scholarly journals Early Identification and Management of Psychological Risk Factors (“Yellow Flags”) in Patients With Low Back Pain: A Reappraisal

2011 ◽  
Vol 91 (5) ◽  
pp. 737-753 ◽  
Author(s):  
Michael K. Nicholas ◽  
Steven J. Linton ◽  
Paul J. Watson ◽  
Chris J. Main
2017 ◽  
Vol 17 (1) ◽  
pp. 309-315 ◽  
Author(s):  
Margaux Le Borgne ◽  
Abdel Halim Boudoukha ◽  
Audrey Petit ◽  
Yves Roquelaure

AbstractBackground and aimsBased on a transdiagnostic approach, this study assesses the impact of cognitive and emotional processes (difficulties in emotional regulation, impulsiveness, rumination and somatosensory amplification) on the psychological risk factors of chronic low-back pain.MethodsThe study was carried out with 256 patients with chronic low-back pain. All the variables were assessed through a booklet of 10 validated questionnaires. Multiple regression analysis and moderation analysis were performed.ResultsPredictors included in multiple regression models explain 3%-42% (adjusted R2) of the variance in psychological risk factors. Moreover, analyses reveal a significant moderator effect of somatosensory amplification on the link between fear-avoidance beliefs linked to work and pain intensity (F(3;250) = 12.33; p = .00), of somatosensory amplification and brooding on the link between depression and functional repercussions (FR) on everyday life (F(3;252) = 13.36; p = .000; F(1;252) = 12.42; p = .00), of the reflection dimension of rumination on the link between the helplessness dimension of catastrophizing and FRs on sociability (F(3;252) = 37.02; p = .00). There is also a moderation analysis with a significant trend concerning the lack of emotional awareness and the difficulties in controlling impulsive behaviours.ConclusionsOur results indicate an important role of some dimensions of difficulties in emotional regulation, somatosensory amplification and rumination in the increase in negative affects and dysfunctional beliefs, and in the links between those psychological risk factors and pain/disability.ImplicationsThis study identifies some cognitive and emotional dysregulations substantially involved in work-related chronic pain. This contribute to put in place psychotherapeutic protocols to tackle these deficits and dysregulations in a relevant way.


Pain ◽  
2008 ◽  
Vol 137 (3) ◽  
pp. 564-573 ◽  
Author(s):  
Manon Truchon ◽  
Denis Côté ◽  
Lise Fillion ◽  
Bertrand Arsenault ◽  
Clermont Dionne

2021 ◽  
pp. 026921552110562
Author(s):  
Nanna Rolving ◽  
Karina Agerbo ◽  
Stine Aalkjær Clausen ◽  
Kate Ane Rauff Denby ◽  
Anna Puk Jacobsen ◽  
...  

Objective To investigate the effects of a group-based cognitive behavioural intervention for patients with persistent low back pain (LBP) and psychological risk factors referred to secondary care. Design A randomised controlled trial. Setting Silkeborg Regional Hospital, Denmark. Subjects A total of 136 participants with chronic LBP and psychological risk factors. Interventions Participants were randomised to the standard care group, including examination by a rheumatologist and/or a physiotherapist, or the intervention group, including standard care plus a multidisciplinary group-based pain management programme. Main measures Patient-reported outcomes were collected at baseline and after 6 and 12 months. The primary outcome was disability (Roland Morris Disability Questionnaire). Secondary outcomes included low back pain intensity, pain catastrophising, health-related quality of life, and sick leave. Results Among 136 participants, 68 (mean age: 41.7 years (SD 11.8)) were randomised to standard care and 68 (mean age: 46.0 years (SD 10.8)) were randomised to the intervention group. Except for age, baseline characteristics were comparable between groups. 12-month follow-up was completed by 92.6% in the intervention group and 80.9% in the standard care group. Both groups achieved significant improvements on disability, with a reduction of −4.8 points (SD 6.1) in the intervention group compared to −3.7 points (SD 5.2), resulting in an insignificant difference between groups. No significant differences were found in the secondary outcomes. Conclusion A group-based pain management programme was no more effective than standard care for patients with persistent LBP and psychological risk factors.


2020 ◽  
Vol 91 (12) ◽  
pp. 940-947
Author(s):  
Matthias Albermann ◽  
Maria Lehmann ◽  
Christian Eiche ◽  
Joachim Schmidt ◽  
Johannes Prottengeier

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.


Author(s):  
J. W. H. Luites ◽  
P. P. F. M. Kuijer ◽  
C. T. J. Hulshof ◽  
R. Kok ◽  
M. W. Langendam ◽  
...  

AbstractPurpose Based on current scientific evidence and best practice, the first Dutch multidisciplinary practice guideline for occupational health professionals was developed to stimulate prevention and enhance work participation in patients with low back pain (LBP) and lumbosacral radicular syndrome (LRS). Methods A multidisciplinary working group with health care professionals, a patient representative and researchers developed the recommendations after systematic review of evidence about (1) Risk factors, (2) Prevention, (3) Prognostic factors and (4) Interventions. Certainty of the evidence was rated with GRADE and the Evidence to Decision (EtD) framework was used to formulate recommendations. High or moderate certainty resulted in a recommendation “to advise”, low to very low in a recommendation “to consider”, unless other factors in the framework decided differently. Results An inventory of risk factors should be considered and an assessment of prognostic factors is advised. For prevention, physical exercises and education are advised, besides application of the evidence-based practical guidelines “lifting” and “whole body vibration”. The stepped-care approach to enhance work participation starts with the advice to stay active, facilitated by informing the worker, reducing workload, an action plan and a time-contingent increase of work participation for a defined amount of hours and tasks. If work participation has not improved within 6 weeks, additional treatments should be considered based on the present risk and prognostic factors: (1) physiotherapy or exercise therapy; (2) an intensive workplace-oriented program; or (3) cognitive behavioural therapy. After 12 weeks, multi-disciplinary (occupational) rehabilitation therapy need to be considered. Conclusions Based on systematic reviews and expert consensus, the good practice recommendations in this guideline focus on enhancing work participation among workers with LBP and LRS using a stepped-care approach to complement existing guidelines focusing on recovery and daily functioning.


2017 ◽  
Vol 20 (01) ◽  
pp. 1750005 ◽  
Author(s):  
Ghorbanali Mohammadi

Low back pain (LBP) is one of the most frequent occupational health problems and accounts for a large number of losses in working days and disability for workers in modern industrialized countries. The aim of this paper was to investigate the prevalence of lower back problem and to associate risk factors among high school teachers. A cross-sectional study was conducted among high school teachers using self-administered questionnaires, which were distributed to randomly selected school teachers of 7 boys’ and 10 girls’ high schools across the city of Kerman and collected between October and November 2010. A total of 296 teachers returned completed questionnaires, yielding a response rate of 78.9%. The 12-month prevalence of LBP was 68.8%, which reporting with moderate disability. The results of multiple logistic regression analysis revealed that females [odds ratio (OR): 1.85, 95% confidence interval (CI): 1.51–2.00] were positively correlated to LBP. Awkward arm posture (OR: 1.81, 95% CI: 1.24–2.62) and awkward body posture (OR: 1.23, 95% CI: 0.87–1.49) were significantly associated with LBP. Psychosocial job demands and job dissatisfaction were also significantly associated with LBP. Smoking cigarette was three times more likely to develop lower back pain when compared with non-smokers. The prevalence of LBP was high among high school teachers. A wide variety of LBP risk factors were identified in the current study. The present study indicates that the high prevalence of lower back pain may lose difficulty to teachers in getting to work and “performing” the work required of them, resulting in work absenteeism, which may decrease work productivity.


2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Vahideh Moradi ◽  
Amir-Hossein Memari ◽  
Monir ShayestehFar ◽  
Ramin Kordi

We aimed to examine systematically the available evidence on risk factors of low back pain (LBP) in athletes. We performed search without language restriction in PubMed, Ovid, Google Scholar, Scopus, and CINAHL. Longitudinal studies that examined possible risk factors of LBP in athletes were included in this systematic review. Based on methodological quality of studies, a best-evidence synthesis was conducted. Seven longitudinal studies were included, four of which had high methodological quality. Results showed that previous LBP, decreased lumbar flexion, and decreased lumbar extension are positively associated with LBP. There was moderate evidence for hip flexor tightness and high body weight as a risk factor. We found insufficient evidence for association between forward bending, previous injury, and amount of training per week, active years, age, and sex with LBP. In conclusion this study would provide a list of risk factors for LBP in athletes, though it showed a strong evidence for only a few including decrease lumbar flexion or extension, previous LBP, and high body weight. This review indicated a high heterogeneity of study characteristics including assessed risk factors and statistical techniques might limit the quality of evidence.


2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Rabia Terzi ◽  
Hasan Terzi ◽  
Tülay Özer ◽  
Ahmet Kale

Pregnancy- and lactation-associated osteoporosis (PLO) is a rare form of osteoporosis. It results in severe low back pain in the last trimester of pregnancy and in the postpartum period, decreases in height, and fragility fractures, particularly in the vertebra. The current case report presents a 32-year-old patient who presented with back and low back pain that began in the last trimester of the pregnancy and worsened at two months postpartum and who was diagnosed with pregnancy- and lactation-associated osteoporosis after exclusion of other causes; the findings are discussed in view of the current literature. PLO is a rare clinical condition causing significant disability. PLO must be kept in mind in the differential diagnosis in patients presenting with low back pain during or after pregnancy. The patients must be evaluated for the risk factors of PLO, and an appropriate therapy must be initiated.


2021 ◽  
pp. 026921552199518
Author(s):  
Mette Høj Skovbo ◽  
Karina Agerbo ◽  
Anna Jakobsen ◽  
Stine Aalkjær Clausen ◽  
Vivian Langagergaard ◽  
...  

Objective: To present the theoretical foundation and methodological considerations for a group-based pain management programme for patients with persistent non-specific low back pain and psychosocial risk factors. Method: The Template for Intervention Description and Replication (TIDieR) checklist was used as a framework for describing the content, structure and context of the program. The theoretical rationale underlying the pain management programme was described using the first three steps of the Intervention Mapping framework. The Fear-avoidance model and the Self-efficacy Theory were identified as the two main theories. These were used to establish specific factors addressed by the pain management programme as well as expected outcomes. Intervention description: A multidisciplinary, group-based programme using a cognitive-behavioural approach was developed. The programme consisting of six sessions of two hours duration, took place at a spine clinic at a regional hospital in Denmark. Psychoeducation and cognitive restructuring were specific strategies hypothesised to induce changes in outcome measures. The outcomes expected to change as a result of the intervention were disability, quality of life, sick leave and physical activity. A pilot study was performed, subsequent adjustments made and the final content and educational materials completed by January 2017. Conclusion: The theoretical foundation and underlying evidence for the hypothesised change mechanisms in the use of a cognitive-behavioural approach was presented. A theoretically sound and practically feasible intervention has been developed and its effectiveness is being determined in a randomised controlled trial, including 130 low back pain patients, which is currently underway.


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