Prevalence and Characteristics of Back Pain in Children and Adolescents from the Region of Murcia (Spain): ISQUIOS Programme

Puberty is a vulnerable period for musculoskeletal disorders due to the existence of a wide inter-individual variation in growth and development. The main objective of the present study was to describe the prevalence of back pain (BP) in the past year and month in school-aged children according to sex, age, maturity status, body mass index (BMI) and pain characteristics. This study involved 513 students aged between 9 and 16 years. Anthropometric measures were recorded to calculate the maturity stage of the students using a regression equation comprising measures for age, body mass, body height, sitting height and leg length. An ad hoc questionnaire composed of eight questions was used to describe BP prevalence in school-aged children. The results showed that the prevalence of BP in school-aged children was observed in 35.1% over the last year (45% boys and 55% girls), and 17.3% (40.4% boys and 59.6% girls, with an association found between female sex and BP) in the last month. The prevalence of back pain in the past year and month was higher the older the students were, or the more pubertal development they had experienced. The prevalence of BP in the last year was also higher in those with overweight or obesity. After adjustment for sex, there was an association between BP and older age and higher BMI in boys and an association between BP and higher pubertal development in girls. In summary, the present study showed that the prevalence of BP was related to the maturity stage and weight of the participants, with different prevalence patterns found according to sex.

The emergency visits for back and neck pain during lockdowns

Purpose To assess the rate of visits to the emergency department of our medical center concerning low back or neck pain as a factor of COVID-19 confinement. Methods The study period was a 30-week interval during the COVID-19 pandemic contrasted by a similar stretch in the year preceding the epidemic. Visits to the emergency department prompted by low back or neck pain were recorded prior to and during lockdowns of the pandemic. The significance of the confinements for the development of pain syndromes was evaluated. Results A total of 1530 patients with newly diagnosed back or neck pain were enrolled. Most patients visited our emergency department for low back pain, commonly those older than 60 years. No significant gender variance was disclosed, although most visits of females were for low back pain. Low back pain presentations were curbed following confinement, but the rate of stays for neck pain swelled by more than 10%. Despite back pain predominance, visits for neck pain persisted. Before COVID-19, the average weekly number of emergency department visits was 38.5. This was followed by sharp drops during the COVID-19 lockdown (mean difference=-22.2, 95% CI=-28.7, -15.7, p<0.001) (not significant). Conclusions COVID-19 lockdowns have a significant impact on emergency department presentations due to back and neck pain. A higher rate of presentation for back pain compared to neck pain is probably related to COVID-19, without being affected directly by SARS-CoV-2: confinement-induced immobility might instigate musculoskeletal sequelae, which may be attributed to stress or other psychosocial afflictions.

Price elasticity of demand for new and recurring opioid prescriptions

Objective: Several U.S. states have recently enacted excise taxes to curb prescription opioid use and other states are considering similar measures. We assessed the effects of increasing out-of-pocket costs (OPC) on new and recurring opioid fills. Methods: We conducted a retrospective cohort study of opioid-naive individuals presenting with acute back pain using data from a nationwide claims repository. We estimated the effect of OPC on the initiation of opioid treatment in logistic regressions, controlling for socio-demographics, medical history, healthcare utilization, insurance type, and region. With the same covariates plus morphine milligram equivalents and days supplied, we estimated the effect of OPC on the number of opioid fills in negative binomial regressions. We report the price elasticity of demand (PED) for prescription opioids, defined as the percentage change in outcome resulting from a two-fold increase in OPC. Results: Of 25,531 adults diagnosed with acute back pain in Q1 of 2018, 2,451 (9.6%) filled at least one opioid prescription. In multivariable regression, the association between OPC and initiating opioid treatment was not significant (PED= -1.9%; 95% CI: -5.5%, 1.7%). However, by region, the PED was -10.3% (95% CI: -18.1%, -2.4%) in the coastal states and 1.6% (95% CI: -2.5%, 5.7%) in the central-southern states. The PED for the number of prescription fills was -3.7% (95% CI: -7.3%, -0.1%), which also differed by region. In the coastal states, the PED was -15.2% (95% CI: -24.7%, -5.7%) and in the central-southern states -1.5% (95% CI: -5.4%, 2.4%). Conclusions: Opioid fills were price sensitive in the coastal states but not in the central-southern states. Policies that would increase OPC might have a restraining effect on opioid consumption in parts, but not all of the U.S.

Misbeliefs about non-specific low back pain and attitudes towards treatment by primary care providers in Spain: a qualitative study

Aim To identify misbeliefs about the origin and meaning of non-specific chronic low back pain and to examine attitudes towards treatment by primary health care providers. Design Generic qualitative study. Methods Ten semi-structured interviews were conducted between October and November 2016 with physicians and nurses from primary health care centres in Lleida. The interviews were transcribed and analysed using inductive thematic analysis via Atlas.ti-8 software. Results Five themes were identified: i. beliefs about the origin and meaning of chronic low back pain, ii. psychosocial aspects of pain modulators, iii. Therapeutic exercise as a treatment for chronic low back pain, iv. biomedical attitudes of primary health care providers, and v. difficulties in the clinical approach to chronic low back pain. Conclusion Primary health care providers have a unifactorial view of chronic low back pain and base their approach on the biomedical model. Professionals attribute chronic low back pain to structural alterations in the lumbar spine while psychosocial factors are only recognized as pain modulators. For professionals, therapeutic exercise represents a possible solution to chronic low back pain; however, they still do not prescribe it and continue to educate on postural hygiene and recommend limiting physical and/or occupational activities, as opposed to clinical practice guidelines. These findings suggest that to improve the adherence of primary health care providers to the biopsychosocial model, it may be necessary first to modify their misbeliefs about non-specific chronic low back pain by increasing their knowledge on pain neurophysiology. Trial registration ClinicalTrials.gov Identifier: NCT02962817. Date of registration: 11/11/2016.

Anti-degenerative effect of melatonin on intervertebral disc: protective contribution against inflammation, oxidative stress, apoptosis, and autophagy

Intervertebral disc (IVD) degeneration is a leading cause of lower back pain. Although the etiology of IVD degeneration (IVDD) is unclear, excessive oxidative stress, inflammation and apoptosis and disruption of autophagy play important role in the pathogenesis of IVDD. Therefore, finding a solution to mitigate these processes could stop or reduce the development of IVDD. Melatonin, a powerful antioxidant, plays an important role in regulating cartilage tissue hemostasis. Melatonin inhibits destruction of extracellular matrix (ECM) of disc. Melatonin preserves ECM contents including sox-9, aggrecan, and collagen II through inhibiting matrix degeneration enzymes such as MMP-13. These protective effects may be mediated by the inhibition of oxidative stress, inflammation and apoptosis, and regulation of autophagy in IVD cells.

Prevalence and Associated Factors of Depressive Symptoms Among Patients With Chronic Low Back Pain: A Cross-Sectional Study

Background: Few studies have focused on depressive symptoms among patients with chronic low back pain in China. The aim of this cross-sectional study was to assess the prevalence and associated factors of depressive symptoms in patients with chronic low back pain.Methods: From May to August 2021, 1,172 patients with chronic low back pain were recruited in China. Depressive symptoms were assessed through the Patient Health Questionnaire. Associations of demographic characteristics, clinical characters and social-psychological factors with depressive symptoms were investigated among patients with chronic low back pain.Results: The prevalence of depressive symptoms was 25.00%. Logistic regression analysis found that duration of pain in 1-5 years (1-3 years: OR = 2.91, 95%CI: 1.65-5.14, 3-5 years: OR = 3.09, 95%CI: 1.55-6.15) and more severe pain (OR = 1.13, 95%CI: 1.10-1.17) were associated with higher risks of depressive symptoms. Better family function (good family function: OR = 0.25, 95%CI: 0.15-0.41, moderate family dysfunction: OR = 0.47, 95%CI: 0.29-0.77) and higher pain self-efficacy (OR = 0.94, 95%CI: 0.93-0.95) were associated with lower risks of depressive symptoms.Conclusion: Patients with chronic low back pain have a high prevalence of depressive symptoms in China. Duration of pain, pain severity, family function and pain self-efficacy were predictors of depressive symptoms among chronic low back pain patients in China. Early identification of the associated factors may be helpful for the timely management of depressive symptoms.

Six-month outcomes of an integrated primary care prevention and management program for chronic low back pain (LBP)

Background Accessible interdisciplinary, patient-centered and integrated primary care programs for chronic pain are needed for averting chronicity and improving patient outcomes. We sought 1) to develop an interdisciplinary low back pain (LBP) primary care program, and 2) to evaluate the program’s implementation and impact on patients’ physical and mental health over 6 months. A quasi-experimental pre-test/post-test design was used, and participants completed baseline, 3 and 6 months post-intervention evaluations. Referral and program process indicators were measured. Methods Clinically meaningful change in patient reported outcome measures of pain interference and intensity, physical function, depression and anxiety were defined a priori and evaluated. A multilevel regression analysis was performed to evaluate the impact of the program on change in individuals’ pain interference over 6 months. Results Forty six percent of participants were seen within 60 days of referral to the LBP program, and 464 individuals completed the program. The majority (≥ 60%) experienced a clinically meaningful improvement for pain intensity and interference at six months. A greater proportion of those with moderate (71%) or high risk (81%) of chronicity showed an improvement in pain interference than those with low risk (51%). A similar pattern emerged for depression and self-efficacy, but not for anxiety. Significant predictors of improvements in pain interference included higher prognostic risk of chronicity, younger age, sex, and lower baseline disability. Conclusion Results supported an improvement in participants’ confidence to manage their LBP. Future research will compare alternative modes of delivery (e.g. telehealth) and stratification approaches to further tailor resources to individuals’ needs.

Faktor Yang Berhubungan Dengan Keluhan Low Back Pain Pada Karyawan Bagian Line Plywood Di PT. Sumber Graha Sejahtera Luwu

Data dari International Labour Organization tahun 2018 menyebutkan bahwa lebih dari 1,8 juta kematian akibat kerja terjadi setiap tahunnya di 156 kawasan Asia dan Pasifik. Menurut world health organization sekitar 70-80% penduduk di negara maju pernah mengalami low back pain, setiap tahun 15- 45% orang dewasa menderita low back pain. Faktor yang mempengaruhi low back pain adalah umur, lama kerja, beban kerja, sikap kerja, dan indeks masa tubuh, tujuan penelitian ini adalah untuk mengetahui faktor yang berhubungan dengan keluhan low back pain pada karyawan bagian line plywood di PT. Sumber Graha Sejahtera Luwu Tahun 2021. Jenis penelitian adalah kuantitatif metode Cross-Sectional Study dengan pengambilan sampel menggunakan metode purposive sampling. Sampel penelitian sebanyak 122 orang. Data diambil dengan menggunakan kuesioner dianalisis dengan menggunakan uji Chi-square pada tingkat kepercayaan 95%. Hasil penelitian diperoleh ada hubungan antara umur dengan keluhan low back pain (p=0,000), ada hubungan antara lama kerja dengan keluhan low back pain nilai (p=0.047), ada hubungan antara beban kerja dengan keluhan low back pain nilai (p=0.000) dan ada hubungan antara sikap kerja dengan keluhan low back pain nilai (p=0.000) serta ada hubungan antara indeks masa tubuh dengan keluhan low back pain nilai (p=0.000). Diharapkan peneliti selanjutnya untuk lebih dapat menganalisis secara mendalam mengenai faktor yang berhubungan dengan keluhan low back pain pada karyawan.