PhD Christine Cedraschi (Research Psychologist) , PT, DSc Margareta Nordin (Director), MD, PhD Alf L. Nachemson (Professor), MD Thomas L. Vischer (Professor)
{"title":"1 Health care providers should use a common language in relation to low back pain patients","authors":"PhD Christine Cedraschi (Research Psychologist) , PT, DSc Margareta Nordin (Director), MD, PhD Alf L. Nachemson (Professor), MD Thomas L. Vischer (Professor)","doi":"10.1016/S0950-3579(98)80003-4","DOIUrl":"10.1016/S0950-3579(98)80003-4","url":null,"abstract":"<div><p>Uncertainty is the rule rather than the exception when it comes to the underlying causes of ‘common’ or ‘non-specific’ low back pain. It may be called many names, depending on whether the diagnostic term is descriptive, anatomopathological or physiopathological. Classifications have been devised, including various criteria: symptoms and signs, duration, treatment, consequences of low back pain on the patients' daily life, etc. Because back pain frequently runs a recurrent course, functional and pain outcomes need to be considered separately: chronic disability and chronic pain may not be parallel. Thus, pain duration (e.g. acute, transient, recurrent, chronic) is only one element in the definition of chronicity. These difficulties in defining and classifying non-specific low back pain may lead to communication problems among health professionals as well as between patients and health professionals. These difficulties raise questions such as: what kind of diagnostic term should we use to avoid dramatization of non-specific low back pain? how can we improve the definition of long-term low back pain? and how can we assure and reassure the patient that this condition is benign in the majority of the population?</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"12 1","pages":"Pages 1-15"},"PeriodicalIF":0.0,"publicationDate":"1998-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(98)80003-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20587256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MD Federico Balagué (Médecin-chef adjoint), MD, FACP, FACR David G. Borenstein (Clinical Professor of Medicine)
{"title":"3 How to recognize and treat specific low back pain?","authors":"MD Federico Balagué (Médecin-chef adjoint), MD, FACP, FACR David G. Borenstein (Clinical Professor of Medicine)","doi":"10.1016/S0950-3579(98)80005-8","DOIUrl":"10.1016/S0950-3579(98)80005-8","url":null,"abstract":"<div><p>A wide variety of mechanical and non-mechanical disorders are associated with the clinical symptom of low back pain. Mechanical disorders are the cause of the vast majority of low back pain. Despite this frequency, the specific cause of mechanical low back pain can not be elucidated in spite of extensive diagnostic evaluation in a majority of individuals. Specific causes of low back pain are associated with less frequently occurring systemic illnesses including rheumatic, infectious, neoplastic, gynaecological and vascular disorders. The diagnostic process is more successful in identifying systemic disorders as the specific cause of low back pain. Non-surgical management is effective therapy with most patients with mechanical disorders of any form. Systemic illnesses require interventions directed specifically at healing the affected organ system.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"12 1","pages":"Pages 37-73"},"PeriodicalIF":0.0,"publicationDate":"1998-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(98)80005-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20585756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PT, MA Marco Campello (Associate Clinical Director), PhD Sherri Weiser (Coordinator Psychological Services), MD, PhD Jan W. van Doorn (Director Business Development), PT, DSc Margareta Nordin (Director)
{"title":"5 Approaches to improve the outcome of patients with delayed recovery","authors":"PT, MA Marco Campello (Associate Clinical Director), PhD Sherri Weiser (Coordinator Psychological Services), MD, PhD Jan W. van Doorn (Director Business Development), PT, DSc Margareta Nordin (Director)","doi":"10.1016/S0950-3579(98)80007-1","DOIUrl":"10.1016/S0950-3579(98)80007-1","url":null,"abstract":"<div><p>The purpose of this chapter is to promote a model to prevent chronicity and disability from non-specific low back pain (NSLBP). Delayed recovery is defined in this chapter as the period between 4 and 8 weeks after onset of NSLBP during which a patient has not yet returned to work. The recognition of predictors associated with delayed recovery at onset of the problem helps health care providers in their treatment plan. An algorithm can be useful for health care providers and employers in guiding the employee back to work. A multidisciplinary return to work programme is an essential part of the algorithm.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"12 1","pages":"Pages 93-113"},"PeriodicalIF":0.0,"publicationDate":"1998-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(98)80007-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20585761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PhD, DO, Eur Erg A. Kim Burton (Director, Spinal Research Unit), DSc, MD, FRCS Gordon Waddell (Orthopaedic Surgeon)
{"title":"2 Clinical guidelines in the management of low back pain","authors":"PhD, DO, Eur Erg A. Kim Burton (Director, Spinal Research Unit), DSc, MD, FRCS Gordon Waddell (Orthopaedic Surgeon)","doi":"10.1016/S0950-3579(98)80004-6","DOIUrl":"10.1016/S0950-3579(98)80004-6","url":null,"abstract":"<div><p>With the emergent concept of evidence-based practice, various countries have produced clinical guidelines for the management of acute low back pain since 1993–94. By and large the evidence-base for these proposals is consistent, though over the last 4 years it has increased considerably, and there has been a slight change of emphasis in several aspects. As all the guidelines are based on the same evidence, the similarity between them is not surprising. The common features are diagnostic triage along with periodic assessment to guide management strategies. There has been progressive reduction in the recommendation of rest as a treatment option, and early activation is increasingly recognized as a potent intervention. There has been a progressive recognition that psychosocial factors are important determinants for the risk of chronicity, and that such factors need to be addressed clinically. Specific therapeutic recommendations vary, but these are probably less important than the overall strategy. It is obviously hoped that clinical management should improve as a result of these initiatives, but effective dissemination and implementation are persisting concerns, and the effectiveness of clinical guidelines in changing clinical practice is still unproven.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"12 1","pages":"Pages 17-35"},"PeriodicalIF":0.0,"publicationDate":"1998-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(98)80004-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20587258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"8 What are the age-related changes in the spine?","authors":"MD, PhD Gunnar B.J. Andersson (Chairman)","doi":"10.1016/S0950-3579(98)80010-1","DOIUrl":"10.1016/S0950-3579(98)80010-1","url":null,"abstract":"<div><p>Degenerative changes of the spinal column have long been and continue to be confused with the presence of spinal distress and pain. All parts of the spine undergo degenerative changes as we age. The purpose of this chapter is to describe the degenerative process and its clinical consequences. The disc degenerative process will be discussed; its consequences on the facet joint and osteophyte formation are considered. The prevalence of disc degeneration, the role of physically demanding work and leisure and the interference of spinal deformity is clarified. A section particularly important for the clinician deals with the clinical consequences of the degenerative process in disc herniation, degenerative spondylolisthesis, spondylolysis and stenosis. This chapter tries to put the degenerative changes of the spine into the context of a normal ageing process.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"12 1","pages":"Pages 161-173"},"PeriodicalIF":0.0,"publicationDate":"1998-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(98)80010-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20585764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PhD, DSc Chris Buckland-Wright (Professor of Radiological Anatomy)
{"title":"6 Current status of imaging procedures in the diagnosis, prognosis and monitoring of osteoarthritis","authors":"PhD, DSc Chris Buckland-Wright (Professor of Radiological Anatomy)","doi":"10.1016/S0950-3579(97)80007-6","DOIUrl":"10.1016/S0950-3579(97)80007-6","url":null,"abstract":"<div><p>X-ray, magnetic resonance imaging (MRI) and arthroscopy are the methods most widely used to assess the status of osteoarthritic joints. How do these methods compare? As diagnostic tools, what is the relative sensitivity of X-ray versus MRI, arthroscopy versus MRI and arthroscopy versus X-ray? Which imaging modalities can be used for predicting progression? Scintigraphy and MRI can assess the degree of cellular activity in the tissues of a joint, which may help in prognosis. Are the methods proven and are they reliable? Recommendations for clinical trials in knee osteoarthritis, state it is essential that reproducible radiographs are obtained for reliable assessment of progression. Two radiographic views of the knee have been proposed; which provides the more reliable assessment, the knee in extension or semi-flexed? Compared with standard radiography, does microfocal radiography make a difference to patient numbers required for drug trials?</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 4","pages":"Pages 727-748"},"PeriodicalIF":0.0,"publicationDate":"1997-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80007-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20358281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MD, FRACP Philip Sambrook (Professor of Rheumatology), MBBS, FRACP Vasi Naganathan (Research Fellow)
{"title":"4 What is the relationship between osteoarthritis and osteoporosis?","authors":"MD, FRACP Philip Sambrook (Professor of Rheumatology), MBBS, FRACP Vasi Naganathan (Research Fellow)","doi":"10.1016/S0950-3579(97)80005-2","DOIUrl":"10.1016/S0950-3579(97)80005-2","url":null,"abstract":"<div><p>Several epidemiological studies have shown a lower incidence and prevalence of hip fractures in people with osteoarthritis (OA) and vice versa which has led to numerous studies examining the association between OA and osteoporosis more generally. There is felt to be an inverse relationship between these two diseases and the evidence for and against this association is discussed. The evidence for an association with osteoporosis is stronger for large joint OA than hand OA or primary generalized OA. A number of possible mechanisms for this association are discussed such as genetic factors, common risk factors, role of subchondral bone in cartilage damage and growth factors. The incidence and prevalence of one disease in the presence of the other is discussed. Despite the inverse relationship seen in some studies, there is currently no evidence that treatment of one disease can have a detrimental effect on the other.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 4","pages":"Pages 695-710"},"PeriodicalIF":0.0,"publicationDate":"1997-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80005-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20358279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MD, MPH David T. Felson (Professor of Medicine and Public Health), MPH Christine E. Chaisson (Project Manager, Epidemiologist)
{"title":"2 Understanding the relationship between body weight and osteoarthritis","authors":"MD, MPH David T. Felson (Professor of Medicine and Public Health), MPH Christine E. Chaisson (Project Manager, Epidemiologist)","doi":"10.1016/S0950-3579(97)80003-9","DOIUrl":"10.1016/S0950-3579(97)80003-9","url":null,"abstract":"<div><p>Overweight people are at high risk of developing knee osteoarthritis (OA) and may also be at increased risk of hand and hip OA. Furthermore, being overweight accelerates disease progression in knee OA. While the increased joint stress accompanying obesity may explain the strong linkage between obesity and knee OA risk, it does not necessarily explain why obese people have a high risk of disease in the hand nor why obese women are at higher comparative risk of knee disease than obese men. Unfortunately, studies of metabolic factors linked to obesity have not provided an explanation for these findings. There are a paucity of data on weight loss as a treatment for OA, but preliminary information suggests it is especially effective in knee disease and that even small amounts of weight reduction may have favourable effects.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 4","pages":"Pages 671-681"},"PeriodicalIF":0.0,"publicationDate":"1997-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80003-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20358277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BMed Stephen J. Brady, MD, FRACP, FAFRM, FAFPHM, MD Hon Causa (Lund) Peter Brooks, MBBS, FRACP Philip Conaghan, Louise M. Kenyon
{"title":"7 Pharmacotherapy and osteoarthritis","authors":"BMed Stephen J. Brady, MD, FRACP, FAFRM, FAFPHM, MD Hon Causa (Lund) Peter Brooks, MBBS, FRACP Philip Conaghan, Louise M. Kenyon","doi":"10.1016/S0950-3579(97)80008-8","DOIUrl":"10.1016/S0950-3579(97)80008-8","url":null,"abstract":"<div><p>Therapy for osteoarthritis (OA) is aimed at relieving symptoms and at maximizing function. Therapies can be considered as either symptom modifying OA drugs (SMOADs) or as disease modifying OA drugs (DMOADs). Currently available agents fall into the catagory of SMOADs. Analgesic medications, particularly paracetamol and capsaicin, have proven efficacy in OA and are recommended first line therapies. Non-steroidal anti-inflammatory drugs (NSAIDs) do appear to provide extra symptomatic benefit for some patients but have greater toxicity. Newer generation NSAIDs may have safety advantages which remain to be confirmed in practice. Further therapies are being developed which aim to prevent cartilage damage and/or aid cartilage restoration, but these DMOADs remain in the experimental stage.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 4","pages":"Pages 749-768"},"PeriodicalIF":0.0,"publicationDate":"1997-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80008-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20358282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MD, DSc Géza Bálint (Professor of Physiotherapy), MD Béla Szebenyi (Consultant Rheumatologist)
{"title":"9 Non-pharmacological therapies in osteoarthritis","authors":"MD, DSc Géza Bálint (Professor of Physiotherapy), MD Béla Szebenyi (Consultant Rheumatologist)","doi":"10.1016/S0950-3579(97)80010-6","DOIUrl":"10.1016/S0950-3579(97)80010-6","url":null,"abstract":"<div><p>Non-pharmacological therapies are very important in osteoarthritis. Each form of this treatment should be individually devised, taking into account the anatomical distribution, the phase and the progression rate of the disease. Indications, contraindications, dosage and precautions are as important in non-pharmacological therapy as they are in drug treatment.</p><p>Therapeutic exercises decrease pain, increase muscle strength and range of joint motion as well as improve endurance and aerobic capacity. Exercise programmes should be designed, conducted and regularly supervised by professionally trained physiotherapists. Weight reduction is of proven benefit in obese patients with osteoarthritis of the knee. Walking aids, crutches, shoe insoles, braces and patellar taping are useful tools in some form of osteoarthritis. Patient education and the management of the psychosocial consequences are priority tasks. Therapeutic heat and cold, electrotherapy, ultrasound, acupuncture, hydrotherapy and spa treatment are widely used, although the effects and benefits have not been fully established.</p><p>Non-pharmacological therapies should undergo rigorous randomized controlled trials in a similar manner to pharmacological studies.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 4","pages":"Pages 795-815"},"PeriodicalIF":0.0,"publicationDate":"1997-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80010-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20358284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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