摘要:

Study Design.The effect of oxytocin on low back pain in patients and its mechanism in rats were investigated.Methods.Intrathecal injection, radioimmunoassay, and potassium lontophoresis tail-flick test were used to investigate the effect of oxytocin.Results.In humans, acute and chronic low back pain causes a marked change of oxytocin content within cerebral spinal fluid and plasma: oxytocin relieves low back pain (ED50 0.172 in chronic and 0.121 μg/kg in acute). In rats, oxytocin had a dose-related analgesic effect (ED50 0.067 μg/kg). At high levels, oxytocin induced locomotor ataxia (ED50 17.915 μg/kg) and death (LD50 27.224 μg/kg). Oxytocin antagonist [d(CH2)5, Tyr(Me)2, OrnF]-vasotocin and opiate receptor-blocker naloxone could reverse oxytocin-induced analgesia. Oxytocin also increased beta-endorphin, L-encephalin, and dynorphin A1–12contents in the spinal cord, whereas oxytocin antagonist caused a decrease.Conclusions.These results suggest that oxytocin induces analgesia in low back pain involving the endogenous opiate peptide system and may be effective and safe in acute and chronic low back pain.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Study Design.This study designed and tested a functional battery based on the Dictionary of Occupational Titles (DOT).Objectives.Such a battery can be used to measure residual functional capacity (RFC) in chronic pain patients (CPP) and results can be matched against the demand minimum functional capacities (DMFC) of DOT jobs.Summary of Background Data.Physicians have difficulty translating medical impairment into functional limitation and thereby establishing the RFC of CPPs.Methods.The DOT, a USA government publication, provides information about physical demands of every USA job according to 36 factors and subfactors. The authors defined and developed a fuctional battery based on these factors/subfactors. This battery was tested on 67 consecutive CPPs to determine the percentage of CPPs able to pass specific job factors and the full battery and return to some DOT job, and evaluated the effects of pain on battery performance. The data were factor analyzed.Results.The battery determined if CPPs could perform DOT job factors and had the necessary RFC to be placed in a DOT job. The vast majority of CPPs could not pass the full battery and the presence of pain and original job classification predicted whether a CPP could perform a job factor. Factor analyses grouped the factors into four independent categories supporting the design of the battery.Conclusion.The battery can assess whether CPPs are able to return to work.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Study Design.Treatment outcomes for low back pain have been measured by varying standards of pain, impairment, and disability. This study examines the relationship between these three outcomes and treatment satisfaction in patients with chronic low back pain (CLBP).Methods.Ninety CLBP patients underwent initial pain (VAS), impairment (PIS), and disability (OPQ) evaluations.Results.Correlation coefficients between initial VAS, PIS, and OPQ were all less than 0.50. At 5-year follow-up, pain and disability scores were closely matched, more with lower mean scores among workers (P= 0.04 and 0.001). For 65 rehabilitation participants, 5-year patient satisfaction scores did not relate closely with VAS, PIS, and OPQ improvements during treatment (r= 0.15, 0.01, and 0.14). Five-year satisfaction correlated weakly with current pain and disability (r = 0.32, −0.36). Satisfaction levels were higher for workers after 1 year (P= 0.01), and after 5 years (P= 0.34).Conclusions.This study suggests that CLBP patients and their health care practitioners mutually set distinct pretreatment pain, impairment, and disability goals and judge outcomes accordingly.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Study DesignThis prospective study analyzed industrial physical work demands. The patients (n = 103), sick-listed 8 weeks because of low back pain, were industrial blue-collar workers in the car manufacturing industry.ObjectivesThis study described industrial physical work demands in a sample of patients with subacute low back pain (LBP), studied the agreement between reported and observed work postures, estimated compression load on the spine, and determined the predictive validity of industrial physical work demands and occupational LBP handicap.MethodsThe patients (n = 103), sick-listed 8 weeks because of low back pain, were industrial blue-collar workers in the car manufacturing industry. Industrial physical work demands were reported by the patients and also studied at the work place. The patients' work demands commonly included lifting, forward bending, standing and twisting, working with the hands above the shoulders and a compression load on the spine of more than 2000 N, and more than 60% of the patients believed that work demands caused their LBP.ResultsSubstantial of moderate agreement was found more often between the patients' reports and the physical therapists' observations of work postures. None of the studied industrial physical work demands predicted the rate of return to work or the sick-leave during the second follow-up year.Conclusion.The correlations between reported or observed physical work demands, individual physical capacity, individual psychological capacity, spare-time activities, other factors and LBP are not clear. A workplace visit made by a physical therapist may facilitate the rehabilitation process, especially since many patients believed that work factors caused their LBP.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Study DesignThis study analyzed an education and training program concerning back and pelvic problems among pregnant women.ObjectiveThe program was aimed at reducing tack and pelvic posterior pain during pregnancy.Summary of Background DataLow back and posterior pelvic pain accounts for the majority of sick leave among pregnant women. No previous study has suggested any type of solution to this problem.MethodsFour hundred and seven consecutive pregnant women were included in the study and randomly assigned into three groups. Group A served as controls while different degrees of interventions were made in groups B and C.ResultsSerious back or posterior pelvic pain developed in 47% of all women. Pain-related problems were reduced in groups B and C (P < 0.05), and sick-leave frequency was reduced in group C (P < 0.01). For some of the women in this group pain intensity was also reduced 8 weeks post partum (P < 0.005). Weekly physical exercise before pregnancy reduced the risk for back pain problems in pregnancy (P < 0.05). A non-elastic sacro-illac belt offered some pain relief to 82% of the women with posterior pelvic pain.ConclusionsAn individually designed program reduced sick leave during pregnancy. Working with groups was less effective. Differentiation between low back and posterior pelvic pain was essential. Good physical fitness reduced the risk of back pain in a subsequent pregnency. Reduction of posterior pelvic pain by a non-elastic pelvic support was experienced by 82% of the women with posterior pelvic pain.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Study DesignThis study examined the hypothesis that a small adult vertebral canal is a marker of early impairment of growth, and that other sensitive systems may be impaired similarly, producing an adult relationship among a small canal, poor health, and academic ability.ObjectivesComparisons of health and some aspects of academic ability were made between patients whose canals were above and those below the mean at L5.MethodsSeventy-five patients were examined, 42 men and 33 women. They had comprehensive cardiovascular, respiratory, and digestive system health assessments. Their post-school qualifications were recorded, and they were assessed by the MILL HILL vocabulary test and the progressive matrices test.ResultsTwenty-two men and 21 women had canals above the mean, and 20 men and 12 women had canals below the mean. A significant difference did not exist in the age of those with wider and narrower canals. Cardlovascular symptoms and gastrcintestinal symptoms were more common in men and women with narrower canals (P = 0.04 and 0.048), but there was no significant difference in respiratory symptoms. Those with wider canals had more post-school qualifications than those with smaller canals [P = 0.04], and in men, their performance in the Mill Hill vocabulary test and the progressive matrics test approached significance (P = 0.08 and 0.06).ConclusionsThe association between a smaller vertebral canal and impairment of health and certain intellectual abilities may result from an adverse environment that affects several growing systems early in life. If the small canal is a marker of a generalized developmental disturbance, it is, to some degree, preventable.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Study DesignIn 24 rabbits, the authors transplanted autologous cancellous bone to the anterior chamber of the eye. Half of the rabbits received nicotine and half received placebo (albumin) from mini-osmotic pumps that were implanted subcutaneously. Revascularization of the bone graft was evaluated postoperatively using ophthalmology slit-lamp and fluorescein anglography, and after sacrifice using microvascular silicone injection and histology.ObjectivesThe hypothesis that nicotine inhibits the revascularization of bone graft because of its pharmacologic action on the microvasculature was tested.Summary of Background Data.Pseudoarthrosis after spinal fusion occurs more frequently in smokers as compared with nonsmokers.Methods.Observations of the bone graft were made regarding the time after implantation when vessels within the graft were noted and the pattern of these vessels. Revascularization of the graft was graded based on the observed percent area of fluorescence after injection of fluorescein. Serum levels of nicotine were measured weekly. Colored silicone was injected at sacrifice to fix the vasculature of the bone graft. Histologic analysis of undecalcified sections was performed.Results.Nicotine, as compared with placebo was associated with delayed revascularization within the graft, a smaller percent area of revascularization, and a larger number of grafts showing necrosis.Conclusions.Nicotine inhibits, but does not prevent, the revascularization of cancellous bone grafts. Inhibition of early revascularization by nicotine is proposed as the pathophysiologic mechanism by which smoking may adversely affect the healing of spinal fusions.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary of Background Data.Spondylolysis of the lower lumbar vertebrae is a non-united childhood fracture of the arch of the vertebra, persisting into adult life. Symptoms of disabling low back pain appear in a minority of patients, usually for the first time in adulthood. This pain is considered to arise from several separate sources one of which may be the spondylolysis ligament.Study Design.The innervation of the ligament has been investigated immunohistochemically.Methods.Speciments from eight patients were divided longitudinally for histology including hemaloxylin and eosin, toluidine blue, and elastic van Gieson. Histochemistry involved immunostaining for the neuropeptides: protein gene product, calcitonin gene related peptide, substance P, vasoactive intestinal peptide, and the c-flanking peptide of neuropeptide Y.Results.Immunoreactivity to calcitonin gene-related peptide, the c-peptide of neuropeptide Y, and vasoactive intestinal peptide was identified in the ligament or in the adjacent adipose tissue.Conclusion.The movement that the ligament allows at the fracture site may result in stimulation of the nerve endings both in the ligament and in the surrounding soft tissue.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Methods.Ligamenta flava obtained from nine patients with lumbar disc hernlation and ten patients with lumbar stenosis were studied at histologic, histochemical, and ultrastructural levels. Lumbar ligaments flava removed from six patients who underwent surgeries for thoracolumber fractures were used as controls.Results.Ligements flave from control subjects consisted of large elastic fibers, thin bundles of collagen fibers, and few spindle-shaped fibroblasts In proximity to the laminal insertion the ligaments had fibrocarilagireous features. In the control subjects who were age 50 or older, the cells decreased in number and areas that had fewer and thinner elastic fibers and a more abundant collagen component were visible occasionally. In patients with disc herniation, the ligaments had similar morphologic features to those of the controls of similar ages. The ligamenta flava from patients with lumbar stenosis showed areas of fibrosis in which the cells were often represented by actively synthesizing fibroblests and areas of chondroid metaplasia. Degenerating elastic fibres were seen occasionally while calcified areas were observed often.Conclusions.Ligamenta flava undergo slight fibrotic and chondrometaplastic changes with aging. No peculiar changes occur in patients with disc herniation. In spinal stenosis, fibrotic changes, chondroid metaplasia, and calcification reduce the dencity of the ligaments, which may thus bulge into the spinal canal in the standing position even if they are normal in thickness.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Study DesignThis study analyzed the relationship of disc degeneration to atherosclerotic changes in the abdominal aorta and stenosis of the ostia of the lumbar and middle sacral arteries, 86 plain radiographs of lumbosacral spines, and the corresponding abdominal aortas were evaluated in connection with routine autopsy.Results.Disc degeneration, advanced atherosclerotic manifestations, and stenosis of the ostia of the lumbar and middle sacral arteries all increased with age (P < 0.001). After partial rank correlation analysis, keeping the effect of age constant, there was still a statistically significant association between the grade of disc degeneration and stenosis of the ostia of the arteries supplying the disc. The association was stronger at upper lumbar levels (0.001 < P < 0.01) than at lower ones (0.01 < P < 0.05). Furthermore, with complicated lesions in the abdominal aorta, disc degeneration at all lumbar levels increased.ConclusionsAtherosclerosis in the abdominal aorta and especially stenosis of the ostio of the segmental arteries may play a part in lumbar disc degeneration.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID