application of painful heat (VR1 transduces heat pain) or during inflammation or exposure to vanilloids. Activation of VR1 by an agonist, such as resiniferatoxin or capsaicin, results in the opening of calcium channels and the transduction of pain sensation (see, e.g., Szalllasi et al., Mol. Pharmacol. 56:581-587, 1999.) After an initial activation of VR1, VR1 agonists desensitize VR1 to subsequent stimuli. This desensitization phenomenon has been exploited in order to produce analgesia to subsequent nociceptive challenge. For example, it has been shown that topical administration of resinferatoxin (RTX), which is a potent vanilloid receptor agonist, at the nerve endings in the skin triggers a long-lasting insensitivity to chemical pain stimulation. Furthermore, it has been shown that both subcutaneous and epidural administration of the RTX produce thermal analgesia when administered to rats, with no restoration of pain sensitivity for over 7 days (see, e.g., Szabo et al., Brain Res. 840:9298, 1999). The effects of intrathecal capsaicin on thermal sensitivity in rats have been investigated. The results, however, have been conflicting (Nagy et al., Brain Res. 211:497-502, 1981; Palermo et al., Brain Res. 208:506-510; Yaksh et al., Science 206:481483, 1979; and Russell et al., Pain 25:109-123, 1986). Russell et al. observed no thermal analgesia, although in three previous studies, at least some degree of thermal analgesia was observed. The conflicting results raised a number of issues such as the possibility of complications in data interpretation resulting from spinal cord damage from cannula implantation, or solvent toxicity problems. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Portable back pain relieving device Inventor(s): Taylor, Walter J.; (McHenry, IL) Correspondence: MATHEW R. P. PERRONE, JR.; 210 SOUTH MAIN STREET; ALGONGUIN; IL; 60102-2639; US Patent Application Number: 20030004446 Date filed: July 2, 2001 Abstract: A back pain reliever has a linear alignment support with at least two bi-pad supports mounted thereon. The linear alignment support runs along the spine of a person with least two bi-pad supports mounted thereon, so each of the two pads of the bi-pad support are on opposite sides of the spine of a person. Excerpt(s): This invention relates to a back pain relieving device, and more particularly to a back pain relieving device for use on either a vehicle seat or any other seat having a back support, or by a person in a supine position. Back pain is a common complaint for a large number of people. In order to minimize back pain, various devices are known to

Patents 207

have been developed. Such devices provide some relief. However, it is difficult to obtain a device that provides an adequate and a safe relief from back pain for a person, while that person is driving a vehicle. Some of the devices for relief of back pain, while the person suffering from the back pain is a rider in or a driver for a vehicle, are too hard and become dangerous in case of an accident. Other devices are not flexible and interfere with the positioning and driving of, or riding in, a vehicle. Thus, it is desired to avoid these difficulties and provide access either to back comfort or reduced back pain, while at the same time minimizing interference with any use of a vehicle. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Portable, inflatable lumbar cushion Inventor(s): Grosso, William M.; (New City, NY) Correspondence: BRIAN L. WAMSLEY, ESQ.; 119 Highview Avenue; Nanuet; NY; 10954; US Patent Application Number: 20020087105 Date filed: December 28, 2000 Abstract: A portable, inflatable lumbar belt cushion for providing support to the lower spine and surrounding paralumbar musculature of the wearer while seated. The present invention is for an inflatable belt cushion which adjustably reinforces the small of the back to support the lower spine in a proper lorsdosis, alleviating lower back pain caused by improper posture and fatigue. The belt encircles the wearer's waist and contains a compartment with an inflatable cushion centrally located in the back of the belt which is superimposeable in the small of the wearer's back. The inflatable cushion is of a hemi-elliptical design which is positioned horizontally in the small of the back such that the thicker center portion of the cushion supports the spine and the thinner end portions support the surrounding musculature. The cushion extends outwardly from the outer surface of the belt and thus does not create a compression between the belt and the spine. Support is provided only when the wearer is seated and the cushion creates pressure between the wearer and the back of a chair. The cushion is inflated by manual means such that the firmness and pressure of the cushion is totally adjustable. Excerpt(s): The present invention relates to a portable device capable of providing variable lower back support. More particularly, the invention relates to an inflatable, portable lumbar cushion which assists the spine being held in a proper forward curve position, or lordosis. The device comprises a portable, inflatable cushion, worn about the waist, having a particular configuration and dimensions to provide an individualized cushion when inflated. Inflating the lumbar cushion of this invention exerts pressure against a chair back when the wearer is seated, which in turn creates pressure against the lumbar vertebrae and the para-lumbar musculature to maintain the lower spine in a proper lordosis. Lower back pain is a serious problem in this country. It is estimated that eight out of ten Americans at one time or another will suffer from severe back pain. Most lower back pain from sitting is related to poor posture in which the person sits in a slumped or rounded posture. This poor posture occurs more readily when the seat or chair does not give proper support. The position that we hold our spine when we sit is crucial to preventing or exacerbating back problems. The proper position is for the spine to be held in a forward curve called a lordosis. When a proper lordosis is maintained, there is less pressure on the lower back. This can be illustrated with regard to the lumbosacral angle, or Ferguson's angle, formed at the base of the spine. See Yochum, T. R. and Rowe, L. J., Essentials of Skeletal Radiology, Vol. 1, Williams & Wilkins, p. 189

208 Back Pain

(1987). When the person is upright,the normal lumbosacral angle is 41.degree., with a standard deviation of.+-.7.degree. A decrease in the lumbosacral angle, such as when the lower back is becomes rounded when a person is seated in a slouched position, has been implicated as a mechanical factor in producing lower back pain by increasing disc pressure and placing undue stress on the lumbosacral posterior joints. Providing proper lower back support while seated would maintain the lumbosacral angle within its normal limits and thus alleviate lower back pain. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Process for making orthotic insert, an orthotic insert, and a shoe comprising the orthotic insert Inventor(s): Branger, Robert Michael; (Red Lodge, MT) Correspondence: HUNTLEY & ASSOCIATES; 1105 NORTH MARKET STREET; P.O. BOX 948; WILMINGTON; DE; 19899-0948; US Patent Application Number: 20030140525 Date filed: January 24, 2003 Abstract: This will describe unique foot orthotics that are designed to restore, reduce or eliminate foot, ankle, knee, hip and back pain by restoring your natural gait, balance and posture by supporting and cushioning different arches under the foot. These unique orthotics are made in a way that allows different areas of a unitary part to be custom made at different hardnesses by controlling the thickness and cross-linking of the orthotic in that area. This is very beneficial as some parts of the foot need more solid support and other parts need softer support. The parts are made of a chemical-resistant, water-resistant microcellular closed cell material. Also, the orthotics can be made in a variety of overall average stiffness by varying the amount of foaming agent and/or changing materials. This is required for different sporting activities. These orthotics can also be made very light weight by increasing the amount of foaming. These parts can incorporate a cushioning device made with the same process, which further improves the supporting and cushioning of the foot. The orthotic and orthotic/cushioning device combination all slip into the shoe from the top and are replaceable. The present invention also provides for a shoe or sandal further comprising an orthotic of unitary construction, the orthotic being reheatable to conform partially to an individual's foot. The orthotics of the present invention can be made with a high degree of reproducibility and with complicated curves and designs. There are two known processes that can manufacture these parts in the precise reproducible quality needed for orthotics or orthotic/midsole combinations. Excerpt(s): This application claims the benefit of U.S. Provisional Application Serial No. 60/352,082, filed Jan. 25, 2002. An orthotic is defined as a device or devices designed to help to reduce or eliminate pain or discomfort by helping to restore a more natural gait, balance and/or posture by supporting and cushioning different parts of the foot, and thus the body. Specifically, foot orthotics are designed to reduce or eliminate foot, ankle, knee, hip and back pain by restoring your natural gait, balance and posture by supporting and/or cushioning different points under the foot or the foot as a whole. Various orthotic devices have been commercially available for years. Similarly, there are a number of different manufacturing methods and materials that have been used to make foot orthotics. Orthotics have been made of solid and foamed polymers. Foamed orthotics are typically made with open cell polyurethane materials, which show uniform cell structure and consistent hardness throughout the part. These known foamed

Patents 209

orthotics are typically made by machining or skiving the orthotic from a larger piece of foam. They can also be made with a poured polyurethane process where polyurethane is poured into a mold and the foaming takes place to fill the mold. Open cell materials, including polyurethane, are problematic as orthotic materials because these materials, especially polyurethane, will break down when exposed to sweat or water. Also, orthotics that have varying hardnesses throughout can be manufactured by cementing foamed pieces of differing hardnesses together. The individual parts of such orthotics are each foamed to different densities or made from different materials that give them the different hardnesses. When the parts are combined to make the orthotic, there is not a smooth hardness transition between the different areas. Also, the glue used to attach the different parts creates unwanted stiffness and rigidity due to the hardness of the bonding agent, as well as being susceptible to breakdown. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Ultrasound device for treatment of intervertebral disc tissue Inventor(s): Burdette, Everette C.; (Champaign, IL), Deardorff, Dana L.; (Oakland, CA) Correspondence: Michael D. Rechtin; Foley & Lardner, One IBM Plaza; Suite 3300; 330 North Wabash Avenue; Chicago; IL; 60611-3608; US Patent Application Number: 20030069569 Date filed: August 29, 2002 Abstract: An ultrasound device and method for the treatment of intervertebral disc tissue for remediation of back pain. An applicator comprises a catheter and/or needle with a distal tip including one or more ultrasound transducer crystals. The crystals produce high-powered ultrasound energy that is transmitted and absorbed in the disc tissue. The resulting temperature elevation of the disc tissue shrinks the collagen fibers in the surrounding tissue, and/or destroying small nerves that may have invaded and innervated the surrounding degenerated tissue, and can provide increased structural integrity and disc support for the fragmented nucleus pulposus to relieve pressure on the spinal nerves. Excerpt(s): The present invention relates generally to ultrasound applicator devices. More particularly, the present invention relates to the structure, design and use of a minimally invasive ultrasound applicator device for the thermal treatment and repair of intervertebral disc tissue. The concept of using heat to treat degenerated disc tissue is conventionally known. For example, the orthopedic company ORATEC Interventions, Inc. has developed and marketed a device for thermal spine treatment based on IntraDiscal Electro-Thermal (IDET) technology. IDET technology involves a minimally invasive catheter using RF induction of a hot-wire tip for thermal conduction. While relatively straightforward in design and use, the ORATEC device is very limited in thermal capabilities and ultimately in treatment efficacy. The region of disc tissue that is heated with this device is quite small with a sharp temperature fall-off from the surface of the catheter tip (therapeutic temperature elevation in the tissue is estimated to be only 1-3 mm from the catheter). As a result, the treatment itself is likely limited in effectiveness for any given patient, simply because the volume of tissue that is heated is not large enough to produce a significant therapeutic effect (i.e., shrinkage of collagen fibers, destruction of invading nerves, and/or reduction of pressure on the spinal nerves). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

210 Back Pain

Keeping Current In order to stay informed about patents and patent applications dealing with back pain, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “back pain” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on back pain. You can also use this procedure to view pending patent applications concerning back pain. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

211

CHAPTER 7. BOOKS ON BACK PAIN Overview This chapter provides bibliographic book references relating to back pain. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on back pain include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “back pain” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on back pain: •

Fast Facts: Low Back Pain Source: Oxford, England: Health Press. 2003. 130 p. Contact: Available from JAMCO Distribution, Inc. 1401 Lakeway Drive, Lewisville, TX 75057-6001. (800) 538-1281. Fax: (972) 353-1300. Website: www.healthpress.co.uk. PRICE: $24.00. Summary: This book for health professionals discusses the causes, diagnosis, and treatment methods for patients with low back pain. Chapter topics include anatomical factors that cause pain, spine abnormalities, symptoms, red flags for diagnosis, diagnostic tests, conservative management of low back pain, injection therapies, surgery, and strengthening and conditioning exercises. A glossary of terms and sources of further information are appended. 49 figures, 10 tables, and 23 references.

212 Back Pain

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “back pain” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “back pain” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “back pain” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

A Beginner's Guide to Shiatsu: Using Japanese Finger Pressure for the Relief of Headaches, Back Pain, and Hypertension by Patrick McCarty (1995); ISBN: 0895296594; http://www.amazon.com/exec/obidos/ASIN/0895296594/icongroupinterna

•

A Color Atlas of Low Back Pain by Kenneth Mills, et al (1991); ISBN: 0803698585; http://www.amazon.com/exec/obidos/ASIN/0803698585/icongroupinterna

•

Almanac of Back Pain Treatments by Julie Zimmerman (1991); ISBN: 1879418037; http://www.amazon.com/exec/obidos/ASIN/1879418037/icongroupinterna

•

American Medical Association Pocket Guide to Back Pain by American Medical Association (1995); ISBN: 0679755608; http://www.amazon.com/exec/obidos/ASIN/0679755608/icongroupinterna

•

Appropriateness of Spinal Manipulation for Low Back Pain: Project Overview and Literature Review (1992); ISBN: 0833011502; http://www.amazon.com/exec/obidos/ASIN/0833011502/icongroupinterna

•

Back in Control!: A Conventional and Complementary Prescription for Eliminating Back Pain by David, Md. Borenstein (2003); ISBN: 1590770153; http://www.amazon.com/exec/obidos/ASIN/1590770153/icongroupinterna

•

Back Pain by Jayson (1992); ISBN: 0192612859; http://www.amazon.com/exec/obidos/ASIN/0192612859/icongroupinterna

•

Back Pain (Doctors' Rx for Health Series) (1997); ISBN: 0899708161; http://www.amazon.com/exec/obidos/ASIN/0899708161/icongroupinterna

•

Back Pain : How to Get Rid of it Forever by Joh Perrier (1999); ISBN: 0868066753; http://www.amazon.com/exec/obidos/ASIN/0868066753/icongroupinterna

•

Back Pain and Spinal Problems: Index of New Information With Authors, Subjects, and References by Wilma V. Randoll (1996); ISBN: 0788310283; http://www.amazon.com/exec/obidos/ASIN/0788310283/icongroupinterna

•

Back Pain Helpbook by James E. Moore (Editor), et al (1999); ISBN: 073820112X; http://www.amazon.com/exec/obidos/ASIN/073820112X/icongroupinterna

•

Back Pain Matters in Primary Care: Clinical Management of Back Pain in a Healthy and Safe Environment by Ruth Chambers, et al (2001); ISBN: 1857754182; http://www.amazon.com/exec/obidos/ASIN/1857754182/icongroupinterna

•

Back Pain Prevention Book (1994); ISBN: 0815163894; http://www.amazon.com/exec/obidos/ASIN/0815163894/icongroupinterna

Books

213

•

Back Pain Remedies For Dummies® by Michael S. Sinel (Author), William W. Deardorff (Author) (1999); ISBN: 0764551329; http://www.amazon.com/exec/obidos/ASIN/0764551329/icongroupinterna

•

Back Pain: An International Review by John K. Patterson, et al (1990); ISBN: 0792389123; http://www.amazon.com/exec/obidos/ASIN/0792389123/icongroupinterna

•

Back Pain: Chinese Qigong for Healing & Prevention by Jwing-Ming, Dr. Yang (1997); ISBN: 1886969515; http://www.amazon.com/exec/obidos/ASIN/1886969515/icongroupinterna

•

Back Pain: Classification of Syndromes by J.C.T. Fairbank, P.B. Pynsent (Editor) (1990); ISBN: 0719032725; http://www.amazon.com/exec/obidos/ASIN/0719032725/icongroupinterna

•

Back Pain: How to Relieve Low Back Pain and Sciatica by Loren Fishman, Carol Ardman (1999); ISBN: 039331961X; http://www.amazon.com/exec/obidos/ASIN/039331961X/icongroupinterna

•

Back Pain: Its Cause and Solution by David B. Tuchinsky (2000); ISBN: 059500623X; http://www.amazon.com/exec/obidos/ASIN/059500623X/icongroupinterna

•

Back Pain: Methods for Clinical Investigation and Assessment by R.C. Mulholland (Editor), David W. Hukins (Editor) (1988); ISBN: 0719023114; http://www.amazon.com/exec/obidos/ASIN/0719023114/icongroupinterna

•

Back Pain: Practical Ways To Restore Health Using Complementary Medicine by Edzard Ernst (1998); ISBN: 0806970642; http://www.amazon.com/exec/obidos/ASIN/0806970642/icongroupinterna

•

Back Pain: Questions You Have. Answers You Need by Sandra Salmans (1995); ISBN: 1882606191; http://www.amazon.com/exec/obidos/ASIN/1882606191/icongroupinterna

•

Back Pain: Recognition and Management by Michael A. Hutson (1993); ISBN: 0750605782; http://www.amazon.com/exec/obidos/ASIN/0750605782/icongroupinterna

•

Back Pain: What You Need to Know by Johns Hopkins (Editor), et al (1999); ISBN: 0737016019; http://www.amazon.com/exec/obidos/ASIN/0737016019/icongroupinterna

•

Back Rx: A Fifteen-Minute-A-Day Yoga-And Pilates-Based Program to End Low Back Pain Forever by Vijay Vad, Hilary Hinzmann (2004); ISBN: 1592400450; http://www.amazon.com/exec/obidos/ASIN/1592400450/icongroupinterna

•

Back Sense: A Revolutionary Approach to Halting the Cycle of Chronic Back Pain by Ronald D. Siegel, et al (2002); ISBN: 0767905814; http://www.amazon.com/exec/obidos/ASIN/0767905814/icongroupinterna

•

Backache Survival: The Holistic Medical Treatment Program for Chronic Low Back Pain by Robert S. Ivker (2003); ISBN: 1585422363; http://www.amazon.com/exec/obidos/ASIN/1585422363/icongroupinterna

•

Backfire: The Untold Secrets of Self Treatment for Neck and Back Pain by Jan F. Tooke (1993); ISBN: 0963569104; http://www.amazon.com/exec/obidos/ASIN/0963569104/icongroupinterna

214 Back Pain

•

Banish Back Pain the Pilates Way by Anna Selby, Clare Fone (2003); ISBN: 0007141262; http://www.amazon.com/exec/obidos/ASIN/0007141262/icongroupinterna

•

Beating Back Pain by Dr. Len Saputo (Editor), Dr. Anthony Campbell (Author) (2003); ISBN: 0764120409; http://www.amazon.com/exec/obidos/ASIN/0764120409/icongroupinterna

•

Better Back: A Self-Help Guide to Preventing and Treating Back Pain With Orthodox and Complementary Medicine by John Tanner (2003); ISBN: 0789496569; http://www.amazon.com/exec/obidos/ASIN/0789496569/icongroupinterna

•

Body Control Pilates Back Book: A Training Program for the Prevention & Management of Back Pain by Lynne Robinson (2002); ISBN: 0330483110; http://www.amazon.com/exec/obidos/ASIN/0330483110/icongroupinterna

•

Chronic Back Pain: Moving on by Julie Zimmerman (1991); ISBN: 1879418045; http://www.amazon.com/exec/obidos/ASIN/1879418045/icongroupinterna

•

Chronic Low Back Pain: Assessment and Treatment from a Behavioral Rehabilitation Perspective (Irv Series in Rehabilitation Research, Vol 1) by Johan W.S. Vlaeyen (1991); ISBN: 9026511736; http://www.amazon.com/exec/obidos/ASIN/9026511736/icongroupinterna

•

Chronic Low Back Pain: Assessment and Treatment from a Behavioral Rehabilitation Perspective (Series in Rehabilitation Research, Vol 1) by Johannes Wolfgang Silvain Vlayen (1991); ISBN: 9026511728; http://www.amazon.com/exec/obidos/ASIN/9026511728/icongroupinterna

•

Clinical Guidelines for the Management of Acute Low Back Pain (1999); ISBN: 0850842298; http://www.amazon.com/exec/obidos/ASIN/0850842298/icongroupinterna

•

Diagostic Reasoning Series Symptom-Based Case Studies : 52-year-old female with back pain by Gilbert Held (Illustrator), et al (1997); ISBN: 0914168444; http://www.amazon.com/exec/obidos/ASIN/0914168444/icongroupinterna

•

Ergonomics in Back Pain: A Guide to Prevention and Rehabilitation by Tarek M. Khalil (Author), et al (1993); ISBN: 0471285447; http://www.amazon.com/exec/obidos/ASIN/0471285447/icongroupinterna

•

Evaluation and Treatment of Low Back Pain (Clinical Symposia, Vol 48, Pt 4) by Allan Jacobs (1997); ISBN: 9999981836; http://www.amazon.com/exec/obidos/ASIN/9999981836/icongroupinterna

•

Evaluation of Practice Guideline Implementation in the Army Medical Department: The Low Back Pain Guideline Demonstration by Donna Farley (Editor) (2003); ISBN: 083303474X; http://www.amazon.com/exec/obidos/ASIN/083303474X/icongroupinterna

•

Exercise-Based Physiotherapy Management of Patients With Persistent, Non-Specific Low Back Pain: A Cognitive-Behavioural Approach to Assessment and Treatment in a Primary Care Setting (Comprehensive Summaries of Uppsala Dissertations, 881) by Eva Johansson (1999); ISBN: 9155445942; http://www.amazon.com/exec/obidos/ASIN/9155445942/icongroupinterna

•

Fight Against Back Pain: Easy to Do Exercises, Everyday Helpful Hints by Kevin Roberts BSc OstMRO (1997); ISBN: 0953236404; http://www.amazon.com/exec/obidos/ASIN/0953236404/icongroupinterna

Books

215

•

Freedom from Back Pain by Eldon Taylor (2001); ISBN: 1559789115; http://www.amazon.com/exec/obidos/ASIN/1559789115/icongroupinterna

•

Freedom from Back Pain : The Mendsendieck System (Karen Perlroth Mensendieck Back Care Education Series)/Audio Cassette by Karen A. Perlroth (Editor) (1994); ISBN: 1880688050; http://www.amazon.com/exec/obidos/ASIN/1880688050/icongroupinterna

•

Guide to a Better Back: A Back Pain Suffererªs Handbook for Exercise and Daily Living by Dee Massengale (1989); ISBN: 0756759331; http://www.amazon.com/exec/obidos/ASIN/0756759331/icongroupinterna

•

Healing Back Pain Naturally : The Mind-Body Program Proven to Work by Art Brownstein (Author) (2001); ISBN: 0743424646; http://www.amazon.com/exec/obidos/ASIN/0743424646/icongroupinterna

•

High Back Pain and Very Close Veins by Helen Wallace, Heather Green (Illustrator) (2002); ISBN: 1931333009; http://www.amazon.com/exec/obidos/ASIN/1931333009/icongroupinterna

•

How to Deal Simply With Back Pain and Rheumatoid Joint Pain by Fereydoon Batmanghelidj (1992); ISBN: 0962994200; http://www.amazon.com/exec/obidos/ASIN/0962994200/icongroupinterna

•

Industrial Back Pain in Europe by Peter R. Davis (Editor), Society Ergonomics (1984); ISBN: 0850669855; http://www.amazon.com/exec/obidos/ASIN/0850669855/icongroupinterna

•

Industrial Low Back Pain (Contemporary Litigation Series) by Sam W. Wiesel, et al (1985); ISBN: 087215856X; http://www.amazon.com/exec/obidos/ASIN/087215856X/icongroupinterna

•

Lifting the Bull: Overcoming Chronic Back Pain Fibromyalgia and Environmental Illness by Diane Dawber (1999); ISBN: 1550821997; http://www.amazon.com/exec/obidos/ASIN/1550821997/icongroupinterna

•

Living With Back Pain by Tom Smith (2003); ISBN: 0859698831; http://www.amazon.com/exec/obidos/ASIN/0859698831/icongroupinterna

•

Loving With Back Pain: Good Sex With a Bad Back by Kathy Ulrich, Vicki Chandler (1996); ISBN: 0965541002; http://www.amazon.com/exec/obidos/ASIN/0965541002/icongroupinterna

•

Low Back Pain by Sam W. Wiesel, et al (1999); ISBN: 0327100133; http://www.amazon.com/exec/obidos/ASIN/0327100133/icongroupinterna

•

Low Back Pain (1990); ISBN: 0683021516; http://www.amazon.com/exec/obidos/ASIN/0683021516/icongroupinterna

•

Low Back Pain by Sam Wielsel (1989); ISBN: 0874734495; http://www.amazon.com/exec/obidos/ASIN/0874734495/icongroupinterna

•

Low Back Pain Fast Facts Indispensable Guides to Clinical Practice by Robert L. Swezey, Andrei Calin (2003); ISBN: 1903734347; http://www.amazon.com/exec/obidos/ASIN/1903734347/icongroupinterna

•

Low Back Pain Syndrome (1995); ISBN: 0803616066; http://www.amazon.com/exec/obidos/ASIN/0803616066/icongroupinterna

216 Back Pain

•

Low Back Pain, A Symptom-Based Approach to Diagnosis and Treatment by Karen S. Rucker, et al (2001); ISBN: 0750694858; http://www.amazon.com/exec/obidos/ASIN/0750694858/icongroupinterna

•

Low Back Pain: An Evidence-Based, Biopsychosocial Model for Clinical Management by Jane Derebery (Editor), John R. Anderson (Editor) (2002); ISBN: 1883595347; http://www.amazon.com/exec/obidos/ASIN/1883595347/icongroupinterna

•

Low Back Pain: Clinical Diagnosis and Management by Leonard P. Seimon (1983); ISBN: 083855685X; http://www.amazon.com/exec/obidos/ASIN/083855685X/icongroupinterna

•

Low Back Pain: Diagnosis and Management by Andrew Frank (2001); ISBN: 1850091595; http://www.amazon.com/exec/obidos/ASIN/1850091595/icongroupinterna

•

Low Back Pain: Health Care Needs Asessment: The Epidemiologically Based Needs Assessment Reviews, Second Series by Wessex Institute for Health Research and (1997); ISBN: 1857752015; http://www.amazon.com/exec/obidos/ASIN/1857752015/icongroupinterna

•

Lumbar Spine and Back Pain (1987); ISBN: 0272797901; http://www.amazon.com/exec/obidos/ASIN/0272797901/icongroupinterna

•

Management of Back Pain (1994); ISBN: 0443029547; http://www.amazon.com/exec/obidos/ASIN/0443029547/icongroupinterna

•

Managing Back Pain: Self-Help Manual: Daily Activities Guide for Back Pain Patients by Michael S. Melnick, et al (1997); ISBN: 0961646160; http://www.amazon.com/exec/obidos/ASIN/0961646160/icongroupinterna

•

Manual Treatment of Back Pain by Vincent C.B. Nwuga (1986); ISBN: 0898747538; http://www.amazon.com/exec/obidos/ASIN/0898747538/icongroupinterna

•

Mechanical Low Back Pain: Perspectives in Functional Anatomy by James A. Porterfield, et al (1998); ISBN: 0721668372; http://www.amazon.com/exec/obidos/ASIN/0721668372/icongroupinterna

•

Mind over Back Pain: A Radically New Approach to the Diagnosis and Treatment of Back Pain by John E. Sarno (1999); ISBN: 0425175235; http://www.amazon.com/exec/obidos/ASIN/0425175235/icongroupinterna

•

Movement, Stability and Low Back Pain: The Essential Role of the Pelvis by Andry Vleeming (Editor) (1997); ISBN: 0443055742; http://www.amazon.com/exec/obidos/ASIN/0443055742/icongroupinterna

•

No Milk: A Revolutionary Solution to Back Pain & Headaches by Daniel A. Twogood (1992); ISBN: 0963112503; http://www.amazon.com/exec/obidos/ASIN/0963112503/icongroupinterna

•

Occupational Back Pain (Spine State of the Art Reviews) (1987); ISBN: 0932883494; http://www.amazon.com/exec/obidos/ASIN/0932883494/icongroupinterna

•

Overcome Neck and Back Pain by Kit Laughlin (1998); ISBN: 0684852527; http://www.amazon.com/exec/obidos/ASIN/0684852527/icongroupinterna

•

Pocket Guide to Back Pain by Anthony Reed (1989); ISBN: 0851407560; http://www.amazon.com/exec/obidos/ASIN/0851407560/icongroupinterna

•

Prevent Back Pain/Cassette, Poster and Instructional Booklet (1985); ISBN: 0932513751; http://www.amazon.com/exec/obidos/ASIN/0932513751/icongroupinterna

Books

217

•

Recover from Back Pain (1985); ISBN: 093251376X; http://www.amazon.com/exec/obidos/ASIN/093251376X/icongroupinterna

•

Release Back Pain [UNABRIDGED] by Michael Reed Gach (2003); ISBN: 1591790875; http://www.amazon.com/exec/obidos/ASIN/1591790875/icongroupinterna

•

Relief from Back Pain: The Tollison Program by C. David Tollison (1987); ISBN: 0898761409; http://www.amazon.com/exec/obidos/ASIN/0898761409/icongroupinterna

•

Say Goodbye to Back Pain: A Simple, Effective,Safe Procedure for Chronic Back Pain by Richard Stuckey (1995); ISBN: 0855722487; http://www.amazon.com/exec/obidos/ASIN/0855722487/icongroupinterna

•

Spine State of the Art Reviews: Occupational Back Pain by Richard Dey (1987); ISBN: 9998773180; http://www.amazon.com/exec/obidos/ASIN/9998773180/icongroupinterna

•

Surgical Management of Low Back Pain (Neurosurgical Topics) by Daniel K. Resnick (Editor), Regis Haid (2001); ISBN: 1879284782; http://www.amazon.com/exec/obidos/ASIN/1879284782/icongroupinterna

•

The Ab Revolution: No More Crunches! No More Back Pain by Jolie, Dr Bookspan, Dr Jolie Bookspan (2003); ISBN: 1410745279; http://www.amazon.com/exec/obidos/ASIN/1410745279/icongroupinterna

•

The Appropriateness of Spinal Manipulation for Low-Back Pain: Data Collection Instruments and a Manual for Their Use by Paul G. Shekelle, et al (1995); ISBN: 0833016563; http://www.amazon.com/exec/obidos/ASIN/0833016563/icongroupinterna

•

The Back Pain Book: A Self-Help Guide for Daily Relief of Neck & Back Pain by Mike Hage, et al (1992); ISBN: 1561450421; http://www.amazon.com/exec/obidos/ASIN/1561450421/icongroupinterna

•

The Bible Cure for Back Pain (Bible Cure Series) by Don, M.D. Colbert (2002); ISBN: 0884198308; http://www.amazon.com/exec/obidos/ASIN/0884198308/icongroupinterna

•

The Complete Doctor's Healthy Back Bible: A Practical Manual for Treating Back Pain by Stephen, MD Reed (2004); ISBN: 0778800911; http://www.amazon.com/exec/obidos/ASIN/0778800911/icongroupinterna

•

The Diagnosis and Misdiagnosis of Back Pain by Julie Zimmerman (1991); ISBN: 1879418029; http://www.amazon.com/exec/obidos/ASIN/1879418029/icongroupinterna

•

The Good Back Book: A Practical Guide to Alleviating & Preventing Back Pain by Renita Fehrsen-Du Toit, Renita Fehrsen-Du Toit (2003); ISBN: 1552978265; http://www.amazon.com/exec/obidos/ASIN/1552978265/icongroupinterna

•

The John Hopkins White Papers: Low Back Pain and Osteoporosis (2001); ISBN: 9990833397; http://www.amazon.com/exec/obidos/ASIN/9990833397/icongroupinterna

•

The Johns Hopkins White Papers 2002, Volume 2: Hypertension and Stroke, Low Back Pain and Osteoporosis, Memory, Prostate Disorders, Vision by Simeon Margolis (Editor) (2002); ISBN: 0929661729; http://www.amazon.com/exec/obidos/ASIN/0929661729/icongroupinterna

218 Back Pain

•

The Management of Back Pain in General Practice (Clinical Series) by Martin Barker (1995); ISBN: 0850842093; http://www.amazon.com/exec/obidos/ASIN/0850842093/icongroupinterna

•

The New Back Doctor: The Program for Lifetime Relief from Back Pain by Hamilton Hall (1995); ISBN: 0770426190; http://www.amazon.com/exec/obidos/ASIN/0770426190/icongroupinterna

•

The Pilates Prescription for Back Pain : A Comprehensive Program for Developing and Maintaining a Healthy Back by Lynne Robinson (Author), et al (2004); ISBN: 1569753946; http://www.amazon.com/exec/obidos/ASIN/1569753946/icongroupinterna

•

The Prevalence of Back Pain in Great Britain in 1996: A Report on Research for the Department of Health Using the ONS Omnibus Survey (Omnibus Survey Publications) by Tricia Dodd (1997); ISBN: 0116209682; http://www.amazon.com/exec/obidos/ASIN/0116209682/icongroupinterna

•

The Prevalence of Back Pain in Great Britain: A Report on OPCS Omnibus Survey Data Produced on Behalf of the Department of Health by Val Mason (1994); ISBN: 0116915749; http://www.amazon.com/exec/obidos/ASIN/0116915749/icongroupinterna

•

Therapeutic Exercise for Spinal Segmental Stabilization: In Lower Back Pain by Carolyn Richardson, et al (1998); ISBN: 0443058024; http://www.amazon.com/exec/obidos/ASIN/0443058024/icongroupinterna

•

Total Health for Women: From Allergies & Back Pain to Overweight & PMS, the Best Preventive & Curative Advice for Over 110 Women's Health Prob by Prevention Magazine, et al (1995); ISBN: 0875963110; http://www.amazon.com/exec/obidos/ASIN/0875963110/icongroupinterna

•

Win the Battle Against Back Pain: An Integrated Mind-Body Approach by Michael S. Sinel, et al (1996); ISBN: 0440507057; http://www.amazon.com/exec/obidos/ASIN/0440507057/icongroupinterna

•

Winning with Back Pain by Harris H. McIlwain (Author), et al (1994); ISBN: 0471303283; http://www.amazon.com/exec/obidos/ASIN/0471303283/icongroupinterna

•

You Can Beat Arthritis: A Message of Hope for the Millions of Sufferers from Arthritis, Rheumatism and Chronic Back Pain by Jeremy Michaels (1992); ISBN: 1897656017; http://www.amazon.com/exec/obidos/ASIN/1897656017/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “back pain” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 11

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed

Books

219

•

Arthritis and back pain. Author: Adams, John Crawford.; Year: 1968; Baltimore, University Park Press [1972]; ISBN: 0839105762 http://www.amazon.com/exec/obidos/ASIN/0839105762/icongroupinterna

•

Interferential current therapy for low-back pain Author: ECRI (Organization). Health Technology Assessment Information Service.; Year: 1964; Plymouth Meeting, PA: ECRI, c2003

•

Intradiscal electrothermal therapy (IDET) for low back pain. Author: Institute for Clinical Systems Integration. Technology Assessment Committee.; Year: 2003; St. Paul, Minn.: Health Technology Advisory Committee, c2002

•

Low back pain and sciatica, with special reference to secondary lumbo-sacral insufficiency. [Tr. by V. Penttilä]. Author: Leikkonen, Olavi.; Year: 1958; Copenhagen, Munksgaard, 1959

•

Low back pain syndrome. Author: Cailliet, Rene.; Year: 1969; Philadelphia, Davis [c1968]

•

Low back pain. Author: Larson, Carroll B. (Carroll Bernard),; Year: 1968; Chicago, Year Book Publishers, 1957

•

Lumbar disc lesions; pathogenesis and treatment of low back pain and sciatica. Author: Armstrong, J. R. (James Rowan); Year: 1965; Edinburgh, Livingstone, 1965

Chapters on Back Pain In order to find chapters that specifically relate to back pain, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and back pain using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “back pain” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on back pain: •

Children and Young Adults Source: in Maddison, P.J.; et al., Eds. Oxford Textbook of Rheumatology. Volume 1. New York, NY: Oxford University Press, Inc. 1993. p. 8-19. Contact: Available from Oxford University Press, Inc., New York, NY. Summary: This chapter for health professionals focuses on rheumatic diseases in childhood. The epidemiology of childhood rheumatic diseases is discussed, focusing on diagnostic criteria, the frequencies of childhood rheumatic diseases, the age of onset, sex ratios, and patterns of inflammatory or noninflammatory bone and joint disease. Agerelated characteristics that affect the physician's approach to childhood rheumatic diseases a reexamined, including psychosocial maturation, motor development, physical growth, and sexual maturation. Guidelines for taking a medical history, performing a

in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

220 Back Pain

physical examination, and conducting laboratory tests are provided. In addition, specific approaches to evaluating a child with limb or back pain, trauma, monoarticular arthritis, fever of unknown origin, and muscle weakness are presented. 26 references, 6 figures, and 12 tables. •

Renal Implications of Herbal Remedies Source: in Miller, L.G. and Murray, W.J., eds. Herbal Medicinals: A Clinician's Guide. New York, NY: Pharmaceutical Products Press. 1998. p. 9-36. Contact: Available from Haworth Herbal Press. 10 Alice Street, Binghamton, NY 139041580. (800) HAWORTH. Fax (800) 895-0582. E-mail: [email protected]. Website: www.haworthpressinc.com. PRICE: $39.95 plus shipping and handling. ISBN: 0789004666. Summary: This chapter on the renal (kidney) implications of herbal medications is from a clinician's guide to the use of herbal medicinals that uses a case based approach to lead readers through clinical considerations and the potential use of alternative medicines. The authors address the increasing use of herbal medications and the potential ramifications of such preparations: first, people may choose to self medicate for ailments related to kidney function and these preparations may or may not be efficacious; second, unintended effects may occur. The difference between choices of standard Western medical practices and alternative herbal medications lies in the mandated requirement for demonstrated safety and efficacy of licensed pharmaceuticals in most of the industrialized countries. The authors note that renal effects of herbal preparations can be beneficial or harmful. Beneficial effects would include diuresis, protection of the kidney from effects of nephrotoxic agents, prevention or amelioration of renal lithiasis (kidney stones), and amelioration of kidney failure. Harmful effects include polyuria causing dehydration, acute kidney failure or chronic renal insufficiency, and stone formation. The case studies in this chapter describe nephrotoxic weight loss preparations, potential problems with some preparations of licorice, other agents with effects on electrolytes and minerals, Tung Shueh used for back pain, Chinese rhubarb (taken to treat chronic renal failure), herbs advocated for the treatment or prevention of kidney stones, and herbs advocated for diuresis. Where available, the authors refer to research studies (primarily animal studies) of the herbs discussed. The authors conclude that there is at present too little information to allow recommendation of any of the reviewed substances. Some compounds do show promise but clearly require much more study and elucidation of mechanisms to be useful. Many more compounds seem to be innocuous, but are without benefit as well. Conversely, there is very convincing information about toxicity of many of these medicinals. One table summarizes the medicinal and pharmaceutical chemistry aspects of the drugs described. An appendix lists the plants used for the kidney (per USDA database). 1 table. 60 references.

•

Chapter 8-C: Musculoskeletal Signs and Symptoms: Disorders of the Low Back and Neck Source: in Klippel, J.H., et al., eds. Primer on the Rheumatic Diseases. 12th ed. Atlanta, GA: Arthritis Foundation. 2001. p. 165-173. Contact: Available from Arthritis Foundation. P.O. Box 1616, Alpharetta, GA 300091616. (800) 207-8633. Fax (credit card orders only) (770) 442-9742. Website: www.arthritis.org. PRICE: $69.95 plus shipping and handling. ISBN: 0912423293. Summary: This chapter provides health professionals with information on disorders of the low back and neck. Axial skeletal pain is associated with various mechanical and

Books

221

medical disorders. Mechanical disorders are caused by overuse, trauma, or physical deformity of an anatomic structure. Medical disorders responsible for spinal pain are associated with constitutional symptoms, disease in other organ systems, and inflammatory or infiltrative disease of the axial skeleton. Most people who have low back or neck pain have a mechanical reason for their pain. The initial evaluation of patients with spinal pain focuses on separating people with mechanical disorders from those with systemic illnesses. The initial diagnostic evaluation includes taking a medical history and performing physical and neurologic examinations. Plain radiographs and laboratory tests are usually not needed for most patients. Symptoms that help identify systemic illnesses in people who have spinal pain include fever or weight loss, pain with recumbency, morning stiffness, localized bone pain, or visceral pain. Mechanical disorders of the lumbosacral spine are the most common causes of low back pain. These disorders include muscle strain, herniated nucleus pulposus, osteoarthritis, lumbar spinal stenosis, spondylolisthesis, and adult scoliosis. Mechanical disorders of the cervical spine are less common than lumbar spine disorders and tend to be less debilitating. Causes of cervical spine pain include neck strain, cervical disc herniation, cervical spondylosis, myelopathy, and whiplash. The chapter describes the clinical features, diagnosis, and treatment of these mechanical causes of back and neck pain. 3 figures, 5 tables, and 27 references. •

Chapter 50: Osteoarthritis Source: in Berkow, R., ed. The Merck Manual of Medical Information: Home Edition (online version). Rahway, NJ: Merck and Company, Inc. 2000. 3 p. Contact: Available online from Merck and Company, Inc. (800) 819-9456. Website: www.merck.com/pubs/mmanual_home/contents.htm. Also available from your local book store. PRICE: $29.95 plus shipping. Summary: This chapter provides the general public and people who have osteoarthritis with information on the causes, symptoms, and treatment of this chronic joint disorder, which is characterized by degeneration of joint cartilage and adjacent bone. Osteoarthritis, the most common joint disorder, occurs in many people by age 70 and affects men and women equally. Osteoarthritis is classified as primary when the cause is not known and secondary when the cause is another disease. Symptoms usually develop gradually and at first affect only one or a few joints. Commonly affected joints are those of the fingers, base of the thumbs, neck, lower back, big toes, hips, and knees. Pain is usually the first symptom. Back pain is the most common symptom of osteoarthritis of the spine. Osteoarthritis of the neck or lower back can cause numbness, odd sensations, pain, and weakness in an arm or leg if bone overgrowth presses on nerves. Stiffness may occur after sleep or some inactivity. As the damage from osteoarthritis worsens, the joint may become less movable. Stretching, strengthening, and postural exercises help maintain healthy cartilage, increase the range of motion, and strengthen surrounding muscles. Physical therapy, often with heat, may be helpful. Orthotic devices can protect joints during painful activities. Massage, traction, and deep heat may be useful for certain types of osteoarthritis of the neck. Drugs are the least important aspect of the treatment program. Useful drugs include analgesics and nonsteroidal antiinflammatory drugs. Joint replacement may be considered when function becomes limited.

222 Back Pain

•

Patients' Experiences with Their Disease: Learning from the Differences and Sharing the Common Problems Source: in Assal, J., Golay, A., and Visser, A.P., eds. New Trends in Patient Education: A Trans-Cultural and Inter-Disease Approach. Amsterdam, The Netherlands: Elsevier Science B.V. 1995. p. 301-312. Contact: Available from Elsevier Science. Regional Sales Office, Customer Support Department, 655 Avenue of the Americas, New York, NY 10010. (212) 633-3730. Fax (212) 633-3680. E-mail: [email protected]. PRICE: $209.50. ISBN: 0444822348. Summary: This chapter, from the proceedings of an international patient education conference, presents patients' experiences and views about the psychological, professional, family, cognitive, and financial costs of several chronic diseases. Diseases covered include arterial hypertension, autonomous dialysis, back pain, bronchial asthma, chronic obstructive pulmonary disease, colostomy, diabetes mellitus, epilepsy, laryngectomy, and Parkinson's disease. (AA-M).

•

Orthopedic Disorders Source: in Mosby 's Patient Teaching Guides. St. Louis, MO: Mosby -Year Book, Inc. 1995. p. 93-112. Contact: Mosby -Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO. 63146. ISBN: 0815158629. Summary: This section of Mosby 's Patient Teaching Guides examines the following orthopedic disorders: arthritis, strains and sprains, osteoporosis and its treatment, scoliosis , low back pain, ruptured disks and prevention of future back problems, transcutaneous electrical nerve stimulation, casts and home cast care, traction, crutch walking, total hip replacement and recovery, total knee replacement and recovery, and total shoulder replacement. Each section provides, where applicable, an explanation of the ailment, risk factors, diagnosis and treatment, and prevention tips. Those topics not specifically disease-oriented cover how to and/or safety information, rehabilitation tips, or information regarding procedures and what to expect such as in discussions involving surgery.

Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to back pain have been published that consolidate information across various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:12 •

Resources for People with Disabilities and Chronic Conditions Source: Lexington, MA: Resources for Rehabilitation. 1996. 288 p.

12

You will need to limit your search to “Directory” and “back pain” using the "Detailed Search" option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Select your preferred language and the format option “Directory.” Type “back pain” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months.

Books

223

Contact: Available from Resources for Rehabilitation. 33 Bedford Street, Suite 19A, Lexington, MA 02173. (617) 862-6455; Fax (617) 861-7517. PRICE: $49.95 plus shipping and handling. ISBN: 0929718178. Summary: This book is a resource guide covering many common conditions, including spinal cord injury, low back pain, diabetes, multiple sclerosis, hearing and speech impairments, visual impairment and blindness, and epilepsy. Each chapter includes information about the disease or condition, psychological aspects of the condition, professional service providers, environmental adaptations, assistive devices, and descriptions of related organizations and publications. Also included is information on rehabilitation services, independent living, self-help, laws that affect people with disabilities, making everyday life easier, children with disabilities, computer bulletin boards, and resources on the Internet. The book concludes with an organization name index. (AA-M).

225

CHAPTER 8. MULTIMEDIA ON BACK PAIN Overview In this chapter, we show you how to keep current on multimedia sources of information on back pain. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on back pain is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “back pain” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “back pain” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on back pain: •

Back Pain (Lower Back) at Time of Diagnosis Source: New York, NY: Patient Education Media, Inc./Time Life Medical. 1996. Contact: Patient Education Media, Inc./Time Life Medical. Time and Life Building, 1271 6th Street, New York, NY 10020. (212) 522-8089. (212) 522-8092 (fax). (800) 588-9959. PRICE: $19.95. Stock Number TLMV219. Summary: This 30-minute videocassette on lower back pain is divided into the following four parts: Part 1 uses computer animation to explain what is going on inside the body and how the lower back pain diagnosis is made; Part 2 discusses what happens after the diagnosis and introduces practical issues, such as types of health professionals who may become involved and what lifestyle changes may need to occur; Part 3 explores options for treatment and management of the condition; and Part 4 addresses issues and answers questions that frequently arise through the use of in-studio question and answer sessions. The videotape is accompaniedby a patient workbook that provides program highlights, a glossary of terms, and a resource guide and a personal journal.

226 Back Pain

Bibliography: Multimedia on Back Pain The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in back pain (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on back pain: •

Back pain patients [videorecording] Source: MAV TV, McMaster Audio Visual; Year: 1984; Format: Videorecording; [S.l.: s.n.], 1984

•

Changing concepts in the care of chronic back pain [videorecording] Source: author, Vert Mooney; Year: 1982; Format: Videorecording; Dallas, Tex.: MEDTV, the Dept. of Biomedical Communications, the University of Texas Health Science Center, c1982

•

Epidural injections for the diagnosis & treatment of low back pain [slide] Source: American Academy of Orthopaedic Surgeons; Year: 1979; Format: Slide; [Chicago]: The Academy, [1979]

•

Evaluation of low back pain [videorecording] Source: Oklahoma University, Health Sciences Center, College of Health, Dept. of Physical Therapy; Year: 1978; Format: Videorecording; Oklahoma City: The Center: [for sale by its Media Productions], c1978

•

Evaluation of low back pain [videorecording] Source: Dept. of Continuing Education, Harvard Medical School and the Massachusetts General Hospital, Emergency Training Course; produced by Health Education Programs, inc; Year: 1979; Format: Videorecording; [New York]: Health Education Programs; [Edina, Minn: for loan or sale by Video Training Resources], c1979

•

Evaluation of low back pain [videorecording] Source: Carolyn Sturges; produced by Health Education Programs Incorporated; Year: 1980; Format: Videorecording; New York: Health Education Programs; [Edina, Minn.: for loan or sale by Video Training Resources], c1980

•

Flexion exercises in management of low back pain [videorecording] Source: Emory University School of Medicine; Year: 1977; Format: Videorecording; Atlanta: Georgia Regional Medical Television Network: [for loan or sale by A. W. Calhoun Medical Library, 1977]

•

Low back pain [videorecording] Source: Emory University School of Medicine; Year: 1977; Format: Videorecording; Atlanta: Georgia Regional Medical Television Network: [for loan or sale by A. W. Calhoun Medical Library, 1977]

•

Low back pain [videorecording] Source: a Hahnemann University and Videotech Associates Inc. production; Year: 1983; Format: Videorecording; [S.l.]: The Associates, c1983

•

Low back pain, solving the clinical challenge [videorecording] Source: with Rodney Bluestone and Mary Rosenberg; Year: 1985; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1985

•

Management of back pain [videorecording] Source: a Hahnemann University and World Video Corp. production; Year: 1983; Format: Videorecording; [S.l.: s.n, 1983]

•

Myofascial release techniques [videorecording]: scientific & clinical rationale in the management of low back pain Source: an AREN production; [produced at the facilities of WQED/Pittsburgh by QED Enterprises]; Year: 1986; Format: Videorecording; Pittsburgh, Pa.: American Rehabilitation Educational Network, c1986

Multimedia 227

•

Orthopaedic surgery: current concepts in the treatment of low back pain [sound recording] Source: American College of Surgeons; Year: 1977; Format: Sound recording; [Chicago]: The College, [1977]

•

Orthopaedic surgery: hand injuries, ankle injuries, and back pain [sound recording] Source: American College of Surgeons; Year: 1976; Format: Sound recording; Chicago: The College, p1976

•

Practical problems in back pain, foot disorders [slide] Source: Department of Continuing Medical Education School of Medicine State University of New York at Buffalo, in cooperation with the Lakes Area Regional Medical Program; Year: 1975; Format: Slide; [Buffalo]: Communications in Learning, 1975

•

Preventing back pain & injury [filmstrip] Source: produced by Concept Media; Year: 1985; Format: Filmstrip; [Irvine, CA]: Concept Media, c1985

•

The Lower back pain syndrome [slide] Source: James Johnston; Year: 1974; Format: Slide; [New York]: Medcom, c1974

•

The Ten commandments of the prevention of low back pain by exercise [videorecording] Source: presented by Emory University, School of Medicine and Interstate Postgraduate Medical Association; Year: 1981; Format: Videorecording; Atlanta, Ga.: Emory Medical Television Network, 1981

•

To flex or not to flex [videorecording]: a discussion on management of low back pain Source: Emory University School of Medicine; Year: 1977; Format: Videorecording; Atlanta: Georgia Regional Medical Television Network: [for loan or sale by A. W. Calhoun Medical Library, 1977]

•

Understanding low back pain [videorecording] Source: Dept. of Medicine, Emory University, School of Medicine; Year: 1978; Format: Videorecording; Atlanta: Georgia Regional Medical Television Network: [for loan and sale by A. W. Calhoun Medical Library], 1978

229

CHAPTER 9. PERIODICALS AND NEWS ON BACK PAIN Overview In this chapter, we suggest a number of news sources and present various periodicals that cover back pain.

News Services and Press Releases One of the simplest ways of tracking press releases on back pain is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “back pain” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to back pain. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “back pain” (or synonyms). The following was recently listed in this archive for back pain: •

Medium-firm, not hard, mattress best for chronic back pain Source: Reuters Medical News Date: November 14, 2003

•

Medium-firm mattress best for back pain, researchers say Source: Reuters Health eLine Date: November 14, 2003

230 Back Pain

•

FDA clears Centerpulse device to treat back pain Source: Reuters Industry Breifing Date: July 10, 2003

•

Therapy, surgery similar for back pain relief Source: Reuters Health eLine Date: June 20, 2003

•

Cognitive therapy as effective as surgery for back pain relief Source: Reuters Industry Breifing Date: June 20, 2003

•

MRI no better than x-rays in management of low back pain Source: Reuters Medical News Date: June 04, 2003

•

Rapid MRI no better than X-ray for back pain: study Source: Reuters Health eLine Date: June 03, 2003

•

Spinal manipulation and standard treatments seen comparable for back pain Source: Reuters Medical News Date: June 02, 2003

•

Back pain number one illness in Germany, and often incorrectly treating Source: Reuters Medical News Date: May 27, 2003

•

Back pain Germany's number one malady, survey finds Source: Reuters Health eLine Date: May 26, 2003

•

Electrical acupuncture beneficial in older patients with chronic low back pain Source: Reuters Industry Breifing Date: May 13, 2003

•

Back pain linked to brain shrinkage, study suggests Source: Reuters Health eLine Date: March 21, 2003

•

On-the-job back pain influenced by social climate Source: Reuters Health eLine Date: February 20, 2003

•

Vertebroplasty improves refractory back pain from compression fractures Source: Reuters Medical News Date: September 24, 2002

•

Medical device an effective alternative to spinal fusion for low back pain Source: Reuters Industry Breifing Date: September 06, 2002

•

Back pain? Nerve block may not help: study Source: Reuters Health eLine Date: August 20, 2002

•

Backpacks not always to blame for kids' back pain Source: Reuters Health eLine Date: August 19, 2002

Periodicals and News

•

No link between epidural analgesia and long-term lower back pain Source: Reuters Medical News Date: August 15, 2002

•

Heat therapy shown effective for chronic back pain Source: Reuters Health eLine Date: May 08, 2002

•

E-mail discussion group helps back pain patients Source: Reuters Health eLine Date: April 10, 2002

•

Kidney stone back pain more likely in morning Source: Reuters Health eLine Date: April 01, 2002

•

FDA approves Vertis' system for treatment of lower back pain Source: Reuters Industry Breifing Date: January 23, 2002

•

Extended-release tramadol shown effective for back pain Source: Reuters Medical News Date: January 14, 2002

•

Gynaecologists found at high risk of back pain Source: Reuters Health eLine Date: December 17, 2001

•

Gynaecologists at high risk of back pain Source: Reuters Medical News Date: December 17, 2001

•

Weight loss, physical therapy can help back pain Source: Reuters Health eLine Date: December 05, 2001

•

Musicians face doubled risk of back pain: study Source: Reuters Health eLine Date: November 02, 2001

•

Study examines role of abs in golfers' back pain Source: Reuters Health eLine Date: October 16, 2001

•

Race car driving may up risk of back pain, injury Source: Reuters Health eLine Date: September 28, 2001

•

Psychological stress in early adulthood linked to low back pain later Source: Reuters Medical News Date: September 27, 2001

•

Low back pain linked to stress in young adulthood Source: Reuters Health eLine Date: September 27, 2001

•

Cyclobenzaprine's benefit in treating back pain "comes at a price" Source: Reuters Industry Breifing Date: July 12, 2001

231

232 Back Pain

•

Education, intensive therapy eases low back pain Source: Reuters Health eLine Date: June 22, 2001

•

Mass media campaign in Australia reduced disability, costs related to back pain Source: Reuters Medical News Date: June 21, 2001

•

Cost versus benefit of effective rehabilitation for low back pain questioned Source: Reuters Medical News Date: June 21, 2001

•

Botulinum toxin A injections seem effective for chronic low back pain Source: Reuters Medical News Date: May 21, 2001

•

Bacterial toxin relieves low back pain Source: Reuters Health eLine Date: May 21, 2001

•

Rofecoxib effective for treatment of chronic low back pain Source: Reuters Industry Breifing Date: April 23, 2001

•

Massage helps lingering back pain Source: Reuters Health eLine Date: April 23, 2001

•

Massage effective for persistent low back pain; acupuncture is not Source: Reuters Medical News Date: April 23, 2001 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to


233

Market Wire’s home page at http://www.marketwire.com/mw/home, type “back pain” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “back pain” (or synonyms). If you know the name of a company that is relevant to back pain, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “back pain” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “back pain” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on back pain: •

How to Avoid Back Pain. Part Three of a Three Part Series Source: Lifelong Health and Fitness. 3(4): 5. Winter 2002. Contact: Available from International Association of Physical Activity, Aging, and Sports. 706 Madison Ave., Albany, NY 12208. Fax: (518) 462-1339. Email: [email protected]. Summary: This newsletter article discusses ways to prevent low back pain. The proper method for lifting heavy objects is described and illustrated. Exercises for strengthening the lower back are also described and illustrated. Causes of back strain include being overweight, improper lifting technique, long periods of sitting or standing, and trauma. 5 figures.

•

The AHCPR Practice Guidelines for Low Back Pain Source: Bulletin on the Rheumatic Diseases. 45(2):6-8; April 1996.

234 Back Pain

Contact: Arthritis Foundation, 1314 Spring Street, NW, Atlanta, GA 30309. (404) 8727100. (404) 872-9559 (fax). Summary: This newsletter article for health professionals discusses the guidelines on low back pain developed by the Agency for Health Care Policy and Research ( AHCPR ). The composition of the 23-member multidisciplinary panel that developed these guidelines is described. The development of the guidelines is reviewed. An overview of the guidelines is presented. The guidelines include information on obtaining a patient history; performing a physical examination; educating patients about back pain; and treating back pain with bed rest, analgesics, and chiropractic techniques. In addition, treatment modalities not favored by the panel are identified. 1 reference. •

Spinal Stenosis: Low Back Pain May be Degenerative Disease Source: Mayo Clinic Women's Health Source. 5(12): 6. December 2001. Contact: Available from Mayo Clinic Women's Health Source. 200 First Street SW, Rochester, MN 55905. (800) 876-8633 or (303) 604-1465. Email: [email protected]. Summary: This newsletter article presents information on spinal stenosis to patients with low back pain. Spinal stenosis is a narrowing of the spinal canal, most often caused by osteoarthritis, resulting in back and lower leg pain. Symptoms may include pain, numbness, or tingling. Diagnosing spinal stenosis may require magenetic resonance imaging, computerized tomography, or myelography. Treatment depends upon the severity and cause of the problem and includes physical therapy, NSAIDs, and bracing. In severe cases surgery to relieve compression on the spine is performed.

•

Sensible Approach to Low Back Pain Source: Bulletin on the Rheumatic Diseases. 50(3): 1-4. 2001. Contact: Available from Arthritis Foundation. 1330 West Peachtree Street, Atlanta, GA 30309. (800) 268-6942 or (404) 872-7100. Fax (404) 872-9559. Website: www.arthritis.org. Summary: This newsletter article provides health professionals with information on the epidemiology, pathogenesis, diagnosis, clinical course, and treatment of low back pain. Although low back pain can occur at any age, it is most common between the ages of 20 and 40. Idiopathic low back pain may come from spinal structures, but in most cases the origin of the pain cannot be determined. In a minority of patients, the pain may come from the vertebral disk region. Other causes of low back pain include spinal stenosis and tumor or infection. Diagnosis is based on history, physical examination, and imaging studies such as plain radiography, computed tomography, and magnetic resonance imaging. Research suggests that pain resolves within a few weeks in most patients, but symptoms may recur in many patients with idiopathic low back pain. Relief from idiopathic back pain can be provided with regular dosing of nonsteroidal antiinflammatory drugs and use of muscle relaxants. Spinal manipulation and physical therapy may provide some benefit. Patients with disk herniation and patients with idiopathic low back pain should be treated similarly, but the latter may require narcotic analgesia for pain relief. Surgery may be needed in some patients. There is no definitive treatment for spinal stenosis because there is variable response to and limited data on the efficacy of physical therapy, NSAIDs, analgesics, and epidural steroid injections. 2 tables and 10 references.

•

What Causes Back Pain? Source: Lifelong Health and Fitness. 3(2): 1,3. Summer 2001.


235

Contact: Available from International Association of Physical Activity, Aging and Sports. The Center for the Study of Aging, Inc., 706 Madison Avenue, Albany, NY 12208-3604. (518) 465-6927. Fax (518) 462-1339. E-mail: [email protected]. Website: members.aol.com/IAPAAS. Summary: This newsletter article provides people who have back pain with information on this problem. The article begins by presenting some basic facts about the anatomy of the back and the spinal column. This is followed by a discussion of the causes of upper and lower back pain. Upper back pain is usually caused by a muscle spasm, arthritis, scoliosis, or stress fracture of the spine. Lower back pain can occur when the lumbar joint is stressed by lifting heavy objects or by a quick twisting movement or a fall. Other causes of lower back pain include a degenerative joint disease called ankylosis spondylitis, herniated or bulging disks, degenerative disk disease, muscle weakness or poor flexibility, and stress. 1 figure. •

Back Pain: The Voice of Hands-On Experience Source: Harvard Health Letter. 25(2): 3. December 1999. Contact: Available from Harvard Health Letter, P.O. Box 380, Department BI, Boston, MA 02117. (800) 829-9045 or (617) 432-1485. E-mail: [email protected]. Summary: This newsletter article uses a question and answer format to provide people who have back pain with information on its causes, diagnosis, treatment, and prevention. Causes of back pain include strained or weakened muscles and ligaments, tight muscles, abnormal alignment of vertebrae, or postural problems. Diagnosis is based on a medical history and a physical examination. X rays and other diagnostic imaging studies are reserved for patients who have trauma or who are not improving. Treatment options include taking anti-inflammatory medications and muscle relaxants, using manual therapy to improve mobility of soft tissue and spinal joints, and exercising. Preventing back pain can be achieved by changing positions frequently and improving posture.

Academic Periodicals covering Back Pain Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to back pain. In addition to these sources, you can search for articles covering back pain that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

237

APPENDICES

239

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute13: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

13

These publications are typically written by one or more of the various NIH Institutes.

240 Back Pain

•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

Physician Resources

241

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.14 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:15 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

14

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 15 See http://www.nlm.nih.gov/databases/databases.html.

242 Back Pain

•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway16 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.17 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “back pain” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 18840 763 889 109 21 20622

HSTAT18 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.19 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.20 Simply search by “back pain” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

16

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

17

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 18 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 19 20

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

Physician Resources

243

Coffee Break: Tutorials for Biologists21 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.22 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.23 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

21 Adapted 22

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 23 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

245

APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on back pain can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to back pain. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to back pain. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “back pain”:

246 Back Pain

•

Other guides Back Injuries http://www.nlm.nih.gov/medlineplus/backinjuries.html Sciatica http://www.nlm.nih.gov/medlineplus/sciatica.html Spinal Diseases http://www.nlm.nih.gov/medlineplus/spinaldiseases.html Spinal Stenosis http://www.nlm.nih.gov/medlineplus/spinalstenosis.html

Within the health topic page dedicated to back pain, the following was listed: •

General/Overview Low Back Pain: Tips on Pain Relief and Prevention Source: American Academy of Family Physicians http://familydoctor.org/healthfacts/117/ Test Your Back Health IQ Source: American Academy of Physical Medicine and Rehabilitation http://www.aapmr.org/condtreat/lbpquiz/lbpquiz.htm

•

Diagnosis/Symptoms Lower Back Pain: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/531.html

•

Treatment Back Surgery: When Is It a Good Idea? Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ00305 IDET (Intradiscal Electrothermal Annuloplasty) Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=339&topcategory=Spine Low Back Exercise Guide Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/booklet/view_exercise.cfm?Thread_ID=18&topcategory =Spine Low Back Surgery Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/booklet/thr_report.cfm?thread_id=10&topcategory=spin e Sacroiliac Injections http://www.nlm.nih.gov/medlineplus/tutorials/sacroiliacinjectionsloader.html

Patient Resources

•

247

Alternative Therapy MEDLINEplus: Chiropractic Source: National Library of Medicine http://www.nlm.nih.gov/medlineplus/chiropractic.html

•

Specific Conditions/Aspects Back Pain: Uncommon Causes Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ00297 Keeping Your Back Healthy at Work Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ00955 Lifting Techniques for Home Caregivers Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/fact/thr_report.cfm?thread_id=6&topcategory=spine Lumbar Sprain and Strain Source: American Association of Neurological Surgeons http://www.neurosurgery.org/pubpages/patres/sprainbroch.html

•

Children Backpack Safety Source: Nemours Foundation http://kidshealth.org/parent/firstaid_safe/home/backpack.html

•

Latest News Medium-firm Mattress Best for Back Pain Source: 11/14/2003, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_14686 .html

•

Men Back Pain during Pregnancy Source: North American Spine Society http://www.spine.org/articles/backpain_pregnancy.cfm Preventing Back Pain: Tips for New Moms Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=338&topcategory=Spine

•

Organizations American Academy of Orthopaedic Surgeons http://www.aaos.org/ American Chiropractic Association http://www.acatoday.com/

248 Back Pain

National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/ National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/ •

Prevention/Screening Don't Let Housework Be a Pain in Your Back Source: American Chiropractic Association http://www.amerchiro.org/media/tips/housework.shtml Exercise: A Healthy Way to Prevent Back Pain Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ00298 Maintain a Healthy Back Source: National Institutes of Health, Office of Research Services, Division of Safety http://www.nih.gov/od/ors/ds/ergonomics/wellbackhealth.html Secret of Good Posture Source: American Physical Therapy Association http://www.apta.org/Consumer/ptandyourbody/posture Taking Care of Your Back Source: American Physical Therapy Association http://www.apta.org/Consumer/ptandyourbody/back

•

Research Effectiveness of Spinal Manipulation Relative to Other Therapies for Low Back Pain Source: American College of Physicians http://www.annals.org/cgi/content/full/138/11/I-33 New Study Is Further Support for Safe Alternatives to Drugs Source: American Chiropractic Association http://www.amerchiro.org/media/releases/060203.shtml Self-Management Program Lessens Back Pain Symptoms for Inner City Patients Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/ne/highlights/spotlight/2003/backpain.htm

•

Women Back Pain during Pregnancy Source: North American Spine Society http://www.spine.org/articles/backpain_pregnancy.cfm Preventing Back Pain: Tips for New Moms Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=338&topcategory=Spine

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the

Patient Resources

249

exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on back pain. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Low Back Pain: A Self-Care Guide Source: San Bruno, CA: StayWell Company. 1999. 16 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This booklet provides people who have back pain with information on the causes and treatment of low back pain. Causes include lifting improperly, making sudden moves, and falling. Common back problems include muscle strains or sprains, disk problems, or nerve problems. During the first few days, relief from back pain can be obtained by applying ice to the area of the back that hurts the most, taking over the counter medications, and applying heat to the sore area. In addition, moving around after a day or so of bed rest is important to resolving back pain. The pelvic tilt is one exercise that loosens tight muscles and helps relieve pain. Gentle stretching exercises help reduce tightness. Floor exercises such as the back extension, back rotation, and partial sit up can stretch and strengthen the lower back and stomach. Maintaining one's routine and making long-term lifestyle changes are also important to relieving back pain. The booklet presents tips on making daily actions such as dressing, brushing one's teeth or shaving, and standing a little easier. The booklet also explains the proper body mechanics involved in getting out of bed, getting out of a car, lifting, and sitting. In addition, the booklet presents the warning signs of the need for medical attention and outlines the elements of a personal action plan.

•

Back Pain During Pregnancy: A Self-Help Program for Relief Source: San Bruno, CA: StayWell Company. 1999. 16 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This booklet provides pregnant women with information on back pain. Almost every part of the body, including the spine and muscles, is affected during pregnancy. Causes of back pain during pregnancy include poor posture and the loosening of the pelvic joints. Good posture decreases back pain by reducing strain on muscles and joints. The booklet explains how to maintain good posture while standing, sitting, sleeping, and relaxing. The booklet then offers tips on moving safely while getting out of bed, bending down, pushing, lifting, standing up, reaching, and turning.

250 Back Pain

In addition, the booklet presents exercises that pregnant women can perform to help reduce back pain, including the pelvic tilt, neck and shoulder stretch, low back stretch, stomach strengthener, hamstring stretch, and wall slide. Other topics include easing back pain by using self care methods, such as applying ice or heat to the painful area and massaging the inflamed area, and improving physical fitness by exercising, eating properly, and relaxing. •

Your Orthopaedist Says Lift It Safe! Prevent Back Pain Source: Chicago, IL: American Academy of Orthopaedic Surgeons. 1993. 8 p. Contact: Available from American Academy of Orthopaedic Surgeons (AAOS). P.O. Box 75838, Chicago, IL 60675-5838. (800) 626-6726. Fax (for credit card or institutional purchase orders) (800) 823-8025. http://www.aaos.org. PRICE: Single copy free; bulk prices available. Summary: This brochure explains for the general public the proper methods of lifting and moving objects to prevent back pain, as well as noting for caregivers the proper way to help an ill or injured person sit up in bed, stand up, or sit down. The brochure also lists risk factors for back pain, offers tips for staying in good physical shape to reduce the risk of low back pain, and presents guidelines for preventing back pain. 11 illustrations.

•

Back Pain Source: Atlanta, GA: Arthritis Foundation. 1997. 20 p. Contact: Available from Arthritis Foundation. P.O. Box 1616, Alpharetta, GA 300091616. (800) 207-8633. Fax (credit card orders only) (770) 442-9742. http://www.arthritis.org. PRICE: Single copy free from local Arthritis Foundation chapter (call 800-283-7800 for closest local chapter); bulk orders may be purchased from address above. Summary: This brochure for people with back pain uses a question and answer format to provide information on the causes, diagnosis, and treatment of this common health problem. It explains back pain, which can occur at any age in both men and women, and how it is one of the leading causes of disability. The brochure describes the forms of back pain, and the structure of the back, as well as some of the causes of back pain and factors that may aggravate it. Further, the brochure explains how back pain is evaluated on the basis of the medical history, a physical examination, and diagnostic tests. Treatments are also discussed, including medication, heat, changes in lifestyle, spinal manipulation, and surgery. Information on the Arthritis Foundation and its services is provided as well. 5 figures.

•

Low Back Pain Rehabilitation Source: Chicago, IL: American Academy of Physical Medicine and Rehabilitation. 1995. 6 p. Contact: Available from American Academy of Physical Medicine and Rehabilitation. One IBM Plaza, Suite 2500, Chicago, IL 60611-3604. (312) 464-9700. Fax (312) 464-0227. http://www.aapmr.org. PRICE: Single copy free. Summary: This brochure for people with low back pain focuses on low back pain rehabilitation. It identifies the kinds of problems that might cause low back pain, explains the role of the physiatrist in diagnosing and treating musculoskeletal problems,

Patient Resources

251

and highlights the three phases of treatment: treating pain and inflammation, developing flexibility and strength to return the body parts to their proper positions, and taking steps to minimize recurrence of the problem and to prevent further injury. •

Self-Care for Low Back Pain Source: San Bruno, CA: StayWell Company. 1995. 6 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This brochure provides information on self care for low back pain. Low back pain may be caused by injured muscles, ligaments, or disks in the back. Immediate pain may be relieved by resting for a day or two to give the back a chance to begin healing; using cold and heat to reduce pain; exercising for strength and flexibility; and learning to move, lift, and sit properly. The brochure provides a checklist so that people can determine when self care is appropriate and when a physician is needed to treat back pain.

•

Lower Back Pain in Athletes Source: American Orthopaedic Society for Sports Medicine. 2000. 2 p. Contact: Available from American Orthopedic Society for Sports Medicine. 6300 North River Road, Suite 500, Rosemont, IL 60018. (847) 292-4900. Fax: (847) 292-4908. Website: http://www.sportsmed.org. Summary: This fact sheet discusses causes and diagnosis of low back pain in athletes. Low back pain may be caused by stress fractures and herniated and bulging discs. Injured muscle can also cause pain. Back injuries may be caused by improper warmup and conditioning, twisting movements, and repetitive or excessive loads on the back. Xrays are used to identify fractures, arthritis, and slippage. MRI's assess degeneration, bulging, and herniated discs. Bone scans are used for assessing stress fractures. Lower back pain is most commonly caused by muscle injury, tears or sprain of the annulus that may be accompanied by sciatica, and bulging and herniated discs. Proper warm up and attention to body mechanics will help prevent lower back injuries.

•

Backpack Misuse Leads to Chronic Back Pain Source: American Chiropractic Association. 2003. 2 p. Contact: Available from American Chiropractic Association. 1701 Clarendon Blvd Arlington, VA 22209. (800) 986-4636. Fax: (703) 243-2593. Website: www.amerchiro.org. Summary: This fact sheet discusses the problem of injuries in children due to improper backpack use. Research suggests that children are experiencing back pain from an early age and that this is due to carrying heavy backpacks. Carrying backpacks over one shoulder and carrying more than 10 percent of the child's body weight are resulting in pain and curvature of the spine and exacerbating scoliosis. To help reduce back pain parents should make sure the backpack weighs no more than 5 to 10 percent of the child's bodyweight, never hangs lower than four inches below the waist, and has individual compartments; that the child use both shoulder straps to balance the load and that the straps are padded; ensure pointed or bulky items don't rest directly on the back; limit use of rollerpacks; and consider specially designed ergonomic back packs.

252 Back Pain

•

Coping With Back Pain Source: Journal of the American Medical Association. JAMA. 284(21): 2826. December 6, 2000. Contact: Available also online from American Medical Association at www.amaassn.org/consumer.htm. Summary: This fact sheet provides people who have back pain with information on its possible causes and treatment. Common causes include stretched or strained back muscles, injuries, herniated disks, osteoporosis, overweight, bad posture, and pregnancy. Ways to ease back pain include lying flat on the back with the knees raised for short periods, combining limited rest with gentle exercise, and taking nonprescription or prescription painkillers. The fact sheet also suggests ways people can protect their back when lifting, lists ways to prevent back pain, presents symptoms that require consultation with a doctor, and identifies sources of additional information. 2 figures.

•

Back Pain During Pregnancy: What To Expect While You're Expecting Source: LaGrange, IL: North American Spine Society (NASS). 2001. 1 p. Contact: Available from North American Spine Society. For bulk orders write to: NASS, Dept 77-6663, Chicago, IL 60678-6663. For single copies write to: NASS, 22 Calendar Court, 2nd Floor, LaGrange, IL 60525. (877) SPINE-DR. Fax (708) 588-1080. E-Mail: [email protected]. Website: www.spine.org. PRICE: Tear-off pads of 25 for $15.00 (members) or $20.00 (nonmembers); single copy free (send self-addressed, stamped envelope). Summary: This full color handout provides pregnant women with information on back pain during pregnancy. Back pain develops during pregnancy because of added weight and the carriage of this added weight in the front of the body. Ways to minimize the discomfort include maintaining a regular exercise program, lifting objects with the leg muscles and not the back muscles, carrying several smaller objects rather than one large object, and placing a pillow under or between the knees when sleeping. Options for dealing with back pain related to pregnancy include learning exercises to support the muscles of the back and pelvis, using supportive garments, and using spot treatments such as heat and cold.

•

Back Pain Risk Scale Source: LaGrange, IL: North American Spine Society (NASS). 2001. 1 p. Contact: Available from North American Spine Society. For bulk orders write to: NASS, Dept 77-6663, Chicago, IL 60678-6663. For single copies write to: NASS, 22 Calendar Court, 2nd Floor, LaGrange, IL 60525. (877) SPINE-DR. Fax (708) 588-1080. E-Mail: [email protected]. Website: www.spine.org. PRICE: Tear-off pads of 25 for $15.00 (members) or $20.00 (nonmembers); single copy free (send self-addressed, stamped envelope). Summary: This full color handout provides the general public with a quiz that can be used to assess back pain risk. The quiz asks readers their age, whether they smoke, whether they are overweight, how often they exercise, how often they lift heavy objects, and whether they have already experienced back pain. The handout informs readers that back pain affects the majority of people over the age of 30 at some point in their lives; smoking, being overweight, and lifting heavy objects contribute to the potential

Patient Resources

253

for back pain; regular exercise can help prevent back pain; and people who have already experienced back pain have a greater chance of it returning. •

Seven Back Pain Warning Signs Source: LaGrange, IL: North American Spine Society (NASS). 2001. 1 p. Contact: Available from North American Spine Society. For bulk orders write to: NASS, Dept 77-6663, Chicago, IL 60678-6663. For single copies write to: NASS, 22 Calendar Court, 2nd Floor, LaGrange, IL 60525. (877) SPINE-DR. Fax (708) 588-1080. E-Mail: [email protected]. Website: www.spine.org. PRICE: Tear-off pads of 25 for $15.00 (members) or $20.00 (nonmembers); single copy free (send self-addressed, stamped envelope). Summary: This full color handout uses a question and answer format to provide people who have back pain with information on the warning signs of spinal problems. The handout answers questions about the occurrence of low back pain that extends down the leg, an increase in pain if the knee is lifted to the chest or the person bends over, the occurrence of severe back pain following a recent fall or back pain lasting more than 3 weeks, and the presence of back pain that becomes worse at rest. Other questions deal with persistent bladder and bowel problems and numbness or weakness in the legs while walking.

•

Lumbar Disk Surgery: Treating Low Back Pain and Sciatica Source: San Bruno, CA: StayWell Company. 2000. 8 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This illustrated booklet provides people who have low back pain and sciatica with information on disk surgery. Although a conservative treatment plan may relieve pain in some people, others may need surgery. The booklet describes the anatomy and function of the lower back and explains how disk problems cause pain. This is followed by a discussion of the medical examination, focusing on the medical history, the physical examination, and diagnostic tests. The booklet then describes various types of disk surgery, including classic diskectomy, microdiskectomy, and percutaneous diskectomy. In addition, the booklet offers guidelines on recovering from back surgery, focusing on undergoing physical therapy, using proper body mechanics, exercising regularly, and obtaining followup care. 13 figures.

•

Low Back Pain: What To Expect Source: American Family Physician. 60(5): 2307-2308. November 15, 1999. Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. E-mail: [email protected]. Website: www.aafp.org. Summary: This information sheet uses a question and answer format to provide people who have low back pain with information on the causes and treatment of this common problem. The most common causes of low back pain are muscle strains and spasms, osteoarthritis, and sciatica. Back pain usually resolves within 2 to 4 weeks with conservative therapy that includes the use of over the counter pain relievers, the application of ice in the first 24 hours and heat on the following day, and a gradual

254 Back Pain

return to normal activities. The article also lists warning signs people with low back pain should look for. 2 figures. •

Study Guide: Primary Care Approach to Low Back Pain Source: Physician Assistant. 24(11): 43-44. November 2000. Summary: This journal article provides health professionals with a summary of the major points of an article on the primary care approach to low back pain. The article presents key points concerning the differential diagnosis of back pain, the features of simple back pain, the risk factors for simple back pain, and the treatment of simple mechanical pain. The article also outlines key points about the etiology and physical features of more serious back pain; the physical features and treatment of ruptured disks, spinal stenosis, and cauda equina syndrome; and the history, workup, and treatment of people with nonmechanical pain. Highlights are also presented with regard to imaging studies and low back pain in children.

•

Using Ice Therapy To Ease Low Back Pain Source: Patient Care. 34(6): 50. March 30, 2000. Summary: This journal article provides people who have low back pain with guidelines on using ice therapy safely to ease low back pain. Guidelines include keeping one ice pack in the freezer while one is being used, keeping at least one layer of cloth between the skin and the ice pack, applying the ice pack using light pressure, using the ice pack for about 25 minutes, taking a 10-minute break between icing sessions, repeating the icing sessions at least 4 times a day, and using the ice pack for 20 to 30 minutes twice daily while at work. People who have Raynaud's phenomenon, severe peripheral vascular disease, or other cold sensitivity should consult with their doctor before using ice packs. In addition, the article explains how to make ice packs.

•

Acute Low Back Pain Source: American Family Physician. 61(6): 1789-1790. March 15, 2000. Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. E-mail: [email protected]. Website: www.aafp.org. Summary: This journal article uses a question and answer format to provide people who have acute low back pain with information on the causes, treatment, and prevention of this ailment. Low back pain is most often caused by a stretched or strained muscle. Other causes include a bulging herniated or ruptured disc, arthritis in the spine, and narrowing of the spinal canal. Although low back pain is rarely a sign of serious illness, signs that indicate the need for professional care include back pain accompanied by a fever, weight loss without dieting, pain that is worse when lying still, or bowel or bladder control problems. Treatment options include avoiding activities that make the pain worse, using muscle relaxants, and putting heat or ice on the painful area. Several stretching exercises can be helpful in the healing process. Ways of preventing low back pain include being in shape, losing excess weight, using good posture, and lifting and carrying objects using appropriate techniques.

•

Low Back Pain Source: Rosemont, IL: American Academy of Orthopaedic Surgeons. 1996. 8 p.

Patient Resources

255

Contact: American Academy of Orthopaedic Surgeons, 6300 North River Road, Rosemont, IL 60018-4262. (847) 823-7186. (800) 346-AAOS. (800) 824-BONES. (800) 6266726. (847) 823-8125 (fax). Summary: This pamphlet for individuals with low back pain uses a question-andanswer format to provide an overview of low back pain. Questions concern what structures comprise the lower back; why low back pain is a common problem; how low back pain is diagnosed; and what factors cause low back pain, including sprains and strains, age, osteoporosis and fractures, and protruding disk. Additional questions deal with the best treatment for low back pain, reasons for surgical intervention, and the prevention of low back pain. •

Patient Education Guide: Exercises for Low Back Pain and Stiffness Source: Journal of Musculoskeletal Medicine. 18(3): 166. March 2001. Summary: This patient education guide provides people who have back discomfort with exercises that relieve low back pain and stiffness. Moderate exercise helps keep the back muscles toned and flexible. Exercises illustrated are the knee to shoulder and flat back exercises. The guide includes space for recording special patient instructions. 5 figures. The National Guideline Clearinghouse™

The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “back pain” (or synonyms). The following was recently posted: •

ACR Appropriateness Criteria for acute low back pain--radiculopathy Source: American College of Radiology - Medical Specialty Society; 1996 (revised 1999); 7 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2441&nbr=1667&a mp;string=back+AND+pain

•

Adult low back pain Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1994 June (revised 2002 Sep); 61 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3498&nbr=2724&a mp;string=back+AND+pain

•

Guideline for hospitalization for low back pain Source: Washington State Department of Labor and Industries - State/Local Government Agency [U.S.]; 1999; 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1891&nbr=1117&a mp;string=back+AND+pain

256 Back Pain

•

Low back pain or sciatica in the primary care setting Source: Department of Defense - Federal Government Agency [U.S.]; 1999 May; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=2578&nbr=1804&a mp;string=back+AND+pain

•

Review of the literature on spinal ultrasound for the evaluation of back pain and radicular disorders. Source: American Academy of Neurology - Medical Specialty Society; 1998 May 16; 2 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1447&nbr=655&am p;string=back+AND+pain

•

Unremitting low back pain. In: North American Spine Society phase III clinical guidelines for multidisciplinary spine care specialists Source: North American Spine Society - Medical Specialty Society; 2000; 96 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2805&nbr=2031&a mp;string=back+AND+pain Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Back Pain Summary: A general overview of back pain that includes a description and information about treatment, prognosis and research. Source: National Institute of Neurological Disorders and Stroke, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2897

•

Back Pain in Children - a Common Clinical Problem in Children Summary: This clinical tool for health care professionals addresses diagnostic algorithm for the workup of a child with back pain; the differential diagnosis for children with back pain and the imaging Source: Educational Institution--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4455

Patient Resources

•

257

Low Back Pain Source: American Academy of Orthopaedic Surgeons http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7421

•

Preventing Back Pain at Work and at Home Source: American Academy of Orthopaedic Surgeons http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7408

•

Sciatica (Back Pain) Summary: If you suddenly start feeling pain in your lower back or hip that radiates down from your buttock to the back of one thigh and into your leg, your problem may be a protruding disk in your lower spinal Source: American Academy of Orthopaedic Surgeons http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7109

•

Tackling Low Back Pain Summary: healthfinder® — your guide to reliable health information health library just for you health care organizations search: go help | about healthfinder® Tackling Low Back Source: American Occupational Therapy Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7332

•

What to Do When Your Back Is in Pain Summary: This consumer health information article discusses back pain, back care, chronic pain and pain management. Source: U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3593 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to back pain. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.

258 Back Pain

Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •


•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Associations and Back Pain The following is a list of associations that provide information on and resources relating to back pain: •

Back Pain Association of America, Inc Telephone: (410) 255-3633 Fax: (410) 255-7338 Email: [email protected] Background: The Back Pain Association of America, Inc. (BPAA) is a national nonprofit organization dedicated to providing information and support to people who are affected by back and neck pain, their family members, friends, and health care professionals. Established in 1991 and consisting of nearly 4,000 members, BPAA offers programs and information to help affected individuals learn more about their spinal disorders and ways to cope with them. The organization also has a program to help individuals prevent back injuries. BPAA publishes a self-titled quarterly newsletter that helps readers stay informed of updated information and new forms of treatment. The organization s 'Friends Across America' networking program enables affected individuals to exchange information and support via telephone. BPAA also has a physician referral service as well as an information service for physicians who treat back and neck pain. In addition, the Association also promotes research and offers a variety of fact sheets including 'The Relationship Between Nerve Damage and Leg Pain,' 'Urinary Problems and Diseases of the Spine,' 'Arachnoiditis, Questions and Answers,' and 'A Guide to Abdominal and Stretching Exercises.'. Relevant area(s) of interest: Back Pain

•

National Back Pain Association (BackCare, the Charity for HealthierBacks) Telephone: 440181 977 5474 Fax: 440181 943 5318 Email: [email protected] Web Site: http://www.backpain.org.uk

Patient Resources

259

Background: The National Back Pain Association (NBPA) is a registered British charity dedicated to providing information and support to people who are affected by back pain, their family members, and health care professionals. Established in 1968 and consisting of 6,000 members, the Association stives to fulfill its mission is to fund patient oriented research into the causes and treatment of back pain; educate people to use their bodies sensibly and thus reduce the incidence of back pain; and help form and support branches through which individuals affected by back pain and those who care for them can receive information, advice, and mutual help. NBPA organizes the annual National Back Pain Week to raise awareness of the causes and ways of preventing back injury. Publications include a regular newsletter, educational pamphlet series, videos, and books geared both toward individuals experiencing back pain and their caregivers. Relevant area(s) of interest: Back Pain

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to back pain. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with back pain. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about back pain. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “back pain” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information.

260 Back Pain

The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “back pain”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “back pain” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “back pain” (or a synonym) into the search box, and click “Submit Query.”

261

APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.24

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

24

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

262 Back Pain

libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)25: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

25

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries

263

•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

264 Back Pain

•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

265

•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

266 Back Pain

•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

267

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on back pain: •

Basic Guidelines for Back Pain Back pain - low Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003108.htm

•

Signs & Symptoms for Back Pain Coughing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003072.htm Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm Muscle aches Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003178.htm Muscle spasm Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm

268 Back Pain

Muscle spasms Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Muscle strain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Numbness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Swelling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003103.htm Upset stomach Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm •

Diagnostics and Tests for Back Pain CT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003330.htm CT of lumbosacral spine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003787.htm MRI of lumbosacral spine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003793.htm Myelogram Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003807.htm X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003337.htm

•

Background Topics for Back Pain Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm Pulled muscle Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000042.htm Strain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000042.htm

Online Glossaries 269

Traction Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002336.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

271

BACK PAIN DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Ablate: In surgery, is to remove. [NIH] Ablation: The removal of an organ by surgery. [NIH] Abrasion: 1. The wearing away of a substance or structure (such as the skin or the teeth) through some unusual or abnormal mechanical process. 2. An area of body surface denuded of skin or mucous membrane by some unusual or abnormal mechanical process. [EU] Abscess: Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. [NIH] Absenteeism: Chronic absence from work or other duty. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Acuity: Clarity or clearness, especially of the vision. [EU] Acupuncture Points: Designated locations along nerves or organ meridians for inserting acupuncture needles. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adhesions: Pathological processes consisting of the union of the opposing surfaces of a wound. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology,

272 Back Pain

nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adjuvant Therapy: Treatment given after the primary treatment to increase the chances of a cure. Adjuvant therapy may include chemotherapy, radiation therapy, or hormone therapy. [NIH]

Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerobic Exercise: A type of physical activity that includes walking, jogging, running, and dancing. Aerobic training improves the efficiency of the aerobic energy-producing systems that can improve cardiorespiratory endurance. [NIH] Aeroembolism: Joint pains, respiratory distress, and central nervous system symptoms which may follow decompression after exposure to air or other gas mixture at a pressure greater than the normal atmospheric pressure. [NIH] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Aggravation: An increasing in seriousness or severity; an act or circumstance that intensifies, or makes worse. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU]

Dictionary 273

Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Allergen: An antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Aminopeptidases: A subclass of exopeptidases that act on the free N terminus end of a polypeptide liberating a single amino acid residue. EC 3.4.11. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Amylase: An enzyme that helps the body digest starches. [NIH] Amyloidosis: A group of diseases in which protein is deposited in specific organs (localized amyloidosis) or throughout the body (systemic amyloidosis). Amyloidosis may be either primary (with no known cause) or secondary (caused by another disease, including some types of cancer). Generally, primary amyloidosis affects the nerves, skin, tongue, joints, heart, and liver; secondary amyloidosis often affects the spleen, kidneys, liver, and adrenal glands. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anaphylactic: Pertaining to anaphylaxis. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU]

274 Back Pain

Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Anisotropy: A physical property showing different values in relation to the direction in or along which the measurement is made. The physical property may be with regard to thermal or electric conductivity or light refraction. In crystallography, it describes crystals whose index of refraction varies with the direction of the incident light. It is also called acolotropy and colotropy. The opposite of anisotropy is isotropy wherein the same values characterize the object when measured along axes in all directions. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Ankle Injuries: Harm or hurt to the ankle or ankle joint usually inflicted by an external source. [NIH] Ankle Joint: The joint that is formed by the inferior articular and malleolar articular surfaces of the tibia, the malleolar articular surface of the fibula, and the medial malleolar, lateral malleolar, and superior surfaces of the talus. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anorexia Nervosa: The chief symptoms are inability to eat, weight loss, and amenorrhea. [NIH]

Anterograde: Moving or extending forward; called also antegrade. [EU] Antiallergic: Counteracting allergy or allergic conditions. [EU] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Anticonvulsants: Drugs used to prevent seizures or reduce their severity. [NIH]

Dictionary 275

Antidepressant: A drug used to treat depression. [NIH] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Antitussive: An agent that relieves or prevents cough. [EU] Anuria: Inability to form or excrete urine. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiety Disorders: Disorders in which anxiety (persistent feelings of apprehension, tension, or uneasiness) is the predominant disturbance. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Aortic Aneurysm: Aneurysm of the aorta. [NIH] Aperture: A natural hole of perforation, especially one in a bone. [NIH] Apnea: A transient absence of spontaneous respiration. [NIH] Aponeurosis: Tendinous expansion consisting of a fibrous or membranous sheath which serves as a fascia to enclose or bind a group of muscles. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arthralgia: Pain in the joint. [NIH] Arthrosis: A disease of a joint. [EU] Articular: Of or pertaining to a joint. [EU]

276 Back Pain

Aseptic: Free from infection or septic material; sterile. [EU] Aspartate: A synthetic amino acid. [NIH] Aspiration: The act of inhaling. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Axonal: Condition associated with metabolic derangement of the entire neuron and is manifest by degeneration of the distal portion of the nerve fiber. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Back Injuries: General or unspecified injuries to the posterior part of the trunk. It includes injuries to the muscles of the back. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH]

Dictionary 277

Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Bed Rest: Confinement of an individual to bed for therapeutic or experimental reasons. [NIH] Bends: The form of aeroembolism that is marked by intense pain in muscles and joints due to formation of gas bubbles in the tissues. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benztropine: A centrally active muscarinic antagonist that has been used in the symptomatic treatment of Parkinson's disease. Benztropine also inhibits the uptake of dopamine. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Bioengineering: The application of engineering principles to the solution of biological problems, for example, remote-handling devices, life-support systems, controls, and displays. [NIH] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biomechanics: The study of the application of mechanical laws and the action of forces to living structures. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bipolar Disorder: A major affective disorder marked by severe mood swings (manic or major depressive episodes) and a tendency to remission and recurrence. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH]

278 Back Pain

Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone Remodeling: The continuous turnover of bone matrix and mineral that involves first, an increase in resorption (osteoclastic activity) and later, reactive bone formation (osteoblastic activity). The process of bone remodeling takes place in the adult skeleton at discrete foci. The process ensures the mechanical integrity of the skeleton throughout life and plays an important role in calcium homeostasis. An imbalance in the regulation of bone remodeling's two contrasting events, bone resorption and bone formation, results in many of the metabolic bone diseases, such as osteoporosis. [NIH] Bone Resorption: Bone loss due to osteoclastic activity. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Botulinum Toxins: Toxins produced by Clostridium botulinum. There are at least seven different substances, most being proteins. They have neuro-, entero-, and hemotoxic properties, are immunogenic, and include the most potent poisons known. The most commonly used apparently blocks release of acetylcholine at cholinergic synapses. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Bronchoconstriction: Diminution of the caliber of a bronchus physiologically or as a result of pharmacological intervention. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Bupivacaine: A widely used local anesthetic agent. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic

Dictionary 279

weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium Channels: Voltage-dependent cell membrane glycoproteins selectively permeable to calcium ions. They are categorized as L-, T-, N-, P-, Q-, and R-types based on the activation and inactivation kinetics, ion specificity, and sensitivity to drugs and toxins. The L- and T-types are present throughout the cardiovascular and central nervous systems and the N-, P-, Q-, & R-types are located in neuronal tissue. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Cannula: A tube for insertion into a duct or cavity; during insertion its lumen is usually occupied by a trocar. [EU] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capsaicin: Cytotoxic alkaloid from various species of Capsicum (pepper, paprika), of the Solanaceae. [NIH] Capsicum: A genus of Solanaceous shrubs that yield capsaicin. Several varieties have sweet or pungent edible fruits that are used as vegetables when fresh and spices when the pods are dried. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Carpal Tunnel Syndrome: A median nerve injury inside the carpal tunnel that results in

280 Back Pain

symptoms of pain, numbness, tingling, clumsiness, and a lack of sweating, which can be caused by work with certain hand and wrist postures. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Catheters: A small, flexible tube that may be inserted into various parts of the body to inject or remove liquids. [NIH] Cathode: An electrode, usually an incandescent filament of tungsten, which emits electrons in an X-ray tube. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Cauda Equina: The lower part of the spinal cord consisting of the lumbar, sacral, and coccygeal nerve roots. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Cellular metabolism: The sum of all chemical changes that take place in a cell through which energy and basic components are provided for essential processes, including the synthesis of new molecules and the breakdown and removal of others. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary

Dictionary 281

process. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemokines: Class of pro-inflammatory cytokines that have the ability to attract and activate leukocytes. They can be divided into at least three structural branches: C (chemokines, C), CC (chemokines, CC), and CXC (chemokines, CXC), according to variations in a shared cysteine motif. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest cavity: Space in body surrounding the lungs. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chiropractic: A system of treating bodily disorders by manipulation of the spine and other parts, based on the belief that the cause is the abnormal functioning of a nerve. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Cholinesterase Inhibitors: Drugs that inhibit cholinesterases. The neurotransmitter acetylcholine is rapidly hydrolyzed, and thereby inactivated, by cholinesterases. When cholinesterases are inhibited, the action of endogenously released acetylcholine at cholinergic synapses is potentiated. Cholinesterase inhibitors are widely used clinically for their potentiation of cholinergic inputs to the gastrointestinal tract and urinary bladder, the eye, and skeletal muscles; they are also used for their effects on the heart and the central nervous system. [NIH] Choroid: The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH]

282 Back Pain

Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic Fatigue Syndrome: Fatigue caused by the combined effects of different types of prolonged fatigue. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Chymopapain: A cysteine endopeptidase isolated from papaya latex. Preferential cleavage at glutamic and aspartic acid residues. EC 3.4.22.6. [NIH] Cicatrix: The formation of new tissue in the process of wound healing. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Civilization: The distinctly human attributes and attainments of a particular society. [NIH] Claudication: Limping or lameness. [EU] Clavicle: A long bone of the shoulder girdle. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup

Dictionary 283

characteristics. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colloidal: Of the nature of a colloid. [EU] Colostomy: An opening into the colon from the outside of the body. A colostomy provides a new path for waste material to leave the body after part of the colon has been removed. [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such

284 Back Pain

as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Concentric: Having a common center of curvature or symmetry. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Cones: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide sharp central vision and color vision. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constitutional: 1. Affecting the whole constitution of the body; not local. 2. Pertaining to the constitution. [EU] Constriction: The act of constricting. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH]

Dictionary 285

Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Conventional therapy: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional treatment. [NIH] Conventional treatment: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Angiography: Radiography of the vascular system of the heart muscle after injection of a contrast medium. [NIH] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer. [NIH] Cost-benefit: A quantitative technique of economic analysis which, when applied to radiation practice, compares the health detriment from the radiation doses concerned with the cost of radiation dose reduction in that practice. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH]

286 Back Pain

Credentialing: The recognition of professional or technical competence through registration, certification, licensure, admission to association membership, the award of a diploma or degree, etc. [NIH] Curare: Plant extracts from several species, including Strychnos toxifera, S. castelnaei, S. crevauxii, and Chondodendron tomentosum, that produce paralysis of skeletal muscle and are used adjunctively with general anesthesia. These extracts are toxic and must be used with the administration of artificial respiration. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyst: A sac or capsule filled with fluid. [NIH] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cystocele: Fallen bladder. When the bladder falls or sags from its normal position down to the pelvic floor, it can cause either urinary leakage or urinary retention. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. [NIH] Decompression: Decompression external to the body, most often the slow lessening of external pressure on the whole body (especially in caisson workers, deep sea divers, and persons who ascend to great heights) to prevent decompression sickness. It includes also sudden accidental decompression, but not surgical (local) decompression or decompression applied through body openings. [NIH] Decompression Sickness: A condition occurring as a result of exposure to a rapid fall in ambient pressure. Gases, nitrogen in particular, come out of solution and form bubbles in body fluid and blood. These gas bubbles accumulate in joint spaces and the peripheral circulation impairing tissue oxygenation causing disorientation, severe pain, and potentially death. [NIH] Decubitus: An act of lying down; also the position assumed in lying down. [EU] Defense Mechanisms: Unconscious process used by an individual or a group of individuals in order to cope with impulses, feelings or ideas which are not acceptable at their conscious level; various types include reaction formation, projection and self reversal. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or

Dictionary 287

involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. [NIH] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Desipramine: A tricyclic dibenzazepine compound that potentiates neurotransmission. Desipramine selectively blocks reuptake of norepinephrine from the neural synapse, and also appears to impair serotonin transport. This compound also possesses minor anticholingeric activity, through its affinity to muscarinic receptors. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Retinopathy: Retinopathy associated with diabetes mellitus, which may be of the background type, progressively characterized by microaneurysms, interretinal punctuate macular edema, or of the proliferative type, characterized by neovascularization of the retina and optic disk, which may project into the vitreous, proliferation of fibrous tissue, vitreous hemorrhage, and retinal detachment. [NIH] Diagnostic Imaging: Any visual display of structural or functional patterns of organs or tissues for diagnostic evaluation. It includes measuring physiologic and metabolic responses to physical and chemical stimuli, as well as ultramicroscopy. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diclofenac: A non-steroidal anti-inflammatory agent (NSAID) with antipyretic and analgesic actions. It is primarily available as the sodium salt, diclofenac sodium. [NIH] Diclofenac Sodium: The sodium form of diclofenac. It is used for its analgesic and antiinflammatory properties. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH]

288 Back Pain

Dilatation: The act of dilating. [NIH] Diphenhydramine: A histamine H1 antagonist used as an antiemetic, antitussive, for dermatoses and pruritus, for hypersensitivity reactions, as a hypnotic, an antiparkinson, and as an ingredient in common cold preparations. It has some undesired antimuscarinic and sedative effects. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discitis: Inflammation of an intervertebral disk or disk space which may lead to disk erosion. Until recently, discitis has been defined as a nonbacterial inflammation and has been attributed to aseptic processes (e.g., chemical reaction to an injected substance). However, recent studies provide evidence that infection may be the initial cause, but perhaps not the promoter, of most cases of discitis. Discitis has been diagnosed in patients following discography, myelography, lumbar puncture, paravertebral injection, and obstetrical epidural anesthesia. Discitis following chemonucleolysis (especially with chymopapain) is attributed to chemical reaction by some and to introduction of microorganisms by others. [NIH] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Diskectomy: Excision, in part or whole, of an intervertebral disk. The most common indication is disk displacement or herniation. In addition to standard surgical removal, it can be performed by percutaneous diskectomy or by laparoscopic diskectomy, the former being the more common. [NIH] Dislocation: The displacement of any part, more especially of a bone. Called also luxation. [EU]

Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dorsum: A plate of bone which forms the posterior boundary of the sella turcica. [NIH] Double-blinded: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH]

Dictionary 289

Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord; called also pachymeninx. [EU] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Dysmenorrhea: Painful menstruation. [NIH] Dysphoric: A feeling of unpleasantness and discomfort. [NIH] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Effector cell: A cell that performs a specific function in response to a stimulus; usually used to describe cells in the immune system. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electric Conductivity: The ability of a substrate to allow the passage of electrons. [NIH] Electroacupuncture: A form of acupuncture using low frequency electrically stimulated needles to produce analgesia and anesthesia and to treat disease. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolysis: Destruction by passage of a galvanic electric current, as in disintegration of a chemical compound in solution. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH]

290 Back Pain

Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Elementary Particles: Individual components of atoms, usually subatomic; subnuclear particles are usually detected only when the atomic nucleus decays and then only transiently, as most of them are unstable, often yielding pure energy without substance, i.e., radiation. [NIH] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocardium: The innermost layer of the heart, comprised of endothelial cells. [NIH] Endophthalmitis: Suppurative inflammation of the tissues of the internal structures of the eye; not all layers of the uvea are affected. Fungi, necrosis of intraocular tumors, and retained intraocular foreign bodies often cause a purulent endophthalmitis. [NIH] Endorphin: Opioid peptides derived from beta-lipotropin. Endorphin is the most potent naturally occurring analgesic agent. It is present in pituitary, brain, and peripheral tissues. [NIH]

Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endotoxin: Toxin from cell walls of bacteria. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH]

Dictionary 291

Enkephalin: A natural opiate painkiller, in the hypothalamus. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epidural Space: Space between the dura mater and the walls of the vertebral canal. [NIH] Epiretinal Membrane: Membrane viruses are thought to acquire their envelopes by budding through modified portions of the host cell membrane. [NIH] Episode of Care: An interval of care by a health care facility or provider for a specific medical problem or condition. It may be continuous or it may consist of a series of intervals marked by one or more brief separations from care, and can also identify the sequence of care (e.g., emergency, inpatient, outpatient), thus serving as one measure of health care provided. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Ergonomics: Study of the relationships between man and machines; adjusting the design of machines to the need and capacities of man; study of the effect of machines on man's behavior. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Escalation: Progressive use of more harmful drugs. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Excrete: To get rid of waste from the body. [NIH] Exercise Therapy: Motion of the body or its parts to relieve symptoms or to improve function, leading to physical fitness, but not physical education and training. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Exopeptidases: A sub-subclass of peptide hydrolases that act only near the ends of polypeptide chains. Exopeptidases are further divided into aminopeptidases, EC 3.4.11; dipeptidases, EC 3.4.13; dipeptidyl peptidases & tripeptidyl peptidases, EC 3.4.14; peptidyldipeptidases, EC 3.4.15; carboxypeptidases, EC 3.4.16 - EC 3.4.18, and omega peptidases, EC 3.4.19. EC 3.4.-. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU]

292 Back Pain

Extensor: A muscle whose contraction tends to straighten a limb; the antagonist of a flexor. [NIH]

External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fetal Weight: The weight of the fetus in utero, which is usually estimated by various formulas based on measurements made during prenatal ultrasonography. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fever of Unknown Origin: Fever in which the etiology cannot be ascertained. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fibrositis: Aching, soreness or stiffness of muscles; often caused by inexpedient work postures. [NIH] Fibrotic tissue: Inflamed tissue that has become scarred. [NIH] Finite Element Analysis: A computer based method of simulating or analyzing the behavior of structures or components. [NIH] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so

Dictionary 293

that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flatus: Gas passed through the rectum. [NIH] Flexion: In gynaecology, a displacement of the uterus in which the organ is bent so far forward or backward that an acute angle forms between the fundus and the cervix. [EU] Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fovea: The central part of the macula that provides the sharpest vision. [NIH] Functional magnetic resonance imaging: A noninvasive tool used to observe functioning in the brain or other organs by detecting changes in chemical composition, blood flow, or both. [NIH]

Fundus: The larger part of a hollow organ that is farthest away from the organ's opening. The bladder, gallbladder, stomach, uterus, eye, and cavity of the middle ear all have a fundus. [NIH] Gait: Manner or style of walking. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastrula: The embryo in the early stage following the blastula, characterized by morphogenetic cell movements, cell differentiation, and the formation of the three germ layers. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH]

294 Back Pain

Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glomerular Filtration Rate: The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to inulin clearance. [NIH] Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH] Glucocorticoids: A group of corticosteroids that affect carbohydrate metabolism (gluconeogenesis, liver glycogen deposition, elevation of blood sugar), inhibit corticotropin secretion, and possess pronounced anti-inflammatory activity. They also play a role in fat and protein metabolism, maintenance of arterial blood pressure, alteration of the connective tissue response to injury, reduction in the number of circulating lymphocytes, and functioning of the central nervous system. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glutamine: A non-essential amino acid present abundantly throught the body and is involved in many metabolic processes. It is synthesized from glutamic acid and ammonia. It is the principal carrier of nitrogen in the body and is an important energy source for many cells. [NIH] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an N-acetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide involves alternate 1,4- and 1,3-linkages consisting of either N-acetylglucosamine or Nacetylgalactosamine. [NIH]

Dictionary 295

Gonadal: Pertaining to a gonad. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Hair Cells: Mechanoreceptors located in the organ of Corti that are sensitive to auditory stimuli and in the vestibular apparatus that are sensitive to movement of the head. In each case the accessory sensory structures are arranged so that appropriate stimuli cause movement of the hair-like projections (stereocilia and kinocilia) which relay the information centrally in the nervous system. [NIH] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Hand Injuries: General or unspecified injuries to the hand. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Health Behavior: Behaviors expressed by individuals to protect, maintain or promote their health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural. [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of

296 Back Pain

health. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Hematuria: Presence of blood in the urine. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells, cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herniated: Protrusion of a degenerated or fragmented intervertebral disc into the intervertebral foramen compressing the nerve root. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Humeral: 1. Of, relating to, or situated in the region of the humerus: brachial. 2. Of or belonging to the shoulder. 3. Of, relating to, or being any of several body parts that are analogous in structure, function, or location to the humerus or shoulder. [EU] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hydra: A genus of freshwater cnidarians, of interest because of their complex organization and because their adult organization corresponds roughly to the gastrula of higher animals.

Dictionary 297

[NIH]

Hydration: Combining with water. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperalgesia: Excessive sensitiveness or sensibility to pain. [EU] Hyperostosis: Increase in the mass of bone per unit volume. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypesthesia: Absent or reduced sensitivity to cutaneous stimulation. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Hypotension: Abnormally low blood pressure. [NIH] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunology: The study of the body's immune system. [NIH]

298 Back Pain

Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive therapy: Therapy used to decrease the body's immune response, such as drugs given to prevent transplant rejection. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In Situ Hybridization: A technique that localizes specific nucleic acid sequences within intact chromosomes, eukaryotic cells, or bacterial cells through the use of specific nucleic acid-labeled probes. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH]

Dictionary 299

Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inpatients: Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment. [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Instillation: . [EU] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Interleukin-1: A soluble factor produced by monocytes, macrophages, and other cells which activates T-lymphocytes and potentiates their response to mitogens or antigens. IL-1 consists of two distinct forms, IL-1 alpha and IL-1 beta which perform the same functions but are distinct proteins. The biological effects of IL-1 include the ability to replace macrophage requirements for T-cell activation. The factor is distinct from interleukin-2. [NIH] Interleukin-2: Chemical mediator produced by activated T lymphocytes and which regulates the proliferation of T cells, as well as playing a role in the regulation of NK cell activity. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervention Studies: Epidemiologic investigations designed to test a hypothesized causeeffect relation by modifying the supposed causal factor(s) in the study population. [NIH] Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracellular Membranes: Membranes of subcellular structures. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intraocular: Within the eye. [EU] Intrathecal: Describes the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord. Drugs can be injected into the fluid or a sample of the fluid can be removed for testing. [NIH] Intravenous: IV. Into a vein. [NIH] Inulin: A starch found in the tubers and roots of many plants. Since it is hydrolyzable to fructose, it is classified as a fructosan. It has been used in physiologic investigation for determination of the rate of glomerular function. [NIH]

300 Back Pain

Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ion Transport: The movement of ions across energy-transducing cell membranes. Transport can be active or passive. Passive ion transport (facilitated diffusion) derives its energy from the concentration gradient of the ion itself and allows the transport of a single solute in one direction (uniport). Active ion transport is usually coupled to an energy-yielding chemical or photochemical reaction such as ATP hydrolysis. This form of primary active transport is called an ion pump. Secondary active transport utilizes the voltage and ion gradients produced by the primary transport to drive the cotransport of other ions or molecules. These may be transported in the same (symport) or opposite (antiport) direction. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isometric Contraction: Muscular contractions characterized by increase in tension without change in length. [NIH] Job Satisfaction: Personal satisfaction relative to the work situation. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Joint Capsule: The sac enclosing a joint. It is composed of an outer fibrous articular capsule and an inner synovial membrane. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keloid: A sharply elevated, irregularly shaped, progressively enlarging scar resulting from formation of excessive amounts of collagen in the dermis during connective tissue repair. It is differentiated from a hypertrophic scar (cicatrix, hypertrophic) in that the former does not spread to surrounding tissues. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Failure, Acute: A clinical syndrome characterized by a sudden decrease in glomerular filtration rate, often to values of less than 1 to 2 ml per minute. It is usually associated with oliguria (urine volumes of less than 400 ml per day) and is always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. [NIH] Kidney Failure, Chronic: An irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and

Dictionary 301

regulate the body's electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Kinetics: The study of rate dynamics in chemical or physical systems. [NIH] Kyphosis: A deformity of the spine characterized by extensive flexion. [NIH] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laryngectomy: Total or partial excision of the larynx. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Laser therapy: The use of an intensely powerful beam of light to kill cancer cells. [NIH] Latency: The period of apparent inactivity between the time when a stimulus is presented and the moment a response occurs. [NIH] Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Lectin: A complex molecule that has both protein and sugars. Lectins are able to bind to the outside of a cell and cause biochemical changes in it. Lectins are made by both animals and plants. [NIH] Leisure Activities: Voluntary use of free time for activities outside the daily routine. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Life Expectancy: A figure representing the number of years, based on known statistics, to which any person of a given age may reasonably expect to live. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum

302 Back Pain

likelihood estimates of the parameters. [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Linkage Disequilibrium: Nonrandom association of linked genes. This is the tendency of the alleles of two separate but already linked loci to be found together more frequently than would be expected by chance alone. [NIH] Lipid: Fat. [NIH] Lithiasis: A condition characterized by the formation of calculi and concretions in the hollow organs or ducts of the body. They occur most often in the gallbladder, kidney, and lower urinary tract. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Lod: The lowest analyte content which, if actually present, will be detected with reasonable statistical certainty and can be identified according to the identification criteria of the method. If both accuracy and precision are constant over a concentration range. [NIH] Lod Score: The total relative probability, expressed on a logarithmic scale, that a linkage relationship exists among selected loci. Lod is an acronym for "logarithmic odds." [NIH] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH] Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Lordosis: The anterior concavity in the curvature of the lumbar and cervical spine as viewed from the side. The term usually refers to abnormally increased curvature (hollow back,

Dictionary 303

saddle back, swayback). It does not include lordosis as normal mating posture in certain animals ( = posture + sex behavior, animal). [NIH] Lordotic: An investigation of the chest for which the body is arched backwards from the waist and the useful beam enters from behind. [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Lumbago: Pain in the lumbar region. [EU] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumbar puncture: A procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give anticancer drugs intrathecally. Also called a spinal tap. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Macula: A stain, spot, or thickening. Often used alone to refer to the macula retinae. [EU] Macula Lutea: An oval area in the retina, 3 to 5 mm in diameter, usually located temporal to the superior pole of the eye and slightly below the level of the optic disk. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Magnetic Resonance Spectroscopy: Spectroscopic method of measuring the magnetic moment of elementary particles such as atomic nuclei, protons or electrons. It is employed in clinical applications such as NMR Tomography (magnetic resonance imaging). [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH]

304 Back Pain

Manic: Affected with mania. [EU] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Mechanoreceptors: Cells specialized to transduce mechanical stimuli and relay that information centrally in the nervous system. Mechanoreceptors include hair cells, which mediate hearing and balance, and the various somatosensory receptors, often with nonneural accessory structures. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Median Nerve: A major nerve of the upper extremity. In humans, the fibers of the median nerve originate in the lower cervical and upper thoracic spinal cord (usually C6 to T1), travel via the brachial plexus, and supply sensory and motor innervation to parts of the forearm and hand. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menopause: Permanent cessation of menstruation. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other

Dictionary 305

career development situations. [NIH] Meperidine: 1-Methyl-4-phenyl-4-piperidinecarboxylic acid ethyl ester. A narcotic analgesic that can be used for the relief of most types of moderate to severe pain, including postoperative pain and the pain of labor. Prolonged use may lead to dependence of the morphine type; withdrawal symptoms appear more rapidly than with morphine and are of shorter duration. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Metastatic cancer: Cancer that has spread from the place in which it started to other parts of the body. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microdialysis: A technique for measuring extracellular concentrations of substances in tissues, usually in vivo, by means of a small probe equipped with a semipermeable membrane. Substances may also be introduced into the extracellular space through the membrane. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH]

306 Back Pain

Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Monotherapy: A therapy which uses only one drug. [EU] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [NIH]

Mucinous: Containing or resembling mucin, the main compound in mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Muscle Denervation: The resection or removal of the innervation of a muscle or muscle tissue. [NIH] Muscle Fatigue: A state arrived at through prolonged and strong contraction of a muscle. Studies in athletes during prolonged submaximal exercise have shown that muscle fatigue increases in almost direct proportion to the rate of muscle glycogen depletion. Muscle fatigue in short-term maximal exercise is associated with oxygen lack and an increased level of blood and muscle lactic acid, and an accompanying increase in hydrogen-ion concentration in the exercised muscle. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH]

Dictionary 307

Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Muscle Spindles: Mechanoreceptors found between skeletal muscle fibers. Muscle spindles are arranged in parallel with muscle fibers and respond to the passive stretch of the muscle, but cease to discharge if the muscle contracts isotonically, thus signaling muscle length. The muscle spindles are the receptors responsible for the stretch or myotactic reflex. [NIH] Muscle tension: A force in a material tending to produce extension; the state of being stretched. [NIH] Muscular Dystrophies: A general term for a group of inherited disorders which are characterized by progressive degeneration of skeletal muscles. [NIH] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Musculoskeletal Diseases: Diseases of the muscles and their associated ligaments and other connective tissue and of the bones and cartilage viewed collectively. [NIH] Musculoskeletal System: Themuscles, bones, and cartilage of the body. [NIH] Myelin: The fatty substance that covers and protects nerves. [NIH] Myelography: X-ray visualization of the spinal cord following injection of contrast medium into the spinal arachnoid space. [NIH] Myocardial Reperfusion: Generally, restoration of blood supply to heart tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. Reperfusion can be induced to treat ischemia. Methods include chemical dissolution of an occluding thrombus, administration of vasodilator drugs, angioplasty, catheterization, and artery bypass graft surgery. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing myocardial reperfusion injury. [NIH] Myocardial Reperfusion Injury: Functional, metabolic, or structural changes in ischemic heart muscle thought to result from reperfusion to the ischemic areas. Changes can be fatal to muscle cells and may include edema with explosive cell swelling and disintegration, sarcolemma disruption, fragmentation of mitochondria, contraction band necrosis, enzyme washout, and calcium overload. Other damage may include hemorrhage and ventricular arrhythmias. One possible mechanism of damage is thought to be oxygen free radicals. Treatment currently includes the introduction of scavengers of oxygen free radicals, and injury is thought to be prevented by warm blood cardioplegic infusion prior to reperfusion. [NIH]

Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Narcotic Antagonists: Agents inhibiting the effect of narcotics on the central nervous system. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense

308 Back Pain

pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Neck Pain: Discomfort or more intense forms of pain that are localized to the cervical region. This term generally refers to pain in the posterior or lateral regions of the neck. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephropathy: Disease of the kidneys. [EU] Nephrotoxic: Toxic or destructive to kidney cells. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Endings: Specialized terminations of peripheral neurons. Nerve endings include neuroeffector junction(s) by which neurons activate target organs and sensory receptors which transduce information from the various sensory modalities and send it centrally in the nervous system. Presynaptic nerve endings are presynaptic terminals. [NIH] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [NIH] Nerve Growth Factor: Nerve growth factor is the first of a series of neurotrophic factors that were found to influence the growth and differentiation of sympathetic and sensory neurons. It is comprised of alpha, beta, and gamma subunits. The beta subunit is responsible for its growth stimulating activity. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuralgia: Intense or aching pain that occurs along the course or distribution of a peripheral or cranial nerve. [NIH] Neuritis: A general term indicating inflammation of a peripheral or cranial nerve. Clinical manifestation may include pain; paresthesias; paresis; or hypesthesia. [NIH] Neurodegenerative Diseases: Hereditary and sporadic conditions which are characterized by progressive nervous system dysfunction. These disorders are often associated with atrophy of the affected central or peripheral nervous system structures. [NIH] Neuroeffector Junction: The synapse between a neuron (presynaptic) and an effector cell other than another neuron (postsynaptic). Neuroeffector junctions include synapses onto muscles and onto secretory cells. [NIH]

Dictionary 309

Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neurologist: A doctor who specializes in the diagnosis and treatment of disorders of the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neuropeptide: A member of a class of protein-like molecules made in the brain. Neuropeptides consist of short chains of amino acids, with some functioning as neurotransmitters and some functioning as hormones. [NIH] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Neurotoxic: Poisonous or destructive to nerve tissue. [EU] Neurotransmitters: Endogenous signaling molecules that alter the behavior of neurons or effector cells. Neurotransmitter is used here in its most general sense, including not only messengers that act directly to regulate ion channels, but also those that act through second messenger systems, and those that act at a distance from their site of release. Included are neuromodulators, neuroregulators, neuromediators, and neurohumors, whether or not acting at synapses. [NIH] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutropenia: An abnormal decrease in the number of neutrophils, a type of white blood cell. [NIH] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by

310 Back Pain

volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nociceptors: Peripheral receptors for pain. Nociceptors include receptors which are sensitive to painful mechanical stimuli, extreme heat or cold, and chemical stimuli. All nociceptors are free nerve endings. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nursing Staff: Personnel who provide nursing service to patients in an organized facility, institution, or agency. [NIH] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Occupational Exposure: The exposure to potentially harmful chemical, physical, or biological agents that occurs as a result of one's occupation. [NIH] Occupational Health: The promotion and maintenance of physical and mental health in the work environment. [NIH] Occupational Health Services: Health services for employees, usually provided by the employer at the place of work. [NIH] Occupational Medicine: Medical specialty concerned with the promotion and maintenance of the physical and mental health of employees in occupational settings. [NIH] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH]

Dictionary 311

Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Opsin: A protein formed, together with retinene, by the chemical breakdown of metarhodopsin. [NIH] Optic Disk: The portion of the optic nerve seen in the fundus with the ophthalmoscope. It is formed by the meeting of all the retinal ganglion cell axons as they enter the optic nerve. [NIH]

Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Orbit: One of the two cavities in the skull which contains an eyeball. Each eye is located in a bony socket or orbit. [NIH] Orbital: Pertaining to the orbit (= the bony cavity that contains the eyeball). [EU] Orthopaedic: Pertaining to the correction of deformities of the musculoskeletal system; pertaining to orthopaedics. [EU] Orthotic Devices: Apparatus used to support, align, prevent, or correct deformities or to improve the function of movable parts of the body. [NIH] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxycodone: Semisynthetic derivative of codeine that acts as a narcotic analgesic more potent and addicting than codeine. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Pain Threshold: Amount of stimulation required before the sensation of pain is experienced. [NIH]

312 Back Pain

Pain, Postoperative: Pain during the period after surgery. [NIH] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Palsy: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Paresis: A general term referring to a mild to moderate degree of muscular weakness, occasionally used as a synonym for paralysis (severe or complete loss of motor function). In the older literature, paresis often referred specifically to paretic neurosyphilis. "General paresis" and "general paralysis" may still carry that connotation. Bilateral lower extremity paresis is referred to as paraparesis. [NIH] Paresthesias: Abnormal touch sensations, such as burning or prickling, that occur without an outside stimulus. [NIH] Particle: A tiny mass of material. [EU] Partnership Practice: A voluntary contract between two or more doctors who may or may not share responsibility for the care of patients, with proportional sharing of profits and losses. [NIH] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH]

Dictionary 313

Peer Group: Group composed of associates of same species, approximately the same age, and usually of similar rank or social status. [NIH] Pelvic: Pertaining to the pelvis. [EU] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Peridural: Around or external to the dura mater. [EU] Perineum: The area between the anus and the sex organs. [NIH] Perineural: Around a nerve or group of nerves. [NIH] Peripheral Nerves: The nerves outside of the brain and spinal cord, including the autonomic, cranial, and spinal nerves. Peripheral nerves contain non-neuronal cells and connective tissue as well as axons. The connective tissue layers include, from the outside to the inside, the epineurium, the perineurium, and the endoneurium. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Neuropathy: Nerve damage, usually affecting the feet and legs; causing pain, numbness, or a tingling feeling. Also called "somatic neuropathy" or "distal sensory polyneuropathy." [NIH] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Peroneal Nerve: The lateral of the two terminal branches of the sciatic nerve. The peroneal (or fibular) nerve provides motor and sensory innervation to parts of the leg and foot. [NIH] Phallic: Pertaining to the phallus, or penis. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenyl: Ingredient used in cold and flu remedies. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and

314 Back Pain

teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Photodynamic therapy: Treatment with drugs that become active when exposed to light. These drugs kill cancer cells. [NIH] Photophobia: Abnormal sensitivity to light. This may occur as a manifestation of eye diseases; migraine; subarachnoid hemorrhage; meningitis; and other disorders. Photophobia may also occur in association with depression and other mental disorders. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Fitness: A state of well-being in which performance is optimal, often as a result of physical conditioning which may be prescribed for disease therapy. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]

Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Piroxicam: 4-Hydroxy-2-methyl-N-2-pyridyl-2H-1,2-benzothiazine-3-carboxamide 1,1dioxide. A non-steroidal anti-inflammatory agent that is well established in the treatment of rheumatoid arthritis and osteoarthritis. Its usefulness has also been demonstrated in the treatment of musculoskeletal disorders, dysmenorrhea, and postoperative pain. Its long half-life enables it to be administered once daily. The drug has also been shown to be effective if administered rectally. Gastrointestinal complaints are the most frequently reported side effects. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Plana: The radiographic term applied to a vertebral body crushed to a thin plate. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasminogen: Precursor of fibrinolysin (plasmin). It is a single-chain beta-globulin of molecular weight 80-90,000 found mostly in association with fibrinogen in plasma; plasminogen activators change it to fibrinolysin. It is used in wound debriding and has been investigated as a thrombolytic agent. [NIH] Platelet Activating Factor: A phospholipid derivative formed by platelets, basophils, neutrophils, monocytes, and macrophages. It is a potent platelet aggregating agent and inducer of systemic anaphylactic symptoms, including hypotension, thrombocytopenia,

Dictionary 315

neutropenia, and bronchoconstriction. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Polyuria: Urination of a large volume of urine with an increase in urinary frequency, commonly seen in diabetes. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postoperative: After surgery. [NIH] Postural: Pertaining to posture or position. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU]

316 Back Pain

Presynaptic Terminals: The distal terminations of axons which are specialized for the release of neurotransmitters. Also included are varicosities along the course of axons which have similar specializations and also release transmitters. Presynaptic terminals in both the central and peripheral nervous systems are included. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary endpoint: The main result that is measured at the end of a study to see if a given treatment worked (e.g., the number of deaths or the difference in survival between the treatment group and the control group). What the primary endpoint will be is decided before the study begins. [NIH] Private Practice: Practice of a health profession by an individual, offering services on a person-to-person basis, as opposed to group or partnership practice. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Procaine: A local anesthetic of the ester type that has a slow onset and a short duration of action. It is mainly used for infiltration anesthesia, peripheral nerve block, and spinal block. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1016). [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prone: Having the front portion of the body downwards. [NIH] Prone Position: The posture of an individual lying face down. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Proprioception: The mechanism involved in the self-regulation of posture and movement through stimuli originating in the receptors imbedded in the joints, tendons, muscles, and labyrinth. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is

Dictionary 317

PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prosthesis: An artificial replacement of a part of the body. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Proteoglycan: A molecule that contains both protein and glycosaminoglycans, which are a type of polysaccharide. Proteoglycans are found in cartilage and other connective tissues. [NIH]

Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a

318 Back Pain

predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Psychotropic: Exerting an effect upon the mind; capable of modifying mental activity; usually applied to drugs that effect the mental state. [EU] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulposus: Prolapse of the nucleus pulposus into the body of the vertebra; necrobacillosis of rabbits. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation

Dictionary 319

therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radicular: Having the character of or relating to a radicle or root. [NIH] Radiculopathy: Disease involving a spinal nerve root (see spinal nerve roots) which may result from compression related to intervertebral disk displacement; spinal cord injuries; spinal diseases; and other conditions. Clinical manifestations include radicular pain, weakness, and sensory loss referable to structures innervated by the involved nerve root. [NIH]

Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH]

320 Back Pain

Reaction Time: The time from the onset of a stimulus until the organism responds. [NIH] Reassurance: A procedure in psychotherapy that seeks to give the client confidence in a favorable outcome. It makes use of suggestion, of the prestige of the therapist. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recuperation: The recovery of health and strength. [EU] Recur: To occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]

Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Relaxant: 1. Lessening or reducing tension. 2. An agent that lessens tension. [EU] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be

Dictionary 321

cancer in the body. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Renal pelvis: The area at the center of the kidney. Urine collects here and is funneled into the ureter, the tube that connects the kidney to the bladder. [NIH] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Reperfusion Injury: Functional, metabolic, or structural changes, including necrosis, in ischemic tissues thought to result from reperfusion to ischemic areas of the tissue. The most common instance is myocardial reperfusion injury. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Resolving: The ability of the eye or of a lens to make small objects that are close together, separately visible; thus revealing the structure of an object. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinae: A congenital notch or cleft of the retina, usually located inferiorly. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinal Detachment: Separation of the inner layers of the retina (neural retina) from the pigment epithelium. Retinal detachment occurs more commonly in men than in women, in eyes with degenerative myopia, in aging and in aphakia. It may occur after an uncomplicated cataract extraction, but it is seen more often if vitreous humor has been lost during surgery. (Dorland, 27th ed; Newell, Ophthalmology: Principles and Concepts, 7th ed, p310-12). [NIH] Retinal pigment epithelium: The pigment cell layer that nourishes the retinal cells; located just outside the retina and attached to the choroid. [NIH]

322 Back Pain

Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Rheumatic Diseases: Disorders of connective tissue, especially the joints and related structures, characterized by inflammation, degeneration, or metabolic derangement. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Sacroiliac Joint: The immovable joint formed by the lateral surfaces of the sacrum and ilium. [NIH] Sagittal: The line of direction passing through the body from back to front, or any vertical plane parallel to the medial plane of the body and inclusive of that plane; often restricted to the medial plane, the plane of the sagittal suture. [NIH] Saline: A solution of salt and water. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to

Dictionary 323

create pictures of areas inside the body. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Sciatic Nerve: A nerve which originates in the lumbar and sacral spinal cord (L4 to S3) and supplies motor and sensory innervation to the lower extremity. The sciatic nerve, which is the main continuation of the sacral plexus, is the largest nerve in the body. It has two major branches, the tibial nerve and the peroneal nerve. [NIH] Sciatica: A condition characterized by pain radiating from the back into the buttock and posterior/lateral aspects of the leg. Sciatica may be a manifestation of sciatic neuropathy; radiculopathy (involving the L4, L5, S1 or S2 spinal nerve roots; often associated with intervertebral disk displacement); or lesions of the cauda equina. [NIH] Scleroderma: A chronic disorder marked by hardening and thickening of the skin. Scleroderma can be localized or it can affect the entire body (systemic). [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Scoliosis: A lateral curvature of the spine. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Second Messenger Systems: Systems in which an intracellular signal is generated in response to an intercellular primary messenger such as a hormone or neurotransmitter. They are intermediate signals in cellular processes such as metabolism, secretion, contraction, phototransduction, and cell growth. Examples of second messenger systems are the adenyl cyclase-cyclic AMP system, the phosphatidylinositol diphosphate-inositol triphosphate system, and the cyclic GMP system. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sedentary: 1. Sitting habitually; of inactive habits. 2. Pertaining to a sitting posture. [EU] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of

324 Back Pain

old age. [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sensitization: 1. Administration of antigen to induce a primary immune response; priming; immunization. 2. Exposure to allergen that results in the development of hypersensitivity. 3. The coating of erythrocytes with antibody so that they are subject to lysis by complement in the presence of homologous antigen, the first stage of a complement fixation test. [EU] Sensory loss: A disease of the nerves whereby the myelin or insulating sheath of myelin on the nerves does not stay intact and the messages from the brain to the muscles through the nerves are not carried properly. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Sex Behavior: Sexual activities of humans. [NIH] Sex Behavior, Animal: Sexual activities of animals. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Sex Ratio: The number of males per 100 females. [NIH] Sharpness: The apparent blurring of the border between two adjacent areas of a radiograph having different optical densities. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Shoulder Pain: Unilateral or bilateral pain of the shoulder. It is often caused by physical activities such as work or sports participation, but may also be pathologic in origin. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or

Dictionary 325

absence of respiratory effort. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Snoring: Rough, noisy breathing during sleep, due to vibration of the uvula and soft palate. [NIH]

Social Class: A stratum of people with similar position and prestige; includes social stratification. Social class is measured by criteria such as education, occupation, and income. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spices: The dried seeds, bark, root, stems, buds, leaves, or fruit of aromatic plants used to season food. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH]

326 Back Pain

Spinal Cord Compression: Acute and chronic conditions characterized by external mechanical compression of the spinal cord due to extramedullary neoplasm; epidural abscess; spinal fractures; bony deformities of the vertebral bodies; and other conditions. Clinical manifestations vary with the anatomic site of the lesion and may include localized pain, weakness, sensory loss, incontinence, and impotence. [NIH] Spinal Cord Injuries: Penetrating and non-penetrating injuries to the spinal cord resulting from traumatic external forces (e.g., wounds, gunshot; whiplash injuries; etc.). [NIH] Spinal Fractures: Broken bones in the vertebral column. [NIH] Spinal Nerve Roots: The paired bundles of nerve fibers entering and leaving the spinal cord at each segment. The dorsal and ventral nerve roots join to form the mixed segmental spinal nerves. The dorsal roots are generally afferent, formed by the central projections of the spinal (dorsal root) ganglia sensory cells, and the ventral roots efferent, comprising the axons of spinal motor and autonomic preganglionic neurons. There are, however, some exceptions to this afferent/efferent rule. [NIH] Spinal Nerves: The 31 paired peripheral nerves formed by the union of the dorsal and ventral spinal roots from each spinal cord segment. The spinal nerve plexuses and the spinal roots are also included. [NIH] Spinal Stenosis: Narrowing of the spinal canal. [NIH] Spinous: Like a spine or thorn in shape; having spines. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Splint: A rigid appliance used for the immobilization of a part or for the correction of deformity. [NIH] Spondylitis: Inflammation of the vertebrae. [EU] Spondylolisthesis: Forward displacement of one vertebra over another. [NIH] Spondylolysis: Dissolution of a vertebra, especially the pars interarticularis. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Stabilization: The creation of a stable state. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Sternum: Breast bone. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones,

Dictionary 327

bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strained: A stretched condition of a ligament. [NIH] Streptococci: A genus of spherical Gram-positive bacteria occurring in chains or pairs. They are widely distributed in nature, being important pathogens but often found as normal commensals in the mouth, skin, and intestine of humans and other animals. [NIH] Streptokinase: Streptococcal fibrinolysin . An enzyme produced by hemolytic streptococci. It hydrolyzes amide linkages and serves as an activator of plasminogen. It is used in thrombolytic therapy and is used also in mixtures with streptodornase (streptodornase and streptokinase). EC 3.4.-. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Supine: Having the front portion of the body upwards. [NIH] Supine Position: The posture of an individual lying face up. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sweat Glands: Sweat-producing structures that are embedded in the dermis. Each gland consists of a single tube, a coiled body, and a superficial duct. [NIH]

328 Back Pain

Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatic treatment: Therapy that eases symptoms without addressing the cause of disease. [NIH] Synapses: Specialized junctions at which a neuron communicates with a target cell. At classical synapses, a neuron's presynaptic terminal releases a chemical transmitter stored in synaptic vesicles which diffuses across a narrow synaptic cleft and activates receptors on the postsynaptic membrane of the target cell. The target may be a dendrite, cell body, or axon of another neuron, or a specialized region of a muscle or secretory cell. Neurons may also communicate through direct electrical connections which are sometimes called electrical synapses; these are not included here but rather in gap junctions. [NIH] Synapsis: The pairing between homologous chromosomes of maternal and paternal origin during the prophase of meiosis, leading to the formation of gametes. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Synovial: Of pertaining to, or secreting synovia. [EU] Synovial Cyst: A nodular, tumorlike lesion in or about a tendon sheath or joint capsule, especially of the hands, wrists, or feet. It is not a true cyst as it lacks an epithelial wall, and it does not communicate with the underlying synovial space. The lesion represents a focal accumulation of mucin in the dermis of the dorsal aspect of the distal phalanges or, less often, other portions of the extremities. [NIH] Synovial Fluid: The clear, viscous fluid secreted by the synovial membrane. It contains mucin, albumin, fat, and mineral salts and serves to lubricate joints. [NIH] Synovial Membrane: The inner membrane of a joint capsule surrounding a freely movable joint. It is loosely attached to the external fibrous capsule and secretes synovial fluid. [NIH] Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tamponade: The inserting of a tampon; a dressing is inserted firmly into a wound or body

Dictionary 329

cavity, as the nose, uterus or vagina, principally for stopping hemorrhage. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Tendinitis: Inflammation of tendons and of tendon-muscle attachments. [EU] Tennis Elbow: A condition characterized by pain in or near the lateral humeral epicondyle or in the forearm extensor muscle mass as a result of unusual strain. It occurs in tennis players as well as housewives, artisans, and violinists. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombocytopenia: A decrease in the number of blood platelets. [NIH] Thrombolytic: 1. Dissolving or splitting up a thrombus. 2. A thrombolytic agent. [EU] Thrombolytic Therapy: Use of infusions of fibrinolytic agents to destroy or dissolve thrombi in blood vessels or bypass grafts. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Tibial Nerve: The medial terminal branch of the sciatic nerve. The tibial nerve fibers originate in lumbar and sacral spinal segments (L4 to S2). They supply motor and sensory innervation to parts of the calf and foot. [NIH] Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU]

330 Back Pain

Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Traction: The act of pulling. [NIH] Tramadol: A narcotic analgesic proposed for severe pain. It may be habituating. [NIH] Transcutaneous: Transdermal. [EU] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Dictionary 331

Triage: The sorting out and classification of patients or casualties to determine priority of need and proper place of treatment. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Tumour: 1. Swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. A new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Ultrasound energy: A form of therapy being studied as an anticancer treatment. Intensified ultrasound energy can be directed at cancer cells to heat them and kill them. [NIH] Umbilicus: The pit in the center of the abdominal wall marking the point where the umbilical cord entered in the fetus. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urachal Cyst: Cyst occurring in a persistent portion of the urachus, presenting as an extraperitoneal mass in the umbilical region. It is characterized by abdominal pain, and fever if infected. It may rupture, leading to peritonitis, or it may drain through the umbilicus. [NIH] Urachus: The urinary canal of the fetus; postnatally it is usually a fibrous cord but occasionally persists as a vesicoumbilical fistula. [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH]

332 Back Pain

Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Uvula: Uvula palatinae; specifically, the tongue-like process which projects from the middle of the posterior edge of the soft palate. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Varicose: The common ulcer in the lower third of the leg or near the ankle. [NIH] Varicose vein: An abnormal swelling and tortuosity especially of the superficial veins of the legs. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Ventricles: Fluid-filled cavities in the heart or brain. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visual Acuity: Acuteness or clearness of vision, especially of form vision, which is dependent mainly on the sharpness of the retinal focus. [NIH] Vitrectomy: Removal of the whole or part of the vitreous body in treating endophthalmitis, diabetic retinopathy, retinal detachment, intraocular foreign bodies, and some types of glaucoma. [NIH] Vitreous Body: The transparent, semigelatinous substance that fills the cavity behind the crystalline lens of the eye and in front of the retina. It is contained in a thin hyoid membrane

Dictionary 333

and forms about four fifths of the optic globe. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Weight Lifting: A sport in which weights are lifted competitively or as an exercise. [NIH] Weight-Bearing: The physical state of supporting an applied load. This often refers to the weight-bearing bones or joints that support the body's weight, especially those in the spine, hip, knee, and foot. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

335

INDEX A Abdomen, 5, 180, 192, 271, 277, 278, 299, 302, 326, 327, 329, 332 Abdominal, 6, 34, 49, 66, 71, 97, 155, 167, 177, 180, 187, 191, 192, 258, 271, 312, 313, 331 Abdominal Pain, 49, 66, 271, 313, 331 Ablate, 185, 271 Ablation, 185, 271 Abrasion, 170, 271 Abscess, 271, 326 Absenteeism, 15, 201, 271 Acetaminophen, 8, 76, 87, 105, 271 Acetylcholine, 204, 271, 278, 281 Activities of Daily Living, 30, 40, 164, 271 Acuity, 176, 271 Acupuncture Points, 22, 271 Adaptation, 28, 50, 86, 147, 271 Adhesions, 15, 60, 271 Adjustment, 13, 54, 61, 177, 178, 179, 271 Adjuvant, 169, 271, 272, 293 Adjuvant Therapy, 169, 272 Adolescence, 49, 272 Adrenal Cortex, 272, 285, 316 Adrenal Glands, 272, 273 Adverse Effect, 45, 201, 272, 324 Aerobic, 6, 26, 69, 272 Aerobic Exercise, 6, 26, 272 Aeroembolism, 272, 277 Afferent, 46, 206, 272, 326 Affinity, 272, 287, 325 Age of Onset, 219, 272 Aggravation, 11, 197, 202, 272 Agonist, 205, 206, 272, 288, 307, 309 Airway, 272, 324 Algorithms, 49, 272, 277 Alimentary, 272, 312 Alkaline, 131, 272, 273, 278 Alkaloid, 273, 279, 306, 309 Alleles, 273, 302 Allergen, 273, 287, 324 Alpha Particles, 273, 318 Alternative medicine, 26, 104, 118, 220, 232, 273 Ameliorating, 33, 169, 273 Amenorrhea, 273, 274 Amino Acid Sequence, 273, 274

Amino Acids, 20, 273, 309, 313, 315, 317, 322, 327, 330, 331 Aminopeptidases, 38, 273, 291 Ammonia, 273, 294, 327, 331 Ampulla, 273, 290 Amylase, 82, 273 Amyloidosis, 43, 273 Anaesthesia, 273, 298 Anal, 17, 18, 273, 292, 302 Analgesic, 5, 10, 26, 114, 169, 195, 203, 206, 271, 273, 282, 287, 290, 305, 306, 311, 330 Anaphylactic, 273, 314 Anatomical, 16, 31, 40, 51, 211, 273, 281, 298, 323 Androgens, 272, 274, 285 Anesthesia, 46, 116, 272, 274, 286, 288, 289, 316 Anesthetics, 169, 274 Animal model, 28, 30, 39, 40, 46, 47, 48, 55, 60, 203, 274 Anions, 274, 300 Anisotropy, 41, 274 Ankle, 55, 208, 227, 274, 332 Ankle Injuries, 227, 274 Ankle Joint, 274 Anorexia, 199, 274 Anorexia Nervosa, 199, 274 Anterograde, 14, 274 Antiallergic, 274, 285 Antibodies, 20, 82, 274, 303, 314 Antibody, 200, 203, 272, 274, 275, 283, 296, 297, 298, 304, 306, 319, 324, 325 Anticoagulant, 274, 317 Anticonvulsants, 8, 274 Antidepressant, 151, 275, 293 Antiemetic, 275, 288 Antigen, 82, 272, 274, 275, 283, 296, 297, 298, 304, 324 Anti-inflammatory, 5, 6, 8, 83, 169, 186, 235, 271, 275, 276, 285, 287, 294, 314 Anti-Inflammatory Agents, 169, 275, 276, 285 Antineoplastic, 275, 285 Antioxidant, 169, 275 Antipyretic, 271, 275, 287 Antitussive, 275, 288, 311 Anuria, 275, 300 Anus, 273, 275, 278, 313

336 Back Pain

Anxiety, 12, 16, 45, 51, 71, 105, 275 Anxiety Disorders, 51, 275 Aorta, 275 Aortic Aneurysm, 71, 275 Aperture, 192, 275 Apnea, 275 Aponeurosis, 275, 293 Aqueous, 275, 276, 286, 290, 301 Arachidonic Acid, 275, 316 Arterial, 200, 222, 275, 294, 297, 317, 328 Arteries, 275, 277, 278, 285, 305 Arterioles, 275, 278, 279 Arthralgia, 49, 275 Arthrosis, 49, 275 Articular, 10, 20, 27, 61, 169, 274, 275, 300, 311 Aseptic, 276, 288 Aspartate, 68, 276 Aspiration, 185, 276 Aspirin, 5, 8, 195, 276 Asymptomatic, 4, 44, 51, 58, 193, 276 Atrophy, 43, 276, 308 Autoimmune disease, 169, 276, 306 Autonomic, 182, 271, 276, 310, 313, 326, 328 Autonomic Nervous System, 276, 313, 328 Axonal, 14, 47, 276 Axons, 14, 47, 276, 308, 311, 313, 316, 326 B Back Injuries, 5, 14, 35, 42, 53, 54, 158, 166, 246, 251, 258, 276 Bacteria, 275, 276, 290, 305, 327, 330, 332 Bacterial Physiology, 271, 276 Bacteriophage, 276, 330 Basal Ganglia, 276, 293 Base, 31, 165, 177, 178, 179, 202, 207, 221, 276, 287, 300, 301, 329 Basement Membrane, 276, 292 Basophils, 277, 301, 314 Bed Rest, 6, 166, 170, 234, 249, 277 Bends, 253, 277 Benign, 7, 59, 146, 277, 293, 295, 308, 319 Benztropine, 151, 277 Bilateral, 46, 186, 277, 312, 324 Bile, 277, 293, 302, 327 Biochemical, 14, 31, 41, 52, 273, 277, 300, 301, 311, 324 Bioengineering, 32, 47, 240, 277 Biological therapy, 277, 295 Biomechanics, 21, 22, 25, 27, 32, 39, 52, 57, 70, 74, 75, 277 Biopsy, 33, 277, 313

Biotechnology, 41, 64, 66, 218, 232, 241, 277 Bipolar Disorder, 82, 200, 277 Bladder, 137, 164, 189, 253, 254, 277, 281, 286, 293, 298, 306, 309, 321, 331 Bloating, 195, 277 Blood Coagulation, 277, 279, 329 Blood Platelets, 277, 324, 329 Blood pressure, 49, 50, 182, 277, 279, 294, 297, 306, 313, 325 Blood vessel, 277, 278, 279, 281, 290, 294, 296, 300, 302, 313, 325, 327, 329, 332 Body Fluids, 278, 289, 325 Body Mass Index, 278, 311 Bone Marrow, 278, 297, 303, 306 Bone Remodeling, 10, 278 Bone Resorption, 278 Bone scan, 4, 11, 251, 278, 322 Botulinum Toxins, 67, 278 Bowel, 253, 254, 273, 278, 287, 299, 327 Bowel Movement, 278, 287, 327 Brachytherapy, 278, 299, 319 Branch, 265, 278, 290, 294, 312, 318, 325, 329 Breakdown, 209, 278, 280, 287, 293, 311 Bronchi, 278, 330 Bronchial, 222, 278, 296 Bronchitis, 278, 282 Bronchoconstriction, 278, 315 Buccal, 278, 303 Bupivacaine, 278, 301 C Calcium, 108, 204, 206, 278, 279, 283, 307 Calcium Channels, 206, 279 Calculi, 279, 302 Cannula, 206, 279 Capillary, 33, 200, 279, 294, 332 Capsaicin, 169, 195, 203, 205, 206, 279 Capsicum, 115, 134, 141, 279 Capsules, 27, 279, 293, 294 Carbohydrate, 279, 285, 294, 315 Carbon Dioxide, 279, 292, 321 Carcinogenic, 279, 298, 316, 327 Carcinoma, 80, 279 Cardiac, 147, 279, 289, 290, 291, 301, 307, 326 Cardiopulmonary, 6, 279 Cardiorespiratory, 272, 279 Cardiovascular, 5, 8, 12, 50, 279, 324 Cardiovascular disease, 8, 279 Carotene, 279, 321

Index 337

Carpal Tunnel Syndrome, 14, 48, 110, 175, 279 Case report, 6, 71, 75, 280, 282 Case series, 280, 282 Catheters, 173, 280, 298, 299 Cathode, 280, 289 Cations, 14, 204, 280, 300 Cauda Equina, 4, 7, 254, 280, 323 Caudal, 280, 297, 315 Causal, 48, 62, 280, 299 Cell Division, 276, 280, 295, 304, 314, 316 Cell membrane, 279, 280, 291, 300 Cell Respiration, 280, 321 Cell Survival, 280, 295 Cellular metabolism, 182, 280 Cellulose, 280, 314 Central Nervous System Infections, 280, 295 Cerebral, 117, 191, 276, 281, 291 Cerebrospinal, 16, 37, 82, 191, 200, 281, 303 Cerebrospinal fluid, 16, 37, 82, 191, 200, 281, 303 Cerebrovascular, 279, 281 Cerebrum, 281 Cervical, 72, 74, 86, 89, 92, 95, 137, 168, 197, 200, 202, 221, 281, 302, 304, 308 Cervix, 281, 293 Character, 281, 286, 319 Chemokines, 30, 281 Chemotherapy, 110, 272, 281 Chest cavity, 186, 281 Chin, 105, 106, 168, 281 Cholesterol, 277, 281, 285, 327 Cholinergic, 45, 278, 281, 309 Cholinesterase Inhibitors, 45, 281 Choroid, 281, 321 Chromatin, 281, 309 Chromosome, 281, 295, 302 Chronic Disease, 48, 222, 282 Chronic Fatigue Syndrome, 199, 200, 282 Chronic Obstructive Pulmonary Disease, 222, 282 Chronic renal, 220, 282 Chymopapain, 282, 288 Cicatrix, 282, 300 CIS, 282, 321 Civilization, 42, 203, 282 Claudication, 51, 282 Clavicle, 190, 282 Clinical Medicine, 282, 315 Clinical study, 29, 282, 284

Cloning, 277, 282 Coagulation, 277, 282, 296, 329 Codeine, 87, 105, 282, 311 Cofactor, 282, 317, 329 Cognition, 45, 282 Cohort Studies, 48, 282 Collagen, 19, 23, 29, 43, 185, 209, 276, 283, 293, 300, 316 Collapse, 194, 278, 283, 324 Colloidal, 283, 289 Colostomy, 222, 283 Comorbidity, 122, 283 Complement, 105, 106, 283, 324 Complementary and alternative medicine, 11, 12, 109, 110, 143, 283 Complementary medicine, 110, 283 Compress, 186, 284 Computational Biology, 241, 284 Computed tomography, 4, 58, 72, 234, 284, 322 Computerized axial tomography, 284, 322 Computerized tomography, 234, 284 Concentric, 6, 284 Conception, 284, 292 Conduction, 51, 209, 284 Cones, 284, 321 Confounding, 54, 61, 284 Connective Tissue, 278, 283, 284, 292, 293, 294, 300, 303, 307, 313, 317, 322 Consciousness, 273, 284, 287 Constitutional, 221, 284 Constriction, 284, 300 Consultation, 64, 252, 284 Contraindications, ii, 284 Control group, 24, 38, 40, 56, 61, 158, 284, 316, 319 Controlled clinical trial, 26, 95, 284, 319 Controlled study, 101, 106, 111, 112, 135, 285 Conventional therapy, 285 Conventional treatment, 12, 23, 285 Coordination, 17, 34, 61, 87, 285, 306 Coronary, 48, 76, 169, 279, 285, 305 Coronary Angiography, 76, 285 Coronary heart disease, 48, 279, 285 Coronary Thrombosis, 285, 305 Cortex, 285, 291 Cortical, 20, 176, 285, 323 Corticosteroid, 8, 285 Cortisol, 49, 52, 285 Cost Savings, 26, 52, 285 Cost-benefit, 13, 285

338 Back Pain

Cranial, 285, 295, 308, 311, 313 Craniocerebral Trauma, 285, 295 Credentialing, 62, 154, 286 Curare, 286, 307 Curative, 218, 286, 309, 329 Cutaneous, 60, 169, 195, 286, 297, 303 Cyclic, 28, 34, 41, 286, 317, 323 Cyst, 286, 328, 331 Cysteine, 281, 282, 286, 327 Cystocele, 180, 286 Cytokine, 31, 60, 199, 286 Cytoplasm, 277, 280, 286, 306, 309, 322 D Data Collection, 19, 29, 36, 49, 217, 286 Databases, Bibliographic, 241, 286 Decision Making, 44, 286 Decompression, 164, 165, 204, 272, 286 Decompression Sickness, 286 Decubitus, 58, 178, 286 Defense Mechanisms, 169, 286 Dehydration, 220, 287 Delivery of Health Care, 287, 295 Dementia, 45, 287 Dendrites, 287, 309 Density, 23, 58, 71, 87, 278, 287, 310, 325 Depressive Disorder, 58, 287 Desensitization, 206, 287 Desipramine, 151, 287 Diabetes Mellitus, 222, 287, 294 Diabetic Retinopathy, 287, 332 Diagnostic Imaging, 235, 287 Diagnostic procedure, 161, 233, 287 Diastolic, 287, 297 Diclofenac, 66, 84, 287 Diclofenac Sodium, 287 Diffusion, 287, 300 Digestion, 272, 277, 278, 287, 299, 302, 327 Digestive system, 159, 287 Dilatation, 288, 316 Diphenhydramine, 100, 288 Diploid, 288, 314 Direct, iii, 12, 26, 30, 31, 56, 62, 154, 186, 205, 282, 288, 306, 320, 328 Discitis, 97, 288 Disease Progression, 45, 288 Diskectomy, 253, 288 Dislocation, 288, 326 Distal, 14, 47, 209, 276, 288, 289, 313, 316, 317, 328 Diuresis, 220, 288 Dopamine, 277, 288

Dorsal, 31, 47, 48, 60, 206, 288, 315, 326, 328 Dorsum, 288, 293 Double-blinded, 56, 288 Drive, ii, vi, 43, 103, 211, 222, 288, 300 Drug Interactions, 288 Drug Tolerance, 289, 329 Duct, 273, 279, 289, 322, 327 Duodenum, 277, 289, 290, 327 Dura mater, 15, 289, 291, 304, 313 Dyes, 277, 289, 309 Dysmenorrhea, 289, 314 Dysphoric, 287, 289 Dystrophy, 20, 199, 200, 289 E Edema, 182, 287, 289, 307 Effector, 271, 283, 289, 308, 309 Effector cell, 289, 308, 309 Elastin, 283, 289 Elective, 18, 289 Electric Conductivity, 274, 289 Electroacupuncture, 26, 129, 289 Electrode, 29, 185, 204, 280, 289 Electrolysis, 274, 280, 289 Electrolyte, 285, 289, 301, 305, 315, 325 Electrons, 275, 276, 280, 289, 300, 303, 311, 318, 319 Electrophoresis, 37, 289 Electrophysiological, 14, 34, 72, 290 Elementary Particles, 289, 290, 303, 309, 317 Embolism, 91, 290 Embolus, 290, 298 Embryo, 290, 293, 298 Emphysema, 282, 290 Empirical, 12, 25, 290 Emulsion, 290, 293 Endocarditis, 91, 138, 290 Endocardium, 290 Endophthalmitis, 290, 332 Endorphin, 6, 195, 290 Endoscope, 173, 290 Endoscopic, 173, 185, 290 Endoscopy, 173, 290 Endotoxin, 290, 331 End-stage renal, 282, 290 Enkephalin, 195, 291 Environmental Health, 102, 240, 242, 291 Enzymatic, 169, 279, 283, 291, 296, 321 Enzyme, 33, 273, 289, 291, 307, 317, 327, 329, 333 Epidemiological, 34, 35, 42, 145, 147, 291

Index 339

Epidural, 15, 100, 104, 105, 173, 186, 199, 200, 206, 226, 231, 234, 288, 291, 326 Epidural Space, 173, 291 Epiretinal Membrane, 176, 291 Episode of Care, 68, 291 Epithelial, 291, 328 Epithelium, 276, 291, 321 Ergonomics, 30, 76, 81, 174, 201, 214, 215, 248, 291 Erythrocytes, 278, 291, 324 Escalation, 10, 291 Esophagus, 287, 291, 327 Eukaryotic Cells, 291, 298 Evoke, 291, 327 Excitability, 60, 291, 307 Excrete, 275, 291, 300 Exercise Therapy, 84, 122, 124, 148, 166, 175, 198, 291 Exogenous, 60, 291 Exopeptidases, 273, 291 Expiration, 291, 321 Extensor, 292, 318, 329 External-beam radiation, 292, 318 Extracellular, 20, 53, 284, 292, 305, 325 Extracellular Matrix, 53, 284, 292 Extracellular Space, 292, 305 Extremity, 14, 38, 43, 44, 48, 51, 179, 292, 304, 312, 323 F Family Planning, 241, 292 Fat, 275, 278, 279, 285, 290, 292, 294, 302, 306, 311, 322, 325, 328 Fatigue, 21, 24, 41, 78, 147, 176, 180, 207, 282, 292, 306 Fatty acids, 292, 316 Femur, 191, 292 Fetal Weight, 180, 292 Fetus, 9, 180, 292, 315, 331, 332 Fever of Unknown Origin, 220, 292 Fibrosis, 41, 55, 168, 185, 292, 323 Fibrositis, 169, 292 Fibrotic tissue, 15, 292 Finite Element Analysis, 27, 292 Fixation, 39, 182, 292, 324 Flatus, 293 Flexion, 9, 11, 51, 58, 79, 165, 177, 178, 226, 293, 301 Fluoxetine, 151, 293 Fold, 35, 179, 293 Foramen, 281, 293, 296 Forearm, 277, 293, 304, 329 Fovea, 293

Functional magnetic resonance imaging, 20, 293 Fundus, 293, 311 G Gait, 146, 208, 293 Gallbladder, 271, 287, 293, 302 Gamma Rays, 293, 318, 319 Ganglia, 47, 60, 271, 293, 308, 313, 326, 328 Ganglion, 31, 60, 293, 311 Gas, 20, 123, 176, 272, 273, 277, 279, 286, 287, 293, 297, 309, 327, 332 Gastrointestinal, 8, 183, 281, 293, 314, 324 Gastrointestinal tract, 281, 293, 324 Gastrula, 293, 296 Gelatin, 293, 294 Gels, 172, 293 Gene, 20, 43, 44, 45, 53, 203, 218, 273, 277, 294 General practitioner, 65, 70, 81, 294 Genital, 294, 332 Genitourinary, 294, 332 Gland, 272, 294, 303, 312, 314, 323, 327, 329 Glomerular, 33, 294, 299, 300, 321 Glomerular Filtration Rate, 33, 294, 300 Glomerulus, 294 Glucocorticoids, 272, 285, 294 Glucose, 280, 287, 294, 322 Glucose Intolerance, 287, 294 Glutamate, 204, 294 Glutamic Acid, 294, 316 Glutamine, 43, 294 Glycine, 38, 294 Glycogen, 294, 306 Glycoprotein, 294, 329, 331 Glycosaminoglycans, 294, 317 Gonadal, 295, 326 Governing Board, 295, 315 Grade, 58, 100, 295 Graft, 186, 295, 296, 298, 307 Grafting, 295, 298 Growth, 53, 219, 272, 274, 280, 295, 303, 308, 314, 323, 329, 331 Growth factors, 53, 295 H Hair Cells, 295, 304 Half-Life, 295, 314 Hand Injuries, 227, 295 Haploid, 295, 314 Headache, 17, 49, 55, 94, 110, 195, 199, 200, 295 Headache Disorders, 295

340 Back Pain

Health Behavior, 156, 295 Health Care Costs, 7, 18, 115, 157, 171, 295 Health Expenditures, 295 Health Services, 26, 36, 43, 136, 158, 287, 295 Health Status, 13, 36, 48, 115, 156, 157, 295, 296 Heart attack, 279, 296 Hematuria, 91, 296 Hemodialysis, 296, 300, 301 Hemolytic, 296, 327 Hemorrhage, 285, 287, 295, 296, 307, 314, 327, 329 Hemorrhoids, 180, 202, 296 Hemostasis, 185, 296, 324 Heredity, 294, 296 Herniated, 4, 6, 13, 18, 44, 47, 60, 152, 153, 165, 185, 194, 221, 235, 251, 252, 254, 296 Histamine, 288, 296 Homeostasis, 278, 296 Homogeneous, 61, 296 Homologous, 273, 296, 324, 328 Hormonal, 9, 49, 276, 285, 296 Hormone, 272, 285, 296, 304, 316, 322, 323, 329 Hormone therapy, 272, 296 Host, 203, 276, 291, 296, 297, 298, 332 Humeral, 296, 329 Hybrid, 8, 46, 296 Hydra, 187, 296 Hydration, 23, 41, 297 Hydrogen, 21, 276, 279, 297, 306, 309, 311, 317 Hydrolysis, 297, 300, 315, 317 Hydrophilic, 205, 297 Hydroxylysine, 283, 297 Hydroxyproline, 283, 297 Hyperalgesia, 20, 46, 60, 195, 297 Hyperostosis, 112, 297 Hypersensitivity, 60, 273, 287, 288, 297, 322, 324 Hypertension, 33, 48, 138, 203, 212, 217, 222, 279, 295, 297 Hypertrophy, 51, 297 Hypesthesia, 297, 308 Hypnotic, 17, 288, 297 Hypotension, 203, 297, 314 Hypothalamus, 276, 291, 297, 314 I Id, 107, 137, 246, 247, 248, 255, 256, 258, 264, 266, 297

Idiopathic, 10, 34, 37, 41, 61, 63, 112, 176, 234, 297 Immune response, 272, 275, 276, 285, 297, 298, 324, 332 Immune system, 277, 289, 297, 298, 303, 306, 332, 333 Immunization, 297, 298, 324 Immunogenic, 278, 297 Immunoglobulin, 274, 297, 306 Immunology, 271, 272, 297 Immunosuppressive, 31, 298 Immunosuppressive therapy, 31, 298 Immunotherapy, 277, 287, 298 Impairment, 14, 15, 43, 44, 53, 55, 56, 90, 164, 174, 223, 298, 304 Implant radiation, 298, 299, 319 Implantation, 206, 284, 298 Impotence, 298, 326 In situ, 31, 170, 298 In Situ Hybridization, 31, 298 In vitro, 28, 44, 52, 298 In vivo, 28, 31, 32, 34, 45, 52, 58, 60, 68, 81, 298, 305 Incision, 298, 300 Incontinence, 203, 298, 326 Indicative, 212, 298, 312, 332 Induction, 12, 209, 274, 298 Infarction, 68, 285, 298, 305, 321 Infection, 4, 5, 7, 137, 203, 234, 271, 276, 277, 288, 298, 303, 309, 322, 327, 333 Infusion, 10, 45, 88, 298, 307 Initiation, 62, 154, 298 Inlay, 299, 321 Innervation, 121, 299, 304, 306, 313, 323, 329 Inpatients, 43, 299 Insight, 31, 34, 192, 299 Instillation, 200, 299 Insulator, 299, 306 Interleukin-1, 199, 200, 299 Interleukin-2, 299 Intermittent, 9, 59, 299, 302 Internal radiation, 299, 318 Interstitial, 278, 292, 299, 321 Intervention Studies, 24, 299 Intervertebral Disk Displacement, 299, 303, 319, 323 Intestine, 278, 289, 296, 299, 301, 327 Intoxication, 299, 333 Intracellular, 298, 299, 304, 315, 317, 320, 323 Intracellular Membranes, 299, 304

Index 341

Intramuscular, 29, 84, 199, 200, 299, 312 Intraocular, 176, 290, 299, 332 Intrathecal, 65, 199, 200, 206, 299 Intravenous, 66, 100, 298, 299, 312 Inulin, 294, 299 Invasive, 19, 23, 40, 41, 49, 58, 155, 173, 194, 209, 300, 303 Involuntary, 300, 307, 320, 325 Ion Channels, 46, 300, 309, 328 Ion Transport, 41, 300, 305 Ions, 204, 276, 279, 289, 297, 300, 306 Ischemia, 169, 182, 276, 300, 307, 321 Isometric Contraction, 39, 175, 300 J Job Satisfaction, 37, 82, 300 Joint Capsule, 27, 39, 300, 328 K Kb, 240, 300 Keloid, 56, 300 Kidney Failure, 220, 290, 300 Kidney Failure, Acute, 300 Kidney Failure, Chronic, 300 Kidney stone, 220, 231, 301 Kinetics, 31, 279, 301 Kyphosis, 186, 301 L Labyrinth, 301, 316 Large Intestine, 287, 299, 301, 320 Laryngectomy, 222, 301 Larynx, 301, 330 Laser therapy, 77, 301 Latency, 51, 301 Least-Squares Analysis, 301, 320 Lectin, 301, 304 Leisure Activities, 38, 301 Lens, 173, 301, 321, 332 Lesion, 182, 185, 301, 326, 328, 331 Leukocytes, 277, 278, 281, 301, 306, 309, 331 Library Services, 264, 301 Lidocaine, 38, 301 Life Expectancy, 45, 301 Ligament, 34, 147, 168, 175, 185, 201, 204, 205, 301, 326, 327 Likelihood Functions, 301, 320 Linear Models, 302, 320 Linkage, 10, 44, 302 Linkage Disequilibrium, 44, 302 Lipid, 302, 306 Lithiasis, 220, 302 Liver, 183, 271, 273, 275, 277, 287, 290, 293, 294, 302, 322, 331

Liver scan, 302, 322 Lobe, 99, 178, 302 Localized, 4, 10, 182, 194, 199, 200, 221, 273, 292, 298, 302, 308, 314, 323, 326, 331 Locomotion, 302, 314 Lod, 44, 302 Lod Score, 44, 302 Logistic Models, 302, 320 Longitudinal Studies, 35, 302 Longitudinal study, 51, 73, 155, 302 Long-Term Care, 32, 57, 302 Lordosis, 71, 89, 186, 201, 202, 207, 302 Lordotic, 183, 184, 303 Lumbago, 152, 169, 303 Lumbar puncture, 288, 303 Lumen, 173, 279, 303 Lupus, 138, 169, 303 Lymph, 281, 303 Lymph node, 281, 303 Lymphatic, 182, 200, 298, 303, 315, 326, 329 Lymphocyte, 275, 303, 304 Lymphoid, 274, 303 M Macrophage, 299, 303 Macula, 176, 293, 303 Macula Lutea, 176, 303 Magnetic Resonance Imaging, 4, 31, 43, 44, 56, 69, 95, 96, 152, 234, 303, 322 Magnetic Resonance Spectroscopy, 21, 68, 303 Malignant, 10, 275, 303, 308, 319 Malnutrition, 276, 303 Mandible, 281, 303, 321 Manic, 277, 304 Manifest, 276, 304 Mechanoreceptors, 27, 295, 304, 307 Medial, 274, 304, 322, 329 Median Nerve, 279, 304 Mediate, 288, 304 Mediator, 30, 299, 304, 324 Medical Records, 304, 322 Medical Staff, 288, 304 MEDLINE, 241, 304 Meiosis, 304, 328 Membrane, 14, 15, 271, 280, 281, 283, 291, 300, 301, 304, 305, 306, 321, 328, 330, 332 Membrane Proteins, 14, 304 Memory, 217, 274, 287, 304 Meninges, 280, 285, 289, 304 Meningitis, 304, 314 Menopause, 304, 315

342 Back Pain

Mental Disorders, 160, 304, 314, 318 Mental Health, iv, 9, 37, 49, 52, 160, 240, 242, 304, 310, 318 Mentors, 31, 304 Meperidine, 87, 305 Meta-Analysis, 120, 131, 305 Metastasis, 305 Metastatic, 7, 10, 305 Metastatic cancer, 7, 10, 305 Methionine, 305, 327 MI, 65, 83, 104, 136, 194, 269, 305 Microbe, 305, 330 Microbiology, 271, 305 Microdialysis, 46, 305 Microorganism, 282, 305, 333 Mineralocorticoids, 272, 285, 305 Mobility, 70, 90, 168, 235, 305 Mobilization, 14, 46, 130, 148, 183, 305 Modeling, 23, 31, 40, 305 Modification, 9, 305, 318 Molecular, 19, 31, 46, 47, 52, 241, 243, 277, 284, 306, 314, 320, 331 Molecular Structure, 306, 331 Molecule, 200, 275, 276, 283, 289, 297, 301, 306, 311, 317, 319, 320, 332 Monitor, 49, 173, 184, 306, 310 Monoclonal, 200, 306, 319 Monocytes, 299, 301, 306, 314 Mononuclear, 306, 331 Monotherapy, 5, 306 Morphine, 195, 282, 305, 306, 307, 311 Morphological, 14, 290, 306 Morphology, 10, 306 Motility, 306, 324 Motion Sickness, 306, 307 Motor nerve, 51, 306, 307 Mucinous, 293, 306 Mucosa, 303, 306 Multiple sclerosis, 111, 223, 306 Muscle Denervation, 51, 306 Muscle Fatigue, 148, 190, 197, 306 Muscle Fibers, 306, 307 Muscle relaxant, 7, 8, 66, 91, 234, 235, 254, 307 Muscle Spindles, 63, 307 Muscle tension, 5, 181, 182, 307 Muscular Dystrophies, 289, 307 Musculature, 11, 34, 46, 174, 191, 207, 307, 326 Musculoskeletal Diseases, 43, 48, 307 Musculoskeletal System, 45, 47, 307, 311 Myelin, 306, 307, 324

Myelography, 234, 288, 307 Myocardial Reperfusion, 307, 321 Myocardial Reperfusion Injury, 307, 321 Myocardium, 305, 307 N Naloxone, 50, 195, 307 Narcosis, 307 Narcotic, 195, 199, 234, 305, 306, 307, 311, 330 Narcotic Antagonists, 195, 307 Nausea, 66, 110, 182, 275, 307, 331 NCI, 1, 159, 239, 282, 308 Neck Pain, 72, 147, 221, 258, 308 Necrosis, 290, 298, 305, 307, 308, 321 Neoplasia, 308 Neoplasm, 308, 326, 331 Neoplastic, 164, 308 Nephropathy, 33, 308 Nephrotoxic, 220, 308 Nerve Endings, 47, 206, 308, 310 Nerve Fibers, 308, 326, 329 Nerve Growth Factor, 16, 45, 308 Nervous System, 27, 31, 45, 61, 195, 200, 204, 271, 272, 276, 279, 280, 281, 293, 294, 295, 304, 306, 307, 308, 309, 311, 313, 324, 328 Neural, 4, 7, 32, 47, 63, 68, 71, 105, 168, 173, 183, 193, 272, 287, 304, 308, 321 Neuralgia, 199, 200, 203, 308 Neuritis, 48, 308 Neurodegenerative Diseases, 199, 308 Neuroeffector Junction, 308 Neurogenic, 51, 309, 331 Neurologic, 4, 7, 9, 19, 169, 199, 221, 309 Neurologist, 75, 309 Neuromuscular, 24, 29, 39, 91, 131, 171, 271, 309 Neuromuscular Junction, 271, 309 Neuronal, 48, 60, 169, 279, 307, 309, 313 Neurons, 27, 45, 48, 60, 203, 206, 287, 293, 307, 308, 309, 326, 328 Neuropathy, 14, 48, 309, 313, 323 Neuropeptide, 37, 309 Neurophysiology, 34, 309 Neurosurgery, 105, 247, 309 Neurotoxic, 47, 309 Neurotransmitters, 16, 309, 316 Neutrons, 273, 309, 318 Neutropenia, 309, 315 Neutrophils, 169, 301, 309, 314 Niacin, 309, 331 Nicotine, 199, 309

Index 343

Nitrogen, 273, 274, 286, 292, 294, 300, 309, 331 Nociceptors, 27, 310 Norepinephrine, 287, 288, 310 Nuclear, 7, 47, 97, 131, 168, 276, 289, 291, 293, 308, 310 Nuclei, 273, 289, 303, 309, 310, 311, 317 Nucleic acid, 298, 310 Nursing Staff, 158, 310 O Observational study, 36, 310 Occupational Exposure, 49, 310 Occupational Health, 15, 26, 48, 54, 75, 79, 310 Occupational Health Services, 15, 26, 310 Occupational Medicine, 36, 79, 96, 310 Odds Ratio, 310, 320 Oliguria, 300, 310 Opacity, 287, 310 Ophthalmology, 100, 176, 292, 311, 321 Opium, 306, 311 Opsin, 311, 321 Optic Disk, 287, 303, 311 Optic Nerve, 311, 321 Orbit, 311 Orbital, 191, 311 Orthotic Devices, 177, 187, 208, 311 Osteoarthritis, 20, 30, 41, 43, 110, 113, 117, 138, 169, 203, 221, 234, 253, 311, 314 Osteoporosis, 10, 138, 177, 217, 222, 252, 255, 278, 311 Outpatient, 67, 77, 80, 106, 128, 151, 155, 291, 311 Overweight, 107, 218, 233, 252, 311 Oxidation, 275, 311 Oxycodone, 76, 105, 311 Oxygen Consumption, 311, 321 P Pain Threshold, 195, 311 Pain, Postoperative, 203, 312 Palate, 312, 325, 332 Palliative, 9, 312, 329 Palpation, 3, 9, 125, 155, 312 Palsy, 186, 312 Pancreas, 271, 287, 312 Pancreatic, 82, 312 Parenteral, 199, 200, 312 Paresis, 308, 312 Paresthesias, 308, 312 Particle, 312, 325, 330 Partnership Practice, 312, 316 Patch, 195, 312, 330

Pathogenesis, 27, 33, 43, 52, 176, 219, 234, 312 Pathologic, 277, 285, 297, 312, 318, 321, 324 Pathologies, 51, 61, 169, 193, 312 Pathophysiology, 14, 20, 23, 312 Patient Education, 8, 24, 76, 147, 156, 222, 225, 249, 255, 262, 264, 269, 312 Patient Satisfaction, 11, 13, 24, 36, 37, 56, 62, 154, 312 Patient Selection, 134, 312 Peer Group, 49, 313 Pelvic, 76, 121, 122, 162, 164, 168, 175, 179, 181, 191, 192, 196, 202, 249, 286, 313 Peptide, 20, 291, 313, 315, 317 Perception, 15, 16, 88, 206, 313, 323 Percutaneous, 26, 29, 40, 120, 125, 253, 288, 313 Perforation, 275, 293, 313 Perfusion, 46, 313 Peridural, 55, 199, 200, 313 Perineum, 201, 313 Perineural, 55, 313 Peripheral Nerves, 14, 313, 326 Peripheral Nervous System, 308, 312, 313, 316 Peripheral Neuropathy, 14, 313 Peripheral Vascular Disease, 254, 313 Peritonitis, 313, 331 Peroneal Nerve, 313, 323 Phallic, 292, 313 Pharmacologic, 8, 26, 43, 274, 295, 313, 330, 331 Phenyl, 305, 313 Phosphorus, 279, 313 Photodynamic therapy, 100, 314 Photophobia, 182, 314 Physical Examination, 3, 6, 8, 9, 34, 51, 128, 220, 234, 235, 250, 253, 314 Physical Fitness, 250, 291, 314 Physiologic, 16, 24, 28, 38, 272, 287, 295, 299, 314, 316, 320, 321 Physiology, 20, 82, 290, 309, 314 Pigment, 314, 321 Pilot study, 16, 23, 51, 62, 67, 71, 77, 80, 104, 111, 115, 117, 314 Piroxicam, 77, 314 Pituitary Gland, 285, 314 Plana, 176, 314 Plants, 220, 273, 279, 294, 299, 301, 306, 310, 314, 322, 325, 330 Plasma, 274, 280, 293, 294, 296, 300, 305, 314

344 Back Pain

Plasma cells, 274, 314 Plasminogen, 314, 327 Platelet Activating Factor, 43, 314 Platelets, 314, 315, 329 Plexus, 304, 315, 323 Poisoning, 299, 308, 315 Polymers, 15, 208, 315, 317 Polypeptide, 203, 273, 283, 291, 315, 333 Polysaccharide, 275, 280, 315, 317 Polyuria, 220, 315 Postmenopausal, 87, 311, 315 Postoperative, 110, 305, 314, 315 Postural, 42, 85, 181, 221, 235, 315 Potassium, 305, 315 Potentiates, 287, 299, 315 Potentiation, 281, 315 Practicability, 315, 330 Practice Guidelines, 62, 127, 154, 233, 242, 255, 315 Preclinical, 45, 315 Precursor, 37, 275, 288, 289, 291, 310, 314, 315, 331 Prenatal, 290, 292, 315 Presynaptic, 308, 315, 316, 328 Presynaptic Terminals, 308, 316 Prevalence, 4, 14, 16, 30, 34, 44, 45, 49, 64, 67, 84, 88, 101, 128, 134, 156, 218, 310, 316 Primary endpoint, 36, 316 Private Practice, 37, 316 Probe, 31, 305, 316 Procaine, 301, 316 Progesterone, 316, 326 Progression, 7, 41, 43, 274, 316 Progressive, 4, 33, 50, 164, 180, 282, 287, 289, 291, 295, 300, 307, 308, 311, 316, 321, 331 Projection, 286, 310, 311, 316 Proline, 283, 297, 316 Promoter, 288, 316 Prone, 192, 316 Prone Position, 192, 316 Prophase, 316, 328 Proprioception, 42, 63, 316 Prospective study, 42, 43, 57, 65, 92, 98, 121, 132, 302, 316 Prostaglandin, 182, 195, 316 Prostaglandins A, 317 Prosthesis, 21, 317 Protein C, 19, 273, 276, 317, 331 Protein S, 218, 277, 317, 322 Proteinuria, 33, 317

Proteoglycan, 23, 317 Proteolytic, 182, 283, 317 Protocol, 15, 17, 18, 24, 25, 26, 29, 33, 40, 164, 165, 317 Protons, 273, 297, 303, 317, 318 Proximal, 288, 315, 317 Pruritus, 288, 317 Psoriasis, 82, 317 Psychiatric, 51, 87, 304, 318 Psychiatry, 16, 51, 54, 58, 79, 292, 318, 327 Psychic, 318, 323 Psychosomatic, 133, 182, 318 Psychotherapy, 318, 320 Psychotropic, 52, 318 Puberty, 49, 318 Public Health, 7, 22, 39, 42, 87, 106, 117, 134, 242, 318 Public Policy, 241, 318 Publishing, 64, 113, 318 Pulmonary, 277, 300, 318 Pulmonary Artery, 277, 318 Pulmonary Edema, 300, 318 Pulposus, 6, 47, 60, 130, 168, 185, 205, 209, 221, 299, 318 Pulse, 306, 318 Q Quality of Life, 12, 15, 18, 26, 36, 45, 75, 82, 106, 121, 192, 201, 318 R Race, 54, 55, 134, 231, 318 Radiation, 56, 164, 272, 285, 290, 292, 293, 299, 318, 319, 322, 333 Radiation therapy, 56, 272, 292, 299, 318 Radicular, 20, 30, 32, 55, 119, 152, 256, 319 Radiculopathy, 30, 44, 65, 168, 199, 200, 255, 319, 323 Radioactive, 278, 295, 297, 298, 299, 302, 310, 318, 319, 322 Radiography, 65, 73, 134, 136, 234, 285, 319 Radiolabeled, 319 Radiological, 49, 193, 313, 319 Radiology, 52, 56, 69, 73, 86, 98, 101, 172, 207, 255, 319 Radiotherapy, 278, 319 Random Allocation, 319 Randomization, 15, 18, 319 Randomized clinical trial, 5, 23, 97, 111, 119, 157, 319 Randomized Controlled Trials, 17, 319 Reaction Time, 24, 320 Reassurance, 12, 45, 320

Index 345

Receptor, 43, 203, 204, 205, 206, 271, 275, 288, 320, 324 Receptors, Serotonin, 320, 324 Recombinant, 44, 320, 332 Rectum, 275, 278, 287, 293, 298, 301, 320 Recuperation, 5, 320 Recur, 9, 234, 320 Recurrence, 5, 50, 52, 90, 186, 251, 277, 320 Refer, 1, 202, 220, 278, 283, 292, 302, 303, 309, 320 Reflex, 20, 34, 42, 65, 131, 140, 199, 200, 307, 320 Refraction, 274, 320 Refractory, 230, 320 Regeneration, 53, 320 Regimen, 289, 320 Regression Analysis, 37, 320 Relative risk, 44, 320 Relaxant, 320 Reliability, 12, 34, 49, 122, 129, 130, 320 Remission, 277, 320 Renal failure, 220, 296, 321 Renal pelvis, 301, 321 Reperfusion, 169, 307, 321 Reperfusion Injury, 169, 321 Resection, 185, 306, 321 Resolving, 249, 321 Resorption, 278, 321 Respiration, 75, 85, 275, 279, 286, 306, 321 Restoration, 80, 206, 307, 314, 321 Retina, 176, 281, 284, 287, 301, 303, 311, 321, 322, 332 Retinae, 176, 303, 321 Retinal, 176, 287, 311, 321, 332 Retinal Detachment, 287, 321, 332 Retinal pigment epithelium, 176, 321 Retinol, 321, 322 Retrograde, 14, 322 Retrospective, 72, 115, 322 Retrospective study, 72, 322 Rheumatic Diseases, 114, 219, 220, 233, 234, 322 Rheumatism, 95, 105, 172, 218, 322 Rheumatoid, 169, 203, 215, 314, 322 Rheumatoid arthritis, 169, 314, 322 Ribosome, 322, 330 Rigidity, 209, 314, 322 Risk factor, 6, 14, 34, 35, 42, 43, 47, 48, 49, 63, 79, 94, 96, 98, 102, 222, 250, 254, 302, 316, 320, 322 Rod, 60, 322

S Sacroiliac Joint, 99, 181, 191, 322 Sagittal, 25, 58, 322 Saline, 46, 183, 322 Saliva, 322 Salivary, 49, 287, 322 Salivary glands, 287, 322 Saponins, 322, 327 Scans, 60, 158, 173, 322 Schizoid, 323, 333 Schizophrenia, 199, 323, 333 Schizotypal Personality Disorder, 323, 333 Sciatic Nerve, 48, 313, 323, 329 Scleroderma, 169, 323 Sclerosis, 199, 200, 306, 323 Scoliosis, 41, 57, 186, 221, 222, 235, 251, 323 Screening, 9, 75, 83, 152, 193, 203, 282, 323 Second Messenger Systems, 309, 323 Secretion, 285, 294, 296, 305, 323 Sedative, 17, 282, 288, 323 Sedentary, 16, 201, 323 Segmental, 39, 52, 57, 63, 155, 218, 323, 326 Segmentation, 323 Seizures, 274, 323 Self Care, 124, 250, 251, 271, 323 Senile, 176, 311, 323 Sensibility, 273, 297, 324 Sensitization, 32, 47, 324 Sensory loss, 319, 324, 326 Sequencing, 20, 324 Serotonin, 151, 287, 293, 320, 324, 331 Sex Behavior, 303, 324 Sex Behavior, Animal, 303, 324 Sex Characteristics, 272, 274, 318, 324 Sex Ratio, 219, 324 Sharpness, 324, 332 Shock, 162, 185, 196, 205, 324, 330 Shoulder Pain, 119, 324 Side effect, 8, 43, 152, 174, 183, 206, 272, 277, 314, 324, 330 Signs and Symptoms, 4, 49, 169, 220, 320, 324 Skeletal, 4, 97, 112, 169, 203, 207, 220, 274, 281, 286, 307, 324, 325 Skeleton, 172, 181, 221, 278, 292, 300, 317, 324 Skull, 182, 183, 191, 285, 311, 324, 329 Sleep apnea, 192, 193, 324 Smooth muscle, 296, 306, 325 Snoring, 192, 193, 325 Social Class, 48, 325

346 Back Pain

Social Environment, 318, 325 Social Support, 35, 88, 146, 157, 325 Sodium, 287, 305, 325, 327 Soft tissue, 105, 173, 175, 235, 278, 324, 325 Solvent, 206, 325 Soma, 325 Somatic, 48, 50, 272, 304, 313, 325 Sound wave, 284, 325 Spasm, 117, 164, 182, 201, 235, 267, 325 Specialist, 259, 325 Species, 143, 169, 279, 286, 296, 304, 306, 313, 318, 325, 327, 330, 331, 332, 333 Specificity, 11, 38, 272, 279, 325 Spices, 279, 325 Spinal Cord Compression, 104, 326 Spinal Cord Injuries, 319, 326 Spinal Fractures, 326 Spinal Nerve Roots, 168, 205, 319, 323, 326 Spinal Nerves, 185, 186, 209, 313, 326 Spinal Stenosis, 6, 7, 13, 18, 35, 36, 51, 57, 60, 153, 154, 221, 234, 246, 254, 326 Spinous, 174, 183, 326 Spleen, 273, 303, 326 Splint, 190, 326 Spondylitis, 10, 114, 235, 326 Spondylolisthesis, 13, 18, 40, 57, 153, 221, 326 Spondylolysis, 131, 326 Sporadic, 308, 326 Sprains and Strains, 255, 303, 326 Stabilization, 64, 155, 164, 180, 218, 326 Staging, 322, 326 Stasis, 191, 326 Steel, 60, 326 Sternum, 177, 326 Steroid, 234, 285, 322, 326 Stimulus, 20, 27, 50, 119, 288, 289, 299, 300, 301, 312, 320, 327, 329 Stomach, 167, 193, 249, 250, 268, 271, 287, 291, 293, 296, 307, 326, 327 Stool, 298, 301, 327 Strained, 235, 252, 254, 327 Streptococci, 327 Streptokinase, 88, 327 Stroke, 110, 160, 203, 217, 240, 248, 256, 279, 327 Stupor, 307, 327 Subacute, 35, 90, 91, 98, 119, 132, 172, 298, 327 Subarachnoid, 295, 314, 327 Subclinical, 298, 323, 327

Subcutaneous, 114, 199, 200, 206, 289, 312, 327 Subspecies, 325, 327 Suction, 196, 327 Sulfur, 176, 305, 327 Supine, 121, 178, 206, 327 Supine Position, 178, 206, 327 Suppression, 12, 285, 327 Sweat, 209, 327 Sweat Glands, 327 Sympathetic Nervous System, 47, 276, 309, 328 Symphysis, 175, 281, 328 Symptomatic, 30, 44, 45, 51, 58, 277, 328 Symptomatic treatment, 277, 328 Synapses, 278, 281, 308, 309, 328 Synapsis, 328 Synaptic, 206, 309, 328 Synaptic Transmission, 309, 328 Synergistic, 39, 169, 328 Synovial, 123, 181, 300, 328 Synovial Cyst, 123, 328 Synovial Fluid, 328 Synovial Membrane, 181, 300, 328 Systemic, 4, 6, 33, 69, 138, 182, 183, 200, 221, 273, 275, 277, 298, 314, 319, 323, 328 Systemic disease, 6, 328 Systolic, 297, 328 T Tamponade, 176, 328 Temporal, 49, 61, 63, 74, 295, 303, 329 Tendinitis, 48, 329 Tennis Elbow, 110, 329 Thermal, 16, 172, 185, 194, 206, 209, 274, 309, 329 Thigh, 48, 152, 257, 329 Thoracic, 168, 177, 186, 197, 276, 304, 329, 333 Thorax, 271, 303, 329 Threshold, 28, 195, 204, 291, 297, 329 Thrombin, 317, 329 Thrombocytopenia, 314, 329 Thrombolytic, 314, 327, 329 Thrombolytic Therapy, 327, 329 Thrombomodulin, 317, 329 Thrombosis, 317, 327, 329 Thrombus, 285, 298, 307, 329 Thymus, 297, 303, 329 Thyroid, 80, 329 Tibial Nerve, 323, 329 Tin, 234, 280, 313, 329 Tolerance, 51, 119, 158, 195, 294, 329

Index 347

Tomography, 303, 330 Tooth Preparation, 271, 330 Topical, 134, 169, 181, 182, 206, 330 Torsion, 298, 330 Toxic, iv, 26, 286, 308, 309, 330 Toxicity, 183, 206, 220, 288, 330 Toxicology, 45, 242, 330 Toxins, 275, 278, 279, 298, 330 Trace element, 329, 330 Trachea, 278, 301, 329, 330 Traction, 163, 164, 165, 166, 168, 198, 221, 222, 269, 330 Tramadol, 8, 231, 330 Transcutaneous, 5, 29, 111, 120, 125, 135, 222, 330 Transdermal, 195, 330 Transduction, 32, 206, 330 Transfection, 277, 330 Translation, 63, 330 Translational, 52, 330 Transmitter, 271, 288, 300, 304, 310, 328, 330 Transplantation, 282, 297, 301, 330 Trauma, 4, 166, 181, 198, 220, 221, 233, 235, 308, 330 Treatment Outcome, 94, 115, 330 Triage, 7, 331 Tricyclic, 8, 287, 331 Tryptophan, 43, 283, 324, 331 Tuberculosis, 303, 331 Tumor Necrosis Factor, 199, 200, 331 Tumour, 293, 331 U Ulcer, 331, 332 Ultrasonography, 292, 331 Ultrasound energy, 209, 331 Umbilicus, 331 Unconscious, 274, 286, 297, 331 Urachal Cyst, 99, 331 Urachus, 331 Urea, 300, 327, 331 Uremia, 300, 321, 331 Ureters, 301, 331 Urinary, 82, 137, 258, 279, 281, 286, 294, 298, 302, 310, 315, 331, 332

Urinary Retention, 286, 331 Urinary tract, 302, 331 Urine, 275, 277, 288, 296, 298, 300, 301, 310, 315, 317, 321, 331 Urogenital, 203, 294, 332 Uterus, 281, 293, 316, 329, 332 Uvula, 325, 332 V Vaccine, 272, 317, 332 Vagina, 281, 329, 332 Varicose, 180, 332 Varicose vein, 180, 332 Vascular, 9, 86, 281, 285, 295, 298, 329, 332 VE, 155, 332 Vector, 45, 168, 330, 332 Vein, 299, 310, 332 Venous, 200, 296, 317, 332 Ventral, 297, 326, 332 Ventricles, 191, 281, 332 Venules, 278, 279, 332 Veterinary Medicine, 241, 332 Viral, 330, 332 Virulence, 330, 332 Virus, 45, 276, 280, 330, 332 Viscera, 325, 332 Visceral, 195, 221, 276, 332 Visual Acuity, 176, 332 Vitrectomy, 176, 332 Vitreous Body, 176, 321, 332 Vitro, 28, 333 Vivo, 28, 45, 52, 58, 333 W Weight Lifting, 165, 169, 333 Weight-Bearing, 97, 333 White blood cell, 274, 301, 303, 309, 314, 333 Windpipe, 329, 333 Withdrawal, 199, 200, 206, 305, 333 X Xenograft, 274, 333 X-ray, 4, 16, 56, 96, 102, 230, 251, 268, 280, 284, 293, 307, 310, 318, 319, 322, 333 Z Zymogen, 317, 333

348 Back Pain

Back Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Lower Back Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Hip Pain: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Pain Medications - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Arm Pain: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Chronic Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Lower Abdominal Pain: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Knee Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Ankle Pain: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Foot Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Muscle Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Leg Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Joint Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Complex Regional Pain Syndrome - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Anal Pain: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Shoulder Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Neck Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Influenza A - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Hepatitis A Vaccine: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Foot and Mouth Disease - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Anagrelide: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Peanut Allergy: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Cauda Equina Syndrome - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Magnesium Citrate: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Lipomas - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Barbiturates - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Cephalexin - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Back Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Lower Back Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Hip Pain: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Pain Medications - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Arm Pain: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Chronic Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Lower Abdominal Pain: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Knee Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Ankle Pain: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Foot Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Muscle Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Leg Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Joint Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Complex Regional Pain Syndrome - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Anal Pain: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Shoulder Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Neck Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Influenza A - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Hepatitis A Vaccine: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Foot and Mouth Disease - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Anagrelide: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Peanut Allergy: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Cauda Equina Syndrome - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Magnesium Citrate: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Lipomas - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Barbiturates - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Cephalexin - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Recommend Documents