Do Patients With Chronic Low Back Pain Benefit From Early Intervention Regarding Absence From Work?: A Randomized, Controlled, Single-Center Pilot Study

Study Design. A randomized, controlled, single-center pilot study. Objective. The aim of this study was to investigate the feasibility of running a trial to explore if early intervention in individuals with chronic low back pain (CLBP) would lead to an early return to work (RTW) and reduce sick leave during 12 months of follow-up compared with patients on a 3-month waiting list. Summary of Background Data. Back pain is the reason for numerous absent days from work. In Norway, the government initiated a priority program, Earlier Return to Work (ERTW), to reduce work absences through early intervention. However, no proper evaluation has been performed on populations with CLBP. There is no consensus on how RTW should be measured. Only a few studies have examined how waiting time affects RTW. Methods. Fifty-eight patients were included in the study. The group with early intervention was examined within 2 weeks, and the group on the waiting list was examined after 12 weeks. The intervention was identical in both groups and consisted of an outpatient, intensive back school. The data were obtained by questionnaire after 3, 6, and 12 months. The primary outcome was absence from work. Results. The sample size in a full-scale study must comprise at least 382 patients on the basis of the assumptions in the pilot. In the pilot study, early intervention directly compared with an ordinary waiting list did not significantly affect the number of sick leave days after 12 months of follow-up. Conclusion. A prerequisite for launching a full-scale clinical trial is a redesign of the intervention, an improvement of procedures concerning inclusion and randomization, and finally a more precise definition of RTW. Level of Evidence: 3

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Effect of Preoperative Sagittal Balance on Cervical Laminoplasty Outcomes

Study Design. Retrospective case series. Objective. To clarify how preoperative global sagittal imbalance influences outcomes in patients with cervical compression myelopathy undergoing cervical laminoplasty. Summary of Background Data. The influence of sagittal balance on outcomes of cervical laminoplasty remains uncertain. Methods. The authors retrospectively reviewed data of 106 patients who underwent double-door cervical laminoplasty between 2004 and 2011 and investigated the influence of the C7 sagittal vertical axis (SVA) on outcome scores. Primary outcomes used were Japanese Orthopedic Association (JOA) scores, Numerical Rating Scale for neck or arm pain, the Short Form 36 Health Survey (physical and mental component summary scores ), and the Neck Disability Index (NDI). Results. Ninety-two patients with complete data were eligible for inclusion. The preoperative C7 SVA was ≤5 cm in 64 patients (69.6%) and > 5 cm in 28 (30.4%). We compared each parameter by the magnitude of spinal sagittal balance (preoperative C7 SVA > 5 cm vs. C7 SVA ≤ 5 cm) after adjusting for age via the least square mean analysis because the average age was significantly higher in patients with C7 SVA > 5 cm. As for the radiographic parameters, both C2–7 SVA and C7 SVA were larger in patients when the C7 SVA was > 5 cm. Numerical Rating Scale for postoperative arm pain, postoperative JOA scores, and both pre- and postoperative physical component summary and NDI were worse in patients with C7 SVA > 5 cm; however, the JOA score recovery rate and changes in physical component summary and NDI were not significantly different. Conclusion. Postoperative functional outcome scores were significantly lower in patients with C7 SVA > 5 cm, although the improvement after cervical laminoplasty was not greatly affected. The involvement of global sagittal balance and cervical regional alignment should be considered in evaluating surgical outcomes for patients undergoing cervical laminoplasty. Level of Evidence: 4

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How Reliable Are the Reported Genetic Associations in Disc Degeneration?: The Influence of Phenotypes, Age, Population Size, and Inclusion Sequence in 809 Patients

Study Design. Prospective genetic association study. Objective. The aim of this study was to document the variations in the genetic associations, when different magnetic resonance imaging (MRI) phenotypes, age stratification, cohort size, and sequence of cohort inclusion are varied in the same study population. Summary of Background Data. Genetic associations with disc degeneration have shown high inconsistency, generally attributed to hereditary factors and ethnic variations. However, the effect of different phenotypes, size of the study population, age of the cohort, etc have not been documented clearly. Methods. Seventy-one single-nucleotide polymorphisms (SNPs) of 41 candidate genes were correlated to six MRI markers of disc degeneration (annular tears, Pfirmann grading, Schmorl nodes, Modic changes, Total Endplate Damage score, and disc bulge) in 809 patients with back pain and/or sciatica. In the same study group, the correlations were then retested for different age groups, different sample, size and sequence of subject inclusion (first 404 and the second 405) and the differences documented. Results. The mean age of population (M: 455, F: 354) was 36.7 ± 10.8 years. Different genetic associations were found with different phenotypes: disc bulge with three SNPs of CILP; annular tears with rs2249350 of ADAMTS5 and rs11247361 IGF1R; modic changes with VDR and MMP20; Pfirmann grading with three SNPs of MMP20 and Schmorl node with SNPs of CALM1 and FN1 and none with Total End Plate Score. Subgroup analysis based on three age groups and dividing the total population into two groups also completely changed the associations for all the six radiographic parameters. Conclusion. In the same study population, SNP associations completely change with different phenotypes. Variations in age, inclusion sequence, and sample size resulted in change of genetic associations. Our study questions the validity of previous studies and necessitates the need for standardizing the description of disc degeneration, phenotype selection, study sample size, age, and other variables in future studies. Level of Evidence: 4

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Reliability, Validity, and Cross-Cultural Adaptation of the Turkish Version of the Bournemouth Questionnaire

Study Design. Validation of a self-report questionnaire. Objective. The purpose of this study was to investigate adaptation, validity, and reliability of the Turkish version of the Bournemouth Questionnaire. Summary of Background Data. Low back pain is one of the most frequent disorders leading to activity limitation. This pain affects most of people in their lives. The most important point to evaluate patient's functional abilities and to decide a successful therapy procedure is to manage the assessment questionnaires precisely. Methods. One hundred ten patients with chronic low back pain were included in present study. To assess reliability, test-retest and internal consistency analyses were applied. The results of test-retest analysis were assessed by using Intraclass Correlation Coefficient method (95% confidence interval). For internal consistency, Cronbach alpha value was calculated. Validity of the questionnaire was assessed in terms of construct validity. For construct validity, factor analysis and convergent validity were tested. For convergent validity, total points of the Bournemouth Questionnaire were assessed with the total points of Quebec Back Pain Disability Scale and Roland Morris Disability Questionnaire by using Pearson correlation coefficient analysis. Results. Cronbach alpha value was found 0.914, showing that this questionnaire has high internal consistency. The results of test-retest analysis were varying between 0.851 and 0.927, which shows that test-retest results are highly correlated. Factor analysis test indicated that this questionnaire had one factor. Pearson correlation coefficient of the Bournemouth Questionnaire with Roland Morris Disability Questionnaire was calculated 0.703 and it was found with Quebec Back Pain Disability Scale is 0.659. These results showed that the Bournemouth Questionnaire is very good correlated with Roland Morris Disability Questionnaire and Quebec Back Pain Disability Scale. Conclusion. The Turkish version of the Bournemouth Questionnaire is valid and reliable. Level of Evidence: 3

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Top 100 Cited Articles on Back Pain Research: A Citation Analysis

Study Design. A bibliometric review of the literature. Objective. Back pain is a global burden that leads people to seek medical service and results in work disability. Numerous studies are published annually to give new insights into back pain. However, characteristics of the high-impact articles on back pain have not been explored. The current study aimed to identify the 100 most cited articles on back pain and determine their characteristics. Summary of Background Data. Back pain is a globally leading cause of work disability. Numerous studies have been published annually to give new insight to back pain. However, comprehensive analysis to identify the most influential articles is not available until now. Methods. The Web of Science core database was searched using the subject terms “back NEAR pain,” “dorsalgia,” “backache,” “lumbar NEAR pain,” “lumbago,” “back NEAR disorder*,” “discitis.” The searching results were listed by citation times and the top 100 cited articles on back pain were identified. Important information such as author, journal, publishing year, country, institution, and study type were elicited. Results. A total of 44,460 articles on back pain were displayed. Citation times of the enrolled 100 articles ranged from 249 to 1638 with a mean value of 418. The most productive periods were 1991 to 1995 and 1996 to 2000. The journal Spine holds the largest number of 45 articles, followed by Pain with seven articles. A total of 11 countries contribute to the 100 articles and the United States topped the list. None of the high-impact articles were produced in Asian and African. Conclusion. The current citation analysis demonstrated the essential advances in the history of back pain research and determined the influential authors, institutions, countries, and journals that had outstanding contributions to the studies of back pain. Level of Evidence: 3

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Biological stress systems, adverse life events and the improvement of chronic multi-site musculoskeletal pain across a 6-year follow-up

Dysfunction of biological stress systems and adverse life events, both independently and in interaction, have been hypothesized to predict chronic pain persistence. Conversely, these factors may hamper the improvement of chronic pain. Longitudinal evidence is currently lacking. We examined whether (1) function of biological stress systems, (2) adverse life events, and (3) their combination predict the improvement of chronic multi-site musculoskeletal pain. Subjects of the Netherlands Study of Depression and Anxiety (NESDA) with chronic multi-site musculoskeletal pain at baseline (n=665) were followed-up 2, 4 and 6 years later.

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The Impact of Pain Catastrophizing on Outcomes: A Developmental Perspective across Children, Adolescents and Young Adults with Chronic Pain

Pain catastrophizing is one of the most powerful predictors of poor outcomes in youth and adults with pain; however, little is known about differential impacts of pain catastrophizing on outcomes as a function of age. The current study examined the predictive value of pain catastrophizing on pain interference and pain intensity across children, adolescents, and two age groups of young adults with chronic pain. Cross-sectional data are presented from the adult and pediatric Collaborative Health Outcomes Information Registry (CHOIR), including measures of pain catastrophizing, pain intensity, pain interference and emotional distress from 1028 individuals with chronic pain.

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