Objective: To develop guidelines for low back pain management according to previous international guidelines and the updated literature.Methods: A report was compiled from a review of systematic reviews of guidelines published between 2013 and 2018 and meta-analysis of the management of low back pain published between 2015 and 2018. This report summarized the state-of-the-art scientific knowledge for each predefined area of the guidelines from a critical review of selected literature. A multidisciplinary panel of experts including 17 health professionals involved in low back pain management and 2 patient representatives formulated preliminary guidelines based on the compilation report and a care pathway. The compilation report and preliminary guidelines were submitted to 25 academic institutions and stakeholders for the consultation phase. From responses of academic institutions and stakeholders, the final guidelines were developed. For each area of the guidelines, agreement between experts was assessed by the RAND/UCLA method. Results:The expert panel drafted 32 preliminary recommendations including a care pathway, which was amended after academic institution and stakeholder consultation. The consensus of the multidisciplinary expert panel was assessed for each final guideline: 32 recommendations were assessed as appropriate; none was assessed as uncertain or inappropriate. Strong approval was obtained for 27 recommendations and weak for 5. Conclusion:These new guidelines introduce several concepts, including the need to early identify low back pain at risk of chronicity to provide quicker intensive and multidisciplinary management if necessary.

PurposeThe purpose of this paper is to analyse the consequences of the increasing prominence of soft skills, focusing specifically on the production of these skills and their recognition and recruitment.Design/methodology/approachThe paper draws on interviews conducted with managers in the service sector in France. Two types of services are covered: large‐scale retailing and hotel and catering services.FindingsThe paper shows that the demand for soft skills has caused the service labour process to become highly personified and underline the risks this entails.Practical implicationsThe personification of the service labour process encourages the development of specific human resource management practices in the spheres of recruitment, pay and training.Social implicationsThe results underline the need for institutional mediation in the regulation of the labour market. The personification of skills has many social implications in terms of discrimination and policies on training and skill recognition.Originality/valueThe originality of the paper lies, first, in the fact that the results relate to France, whereas most of the literature on soft skills has focused on the UK, the US and other English‐speaking countries. Furthermore, the article emphasises that managers’ practices are shaped by their attitudes towards soft skills, and in particular whether they believe them to be acquired or innate.

A systematic assessment of social role is needed in LBP care.

Pain in rheumatic diseases is primarily due to mechanical or inflammatory mechanism, but neuropathic pain (NP) component is also occurring in many conditions and is probably underdiagnosed. The purpose of this article is to provide an overview of prevalence, pathophysiological and currently available treatment of NP in rheumatic diseases. When associated with clinical evaluation assessing neurological clinical signs and neuroanatomical distribution, Douleur Neuropathique 4 Questions, painDETECT, Leeds assessment of neuropathic symptoms and signs and Neuropathic Pain Questionnaire can detect NP component. Inflammatory or connective diseases, osteoarthritis, back pain or persistent pain after surgery are aetiologies that all may have a neuropathic component. Unlike nociceptive pain, NP does not respond to usual analgesics such as paracetamol and non-steroidal anti-inflammatory drugs. Entrapment neuropathy, peripheral neuropathy or small-fibre neuropathy are different aetiologies that can lead to NP. A part of the pain labelled neuropathic is rather nociplastic, secondary to a central sensitisation mechanism. Identifying the right component of pain (nociceptive vs neuropathic or nociplastic) could help to better manage pain in rheumatic diseases with pharmacological and non-pharmacological treatments.

Purpose To compare, in a case-control study, clinical characteristics of patients with low back pain (LBP) with and without Modic 1 signal changes on MRI. Methods Patients with chronic non-specific LBP and a recent (\6 months) MRI were prospectively screened and included in Modic 1 group or control group. Patients in control group were age-and gender-matched with patients with Modic 1 group. Pain characteristics, including night pain and worse pain on waking and morning stiffness, were recorded. The presence of at least one of these three characteristics indicated an inflammatory pain pattern. Patients were evaluated by questionnaires and physical examination (including lumbar range of motion). Data were analyzed by univariate and multivariate analyses.

BackgroundAxial Spondyloarthritis (AxSpA) and chronic low back pain are rheumatic diseases that impact patients’ health-related quality of life (HRQoL). In other chronic conditions, HRQoL was positively associated with dispositional optimism, a personality trait. The objective was to explore the relationship between optimism and HRQoL in these two diseases.MethodA cross-sectional study was performed in 2 tertiary care hospitals and 2 private practices in France. Patients had definite AxSpA or chronic low back pain according to the rheumatologist. A generic HRQoL questionnaire (Short Form, SF-12) with physical and mental composite scores (PCS and MCS respectively) and an optimism questionnaire (the Life Orientation Test-revised, LOT-R) were collected. Analyses included non-parametric correlations and multiple regression analyses to study the effect of optimism on PCS and MCS.ResultsIn all, 288 (199 AxSpA and 89 low back pain) patients were included: mean age, 47.3 ± 11.9 years, 48.6 % were males. Pain levels (0–10) were 4.5 ± 2.4 and 4.3 ± 2.4 in AxSpA and LOW BACK PAIN patients, respectively. HRQoL was similarly altered in both diseases, for both physical and mental composite scores (mean PCS: 43.7 ± 8.2 vs. 41.9 ± 7.1; mean MCS: 45.9 ± 7.8 vs. 46.7 ± 8.1 for AxSpA and low back pain respectively). Optimism was moderate and similar in both populations. Optimism was positively correlated to MCS in both diseases (rho = 0.54 and 0.58, respectively, both p <0.01) and these relations persisted in multivariate analyses (beta = 1.03 and 1.40, both p <0.0001).ConclusionsOptimism was similar in these 2 chronic diseases and was an explanatory factor of the mental component of HRQoL, but not physical HRQoL. Physical HRQoL may reflect more the disease process than character traits.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-015-0268-7) contains supplementary material, which is available to authorized users.

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Patients' symptoms have a place of prominence in the rheumatology landscape, and among them pain is the most conspicuous. Several pain assessment tools have been validated. Onedimensional pain scales such as visual analog scales (VASs) and numeric rating scales (NRSs) are fast to administer but have limitations that must be acknowledged. Some clinical situations require the use of multidimensional scales such as the McGill Pain Questionnaire or the Multidimensional Pain Inventory (MPI). These tools allow the assessment and management of the diverse components of pain. Here, we review the main patient-reported outcomes that can serve to evaluate pain and the psychometric properties of pain assessment tools. We also discuss the selection of the tool most appropriate for each situation (e.g., everyday practice and research).