What Triggers an LBP Flare? A Content Analysis of Individuals’ Perspectives

Pain Medicine ◽  
2019 ◽  
Vol 21 (1) ◽  
pp. 13-20 ◽  
Author(s):  
Nathalia Costa ◽  
Paul W Hodges ◽  
Manuela L Ferreira ◽  
Joanna Makovey ◽  
Jenny Setchell
Keyword(s):  
Risk Factors ◽  
Content Analysis ◽  
Low Back Pain ◽  
Online Survey ◽  
Psychological State ◽  
Low Back ◽  
Biological Factors ◽  
Lack Of Exercise ◽  
Over Time

Abstract Objective For many, low back pain (LBP) is a lifelong condition with symptoms varying over time. Previous studies have investigated long-term risk factors and triggers for onset of LBP. No study has examined causes for less distinct fluctuations of symptoms, such as “flares,” which individuals with LBP identify as a significant and worrisome part of LBP. As little is known about what triggers this type of fluctuation, we aimed to investigate individuals’ perspectives on LBP flare triggers. Methods We conducted an online survey of 130 people with LBP, asking what they think triggers their flares. Data were qualitatively examined using content analysis. Results Most participants identified biomedical (84.8%) triggers, endorsing physical/biological factors to explain the flare occurrence. Themes included active movements (35% of participants), static postures (28.1%), overdoing a task (5.3%), biomechanical dysfunction (4.4%), comorbidities (4%), lack of exercise (3.3%), work (1.8%), and medications (1.5%). Nonbiomedical triggers were reported by 15.2% and included psychosocial and contextual factors, including psychological state (6%), weather (5%), sleep (2%), diet (1.2%), and fatigue (1%). These results indicate that individuals consider biomedical factors to be the main triggers of LBP flares, but some acknowledge nonbiomedical triggers. Conclusions Study findings contrast with current pain theories, which suggest that there is a need for a reduced emphasis on biomedical causes of LBP pain, especially when persistent. Recognition of patients’ views on causes of LBP flares is crucial to better guide clinical practice and inform further research. The validity of triggers identified by LBP patients requires further investigation.

Low Back Pain in Commercial Airline Pilots

2020 ◽  
Vol 91 (12) ◽  
pp. 940-947
Author(s):  
Matthias Albermann ◽  
Maria Lehmann ◽  
Christian Eiche ◽  
Joachim Schmidt ◽  
Johannes Prottengeier
Keyword(s):  
Risk Factors ◽  
Low Back Pain ◽  
Back Pain ◽  
Online Survey ◽  
German Population ◽  
Low Back ◽  
Airline Pilots ◽  
Acute Low Back Pain ◽  
Commercial Airline ◽  
Negative Effect

BACKGROUND: In their working life, airline pilots are exposed to particular risk factors that promote nonspecific low back pain (LBP). Because of the varying incidence internationally, we evaluated the point prevalences of acute, subacute, and chronic nonspecific LBP, as well as the current prevalences in German airline pilots. Furthermore, we compared the prevalence to the general German population and to European counterparts.METHODS: An anonymous online survey of 698 participating German airline pilots was evaluated. The impairment between groups was analyzed. Prevalences from our data were compared to existing data.RESULTS: The following point prevalences were found: 8.2% acute, 2.4% subacute, 82.7% chronic LBP; 74.1% of all individuals were suffering from current LBP when answered the questionnaire. A total time spent flying greater than 600 h within the last 12 mo was significantly related to acute nonspecific LBP. Individuals with any type of LBP were significantly impaired compared to those unaffected. It was found that German airline pilots suffer more often from current LBP than the general population and have a higher point prevalence of total LBP than their European counterparts.CONCLUSIONS: The evaluation showed a surprisingly high, previously unidentified, prevalence of nonspecific LBP in German airline pilots. Why German airline pilots suffer more often from LBP remains uncertain. The number of flying hours appears to have a negative effect on developing acute low back pain, but causation cannot be concluded. Other risk factors could not be confirmed.Albermann M, Lehmann M, Eiche C, Schmidt J, Prottengeier J. Low back pain in commercial airline pilots. Aerosp Med Hum Perform. 2020; 91(12):940947.

scholarly journals Physical and psychosocial work environmental risk factors of low-back pain: protocol for a 1 year prospective cohort study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Rúni Bláfoss ◽  
Per Aagaard ◽  
Lars Louis Andersen
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Low Back Pain ◽  
Back Pain ◽  
Low Back ◽  
Psychosocial Work ◽  
Before And After ◽  
Warehouse Workers ◽  
Trunk Extensor

Abstract Background Musculoskeletal disorders, and in particular low-back pain (LBP), are common among blue collar workers. In the work environment, both physical- and psychosocial risk factors exist. Working in warehouses in Denmark involve large quantities of occupational lifting, high work pace and a low degree of influence at work. This study investigates both acute and long-term associations between physical- and psychosocial work environmental factors and risk of LBP in warehouse workers. The specific study aims are to investigate 1) exposure-response associations between quantity of occupational lifting and short-term (day-to-day) changes in LBP, 2) the influence of accumulated workdays and rest days during a working week on LBP, 3) long-term association between occupational lifting exposure and LBP when assessed over 1 year, and 4) the role of psychological and social factors on the above associations. Methods The present study is designed as a 1-year prospective cohort study that will examine full-time warehouse workers from up to five retail chains in Denmark. Study aims 1 and 2 will be addressed using objective data based on company records with information on weight of all the goods handled by each warehouse worker during every single workday for 3 weeks. During this period, each worker will reply to text messages received before and after every workday (also on days off work) in which study participants will score their pain in the low back, bodily fatigue and perceived mental stress (scale 0–10). Long-term pain development is assessed using questionnaire surveys before and after 1 year. Further, pressure pain threshold (PPT) will be measured for selected trunk extensor muscles in approximately 50 workers using algometry along with measurements of maximal trunk extensor strength. Associations are modelled using linear mixed models with repeated measures between variables and LBP controlled for relevant confounders. Discussion This study provides knowledge about the acute and long-term associations between physical- and psychosocial work environmental factors and LBP. The obtained data will have the potential to provide recommendations on improved design of the working week to minimize the risk of LBP among warehouse workers, and may potentially enable to identify a reasonable maximum lifting threshold per day (ton lifted/day).

scholarly journals Cardiovascular risk factors and low back pain in a long-term follow-up of industrial employees

2006 ◽  
Vol 32 (1) ◽  
pp. 12-19 ◽  
Author(s):  
Päivi Leino-Arjas ◽  
Svetlana Solovieva ◽  
Juhani Kirjonen ◽  
Antti Reunanen ◽  
Hilkka Riihimäki
Keyword(s):  
Risk Factors ◽  
Low Back Pain ◽  
Back Pain ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Low Back ◽  
Long Term Follow Up

scholarly journals What decreases low back pain? A qualitative study of patient perspectives

2019 ◽  
Vol 19 (3) ◽  
pp. 597-603 ◽  
Author(s):  
Jenny Setchell ◽  
Nathalia Costa ◽  
Manuela Ferreira ◽  
Paul W. Hodges
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Online Survey ◽  
Low Back ◽  
Research Perspectives ◽  
Research Findings ◽  
Management Approaches ◽  
The Individual ◽  
Survey Responses

Abstract Background and aims This study aimed to determine, from the perspective of individuals living with the condition, what decreases their low back pain (LBP). LBP affects most people at some point during their life. The condition has a meaningful effect on people’s lives including pain, reduced physical and social function, mood fluctuations, and a reduced ability to work. Despite a considerable amount of research on the topic, few strategies to reduce LBP are considered successful, and there has been little investigation into what individuals with the condition believe reduce it. This study aimed to address this gap in the literature by investigating what individuals with the condition believe reduces their LBP. Methods We employed a descriptive qualitative design using a custom-built online survey. Participants were 130 adults in Australia who self-identified as having current or having had previous LBP with or without co-morbidities. Data from the survey responses were analysed using content analysis to determine which management approaches participants considered to be effective in reducing their LBP. Results Participants most commonly said that they believed their LBP was reduced by: heat/cold (86, 66%), medication (84, 64.1%), and rest (78, 60%). Next most common was activity/exercise (73, 55.7%). Other factors such as consulting a health professional (52, 39.7%), stretching/therapeutic exercise (50, 38.1%), resting from aggravating activities (45, 34.3%), and psychological changes (41, 31.3%) were mentioned, but considerably less often. Conclusions Current literature points to the inefficacy of many of the factors participants reported as helping to reduce the effects of their condition, including the treatments that were most commonly listed by the participants in this study, namely: heat/cold, medication and rest. A possible cause of this discrepancy might be that individuals with LBP consider temporary relief (on a scale of hours) to be an acceptable outcome, whereas clinical trials tend to consider efficacy by long term outcomes (on a scale of weeks, months or years). Implications There are several implications of this research. From one perspective, there is the implication that public education about efficacious treatments may need to be enhanced as there is a discrepancy between research findings and the perspectives of individuals living with LBP. On the other hand, these findings also suggest that it is timely to re-examine the focus of LBP research to consider outcomes that are valuable to people living with the condition, which this study implies should include short term or temporary effects. The findings may also help clinicians tailor management to suit the individual patients by increasing the awareness that patient and research perspectives may at times diverge.

scholarly journals What constitutes back pain flare? A cross sectional survey of individuals with low back pain

2017 ◽  
Vol 17 (1) ◽  
pp. 294-301 ◽  
Author(s):  
Jenny Setchell ◽  
Nathalia Costa ◽  
Manuela Ferreira ◽  
Joanna Makovey ◽  
Mandy Nielsen ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Online Survey ◽  
Muscle Tension ◽  
Limited Attention ◽  
Low Back ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Duration Of Symptoms ◽  
Over Time

AbstractBackground and purposeLow back pain (LBP) is a lifelong problem for many. In acute episodes, or as a persistent condition, LBP is fluctuating in nature, with pain and other features of the condition varying in intensity and duration over time. Symptom flares (also known as flare ups) contribute to this variation and can have a great impact on the lives of those who have LBP. An important goal of treatments for, and research on, LBP is arguably to decrease symptom flare in both frequency and severity. However, this goal is problematic with little research, and no consensus, on how to define LBP flare. In particular, patients’ understandings of LBP flare have received limited attention in the literature. To appropriately address this issue, we sought to understand how flares are conceptualized by individuals with LBP.MethodsWe used an inductive, predominantly qualitative methodology, conducting an online survey with 130 individuals who self-reported experiencing LBP. The survey investigated participants’ views on LBP flare including its meaning, features and symptoms, and whether ‘flare’ and ‘pain increase’ were synonymous. Qualitative analysis of responses involved thematic and content analysis with descriptive statistics used for the quantitative component.ResultsOur data analysis found that participants identified many aspects of a flare to be important. Qualitative analyses highlighted a number of themes including that LBP flare was conceptualized as: (1) on increase in pain and other uncomfortable sensations such as paraesthesia or muscle tension, (2) an increase in the area, quality and/or duration of symptoms, (3) a reduction in physical, cognitive and/or social functioning, and (4) negative psychological and/or emotional factors. Flare was also discussed as a change that was difficult to settle. When participants considered whether ‘flare’ and ‘pain increase’ were synonymous, responses were evenly divided between ‘no’ (47%) and ‘yes’ (46%) with remaining participants ‘unsure’.ConclusionsThe key finding was that many people with LBP do not consider their condition to be flared simply on the basis of a pain increase. In general, other features were required to also change. Results highlighted that a narrow focus on pain is unlikely to differentiate minor pain events from a flare. these findings are important as they contrast with most commonly used definitions of a flare that focus predominantly on pain increase.ImplicationsOur findings have implications for understanding the trajectory of LBP over time. Understandings derived from perspectives of individuals with LBP highlight that defining flare in LBP is complex. In order to provide person-centred care, individual context and experiences should be taken into account. Therefore, understandings of LBP flare require consideration of factors beyond simply an increase in pain. A comprehensive, person-centred understanding of flare that includes a number of features beyond simply an increase in pain intensity is likely to be useful to better identify flares in research settings, assisting endeavours to understand and reduce LBP. Similarly, in clinical settings a nuanced conceptualisation of flare is likely to help health professionals communicate understandings of flare when working with individuals to manage their LBP.

scholarly journals P268 Physiotherapists' awareness, knowledge and confidence in screening and referral of suspected axSpA: a survey of UK clinical practice

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Eliza Steen ◽  
Melinda Cairns ◽  
Carol McCrum
Keyword(s):  
Risk Factors ◽  
Low Back Pain ◽  
Back Pain ◽  
Professional Education ◽  
Online Survey ◽  
Diagnostic Delay ◽  
Special Interest Groups ◽  
Free Text ◽  
Low Back ◽  
Nice Guidance

Abstract Background Axial spondyloarthritis (axSpA) is an inflammatory disease underlying around 5% of back pain presentations. It is essential that physiotherapists screen for possible axSpA and know when to refer to rheumatology. In the UK, diagnostic delays of 5-8.5 years are common. Challenges with differentiating axSpA from non-specific low back pain and poor awareness of features of axSpA that should prompt rheumatology referral may be contributing factors. Early intervention is important and NICE guidance on back pain and sciatica (2016), spondyloarthritis (2017) and the National Back and Radicular Pain Pathway (2017) aim to support better screening and earlier diagnosis. This study aimed to explore physiotherapistś awareness, knowledge and confidence in screening for and recognising signs, symptoms and risk factors of suspected axSpA and criteria for rheumatology referral. Methods An online survey of UK musculoskeletal physiotherapists was undertaken combining a multi-vignette design (axSpA, non-specific low back pain and radiculopathy) and questioning on awareness, knowledge and confidence in screening for axSpA. Distribution included online professional networks, special interest groups, social media and snowballing. Data analysis used descriptive statistics and conceptual content analysis for free text responses. Results One hundred and thirty-two surveys were analysed. Vignette analysis found only 67% of respondents (n=88/132) indicated inflammatory pathologies as a possible cause of persistent back pain. Only 60% (79/132) of respondents identified the vignette with features suspicious of axSpA compared to the vignettes of non-specific low back pain (94%) and radiculopathy (80%). Most respondents (92%, n=73/79) who correctly identified the axSpA vignette appropriately indicated referral to rheumatology. Demonstrating a ‘full awareness’ or ‘good awareness’ of NICE guidance (2017) referral criteria for axSpA was only evident within 50% of ‘clinical reasoning’ responses, and only within 20% of responses describing their approach to ‘further subjective screening’. Importance of features raising suspicion of axSpA was rated highest for family history of inflammatory arthritis (median=9/10) and least for male gender (median=5/10). Considerable importance was given to CRP, ESR and HLAB27 positivity (median=8/10). Despite expressing confidence (≥7/10) in recognising features of possible axSpA, a significant number failed to identify the axSpA vignette. Better awareness and knowledge of axSpA was associated with greater familiarity with the NICE guidance on spondyloarthritis and previous education on SpA. Conclusion The study suggests that physiotherapists may not be giving adequate consideration to possible axSpA in the differential diagnosis of persistent low back pain. Although certain features of SpA were better recognised, a significant lack of awareness and knowledge of signs, symptoms and risk factors for suspected axSpA was found. Awareness of criteria for referral to rheumatology was also limited. The consequences for diagnostic delay are significant and indicate the need for professional education and applying guidance to improve screening and earlier recognition. Disclosures E. Steen None. M. Cairns None. C. McCrum Honoraria; Novartis.

scholarly journals Long-term improvements following a residential combined physical and psychological programme for chronic low back pain

2021 ◽  
Vol 10 (2) ◽  
pp. e001068
Author(s):  
Shaun Wellburn ◽  
Cormac G Ryan ◽  
Andrew Coxon ◽  
Alastair J Dickson ◽  
D John Dickson ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Outcome Measures ◽  
Chronic Low Back Pain ◽  
Rating Scale ◽  
Secondary Outcome ◽  
Low Back ◽  
Residential Setting ◽  
Wide Range

ObjectivesEvaluate the outcomes and explore experiences of patients undergoing a residential combined physical and psychological programme (CPPP) for chronic low back pain.DesignA longitudinal observational cohort design, with a parallel qualitative design using semistructured interviews.SettingResidential, multimodal rehabilitation.Participants136 adults (62 male/74 female) referred to the CPPP, 100 (44 male/56 female) of whom completed the programme, during the term of the study. Ten (2 male/8 female) participated in the qualitative evaluation.InterventionA 3-week residential CPPP.Outcome measuresPrimary outcome measures were the STarT Back screening tool score; pain intensity—11-point Numerical Rating Scale; function—Oswestry Disability Index (ODI); health status/quality of life—EQ-5D-5L EuroQol five-Dimension-five level; anxiety—Generalised Anxiety Disorder-7; depression—Patient Health Questionnaire-9. Secondary outcome measures were the Global Subjective Outcome Scale; National Health Service Friends and Family Test;.ResultsAt discharge, 6 and 12 months follow ups, there were improvements from baseline that were greater than minimum clinically important differences in each of the outcomes (with the sole exception of ODI at discharge). At 12 months, the majority of people considered themselves a lot better (57%) and were extremely likely (86%) to recommend the programme to a friend. The qualitative data showed praise for the residential nature of the intervention and the opportunities for interaction with peers and peer support. There were testimonies of improvements in understanding of pain and how to manage it better. Some participants said they had reduced, or stopped, medication they had been taking to manage their pain.ConclusionsParticipants improved, and maintained long term, beyond minimum clinically important differences on a wide range of outcomes. Participants reported an enhanced ability to self-manage their back pain and support for the residential setting.

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