Backs Tool: A Study In Identifying Associated Factors Of Occupational Chronic Low Back Pain In A Developing Country

@#In the absence of objective definition of work- relatedness; decision- making processes, assessments, investigations, treatment and rehabilitation on chronic back pain due to work had been challenging. BACKS questionnaire was designed to assist physicians in determining occupational low back pain among employees from the aspect of reliability and validity. Each identified employee with history of chronic back pain was given chronic back pain was given the BACKS Tool prototype to be filled in. Data was analyzed via stepwise linear regression to develop a temporary model for the BACKS Tool questionnaire. A total 220 respondents were included in the study. Among the associated factors of chronic occupational back pain were physical demand, psychological demand, colleagues who complain of similar back pain, job task involved in twisting for more than 20o, age of the employees and Pain Score that was reported by the respective employees. The regression reported sensitivity of 90.9% and specificity of 95.5%. In search of determining work- relatedness among employees with occupational back pain versus those due to aging, a screening tool had to be developed to assist in providing scientific assessments that would improve employee satisfaction during educational promotion and counseling.

A Study Of Sacralisation Of Fifth Lumbar Vertebra In South Indian Population

Background: Among the congenital anomalies of the spine LSTV- Lumbosacral Transitional Vertebra is the mostcommon anomaly which is associated with the complaint of low back pain in modern era. LSTVs includesacralisation of the lowermost lumbar vertebra as well as lumbarisation of uppermost sacral segment.Aims and Objectives: The present study was done to know the incidence of sacralisation of fifth lumbar vertebrain South Indian Population.Materials and Methods: The present study includes 70 dry adult human sacra of both sexes. Note was made onthe number of sacral segments in each sacrum. Sacrum with six elements and five sacral foramina were identifiedand studied.Results and Conclusion: In the present study sacralisation was observed in 8 sacra. The knowledge of sacralisationof fifth lumbar vertebra is important to clinicians in the diagnosis and treatment of low back pain

The Relationship between Weight of Backpack and Backpain in Primary School Children in Korea

OBJECTIVE: To investigate school children's backpack loads, its association with backpack loads and backpain, school-children's perception of their backpack loads, school conditions, and personal factors that determine backpack loads in Korea. METHOD: We weighed the backpacks of 642 school children in three elementary schools in Suwon city. A validated questionnaire evaluating backpain, features of backpack carrying and subjective perceptions of backpack loads was administered to 450 schoolchildren. The data were divided into two groups, those who had experienced backpain and those who had not. Each group was analyzed according to backpack load, perception of backpack load, school condition and personal factors. RESULTS: The mean weight of the backpack was 2.65 kg, which was 7.85% of mean body weight. The number of children whose backpack loads exceeded 15% of their body weight was 3.3%. 34.5% of children experienced backpain and backpack weight and backpack weight/body weight ratio were significantly higher in the group who experienced backpain. Time spent carrying of backpacks was longer and more students reported heaviness and fatigue when carrying backpacks in the same group. There was a difference in manners of carrying of backpacks and locker usage between the two groups. An improper method of backpack carrying, which is more than 10 cm below the waistline was noted in 85% of the school children. CONCLUSION: Carrying a heavier backpack is related to backpain in schoolchildren and a wide investigation should be performed concerning backpack loads of school children in Korea. Adequate backpack load guidelines should be determined.

Incidental Diagnosis of Multiple Myeloma during Conservative Treatment for Vertebral Fracture / 대한마취과학회지

A 42-year-old male came to our pain clinic for consultation for the control of pain caused by compression fractures at T12 and L1. About 2 months ago, the patient had a T9 compression fracture after a trivial injury. We started to control the pain with epidural steroid injections and epidural patient controlled analgesia (PCA). The patient got new fractures at T8 and L2, even though on bed rest. No evidence of metabolic bone disease or malignancy was noted on routine laboratory tests. Increased uptake of radioactivity at multiple vertebrae was shown on bone scan and the magnetic resonance imaging (MRI) finding was suspected to be an infiltrative bone marrow disease. Therefore, we consulted an oncologist for further evaluation, then the patient was diagnosed with multiple myeloma with bone marrow biopsy. This case report suggests that clinicians should consider the possibility of malignancy in the case of multiple compression fractures of vertebrae especially in young male patients.

Application of Pulsed Radiofrequency to Intractable Neuropathic Pain / 대한마취과학회지

For several decades, Radiofrequency lesioning has been used for intractable pain that originates from the spinal area. Heating of the tissue has been assumed to be the only mechanism that can cause this effect. There has never been the suggestion that the RF fields themselves can modify the neuro-cellular function independently of the thermal effect. Additionally, Radiofrequency machines can not be used in neuropathic pain because of their thermal effect. Recently, a modified type of Radiofrequency machine was developed, using a non-thermal pulse, and applying a relatively high voltage. Some authors have reported remarkable results using this technique recently. There are several possible mechanisms and several attempts have been tried to explain this therapeutic effect respectively, but none of them explain it fully. One possible mechanism is through an Electro-Magnetic Field (EMF) that doesn't produce high temperature in the tip area. This is done in a pulsed fashion to avoid the high temperature made during the active cycle. However there is no apparent mechanism that explains this therapeutic effect clearly. The patient whom we report now was a 23 year-old male who suffered from repetitive low back pain and radiculopathy. He failed to respond to other oral and invasive conventional therapies. We experienced a successful result in the treatment of his intractable neuropathic pain using this pulsed RF machine.

Detection of Lumbar Disc Herniation after General Anesthesia: A case report / 대한마취과학회지

Reports of neural and non-neural injury associated with anesthesia have appeared in the medical literature. The majority of these injuries were due to improper patient positioning on the operating table and mostly correlated with the duration of surgery. We observed a case of lumbar disc herniation that was detected after general anesthesia in the traditional supine position. A 34-year-old woman underwent an operation for removal of uterine myoma. She complained of newly developed severe back pain that radiated down the lower right leg. HIVD L4~5 confirmed by lumbar MRI at POD 4th. We felt the cause of HIVD was related to the supine position or preexisting back pain with HIVD was exacerbated during surgery. This is possible to be prevented by evaluating the patient's postural limitation during the visit before anesthesia, padding under lumbar area and a more appropriate position to suit the patient needs for example, Lawn-chair position. The patient was treated with epidural injection of steroid at pain clinic.

Detection of Lumbar Disc Herniation after General Anesthesia: A case report / 대한마취과학회지

Reports of neural and non-neural injury associated with anesthesia have appeared in the medical literature. The majority of these injuries were due to improper patient positioning on the operating table and mostly correlated with the duration of surgery. We observed a case of lumbar disc herniation that was detected after general anesthesia in the traditional supine position. A 34-year-old woman underwent an operation for removal of uterine myoma. She complained of newly developed severe back pain that radiated down the lower right leg. HIVD L4~5 confirmed by lumbar MRI at POD 4th. We felt the cause of HIVD was related to the supine position or preexisting back pain with HIVD was exacerbated during surgery. This is possible to be prevented by evaluating the patient's postural limitation during the visit before anesthesia, padding under lumbar area and a more appropriate position to suit the patient needs for example, Lawn-chair position. The patient was treated with epidural injection of steroid at pain clinic.

The Effects of Selective Spinal Nerve Root Steroid Injedtion for Low Back Pain and Radicular Pain in Patients with Interbetebral Disc Herniation or Spinal stenosis / 대한마취과학회지

BACKGROUND: At present, epidural steroid injection is one of the most frequently used methods in the treatment for low back pain.. But this method is nonspecific and results in a widespread of injected agent around the target point. Therefore we thought direct injection to the nerve root is more specific and effective. METHODS: The authors evaluated the effects of lumbar paravertebral steroid injection in 39 patients with low back pain and radicular pain, retrospectively. We used triamcinolone 40mg(1ml) and 0.25% bupivacaine 3ml as injection agents and used pain relief scale(PRS) score for assessment of the effect. RESULTS: One week after injection, the patients of PRS score less than 5 were 65% in spinal stenosis and 85% in herniated intervertebral disc(HIVD). The patients of effective response more than 4 weeks after injection were 48% in spinal stenosis and 68% in HIVD, more than 12 weeks were 22% and 38%, respectively. The patients of PRS score less than 5 were 45% at the time of follow-up study. CONCLUSIONS: We think paravertebral steroid injection is effective in patients with low back pain and radicular pain. Therefore, this technique could be alternative method to epidural steroid injection.

The Effects of Single Epidural Triamcinolone Injection on the Blood ACTH and Cortisol Level / 대한마취과학회지

BACKGROUND: Epidural steroids injections are often used for the treatment of low back pain but their effects on the endocrine system have not been determined. Few studies have quantified the degree or duration of the suppression of the hypothalamic-pituitary-adrenal (HPA) axis in humans given epidural triamcinolone injection (ETI) for low back pain. The evaluation of the blood adrenocorticotropic hormone (ACTH) and cortisol was undertaken to determine the extent of suppression of the HPA axis in patients given ETI. METHODS: Lumbar epidural triamcinolone injections were performed on the painful lumbar intervertebral space with patients in the lateral decubitus position. The injection consisted of 40 mg of triamcinolone acetonide diluted in 10 mL of 1% lidocaine. Patients remained in the lateral position for 10 min after the procedure. Basal blood sampling was performed at 30 min before ETI and tested blood sampling was obtained at 7 days, 10 days, and 14 days after ETI. RESULTS: The blood cortisol level was significantly decreased at 7 days and 10 days but at 14 days was not significantly decreased and the blood ACTH level was not significantly decreased at 7 days, 10 days, and 14 days. CONCLUSIONS: Above results demonstrate that blood ACTH and cortisol level normalize 7 days and 14 days, respectively, after epidural triamcinolone 40 mg injection.