Chronic Widespread Pain in Patients With Occupational Spinal Disorders

Mayer, Tom G.; Towns, Benjamin; Neblett, Randy; Theodore, Brian R.; Gatchel, Robert J.

doi:10.1097/brs.0b013e3181808c4e

Cited by 29 publications

(11 citation statements)

References 57 publications

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“…However, recent research indicates that the presence of pain is associated with depressed mood in a range of other illnesses, where pain is one symptom but not necessarily the cardinal symptom for which the patient is seeking treatment. For example, in patients following spinal cord injury, the experience of chronic widespread pain is associated with psychiatric symptoms [21]. Similar findings have been reported in patients with multiple sclerosis [22], cancer [23] and arthritis [24].…”

Section: Introductionsupporting

confidence: 57%

“…Participants in these studies typically have a high mean number of illnesses (e.g. TG Mayer, BL Towns, R Neblett, BR Theodore and RJ Gatchel [21] had a mean of three illnesses) and therefore, there is good reason to believe that these approaches would result in significant patient gain for those with complex needs, such as multi-morbidity. This is especially true of the older (> 75 years) and more frail elderly, where pain has been shown to be a particularly important challenge [57].…”

Section: Discussionmentioning

confidence: 99%

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Pain severity predicts depressive symptoms over and above individual illnesses and multimorbidity in older adults

et al. 2017

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BackgroundMulti-morbidity in older adults is commonly associated with depressed mood. Similarly, subjective reports of pain are also associated with both physical illness and increased depressive symptoms. However, whether pain independently contributes to the experience of depression in older people with multi-morbidity has not been studied.MethodsIn this study, participants were 1281 consecutive older adults presenting to one of 19 primary care services in Australia (recruitment rate = 75%). Participants were asked to indicate the presence of a number of common chronic illnesses, to rate their current pain severity and to complete the Geriatric Depression Scale.ResultsResults confirmed that the number of medical illnesses reported was strongly associated with depressive symptoms. Twenty-six percent of participants with multi-morbidity scored in the clinical range for depressive symptoms in comparison to 15% of participants with no illnesses or a single illness. In regression analyses, the presence of chronic pain (t = 5.969, p < 0.0005), diabetes (t = 4.309, p < 0.0005), respiratory (t = 3.720, p < 0.0005) or neurological illness (t = 2.701, p = 0.007) were all independent contributors to depressive symptoms. Even when controlling for each individual illness, and the overall number of illnesses (t = 2.207, p = 0.028), pain severity remained an independent predictor of depressed mood (F change = 28.866, p < 0.0005, t = 5.373, p < 0.0005).ConclusionsPhysicians should consider screening for mood problems amongst those with multi-morbidity, particularly those who experience pain.

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Section: Introductionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Pain severity predicts depressive symptoms over and above individual illnesses and multimorbidity in older adults

et al. 2017

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“…In patients with chronic LBP it has been reported that 25–38% develop chronic widespread pain [164–166], and the condition is closely associated with systemic co-morbidity and psychological disorders [167]. …”

Section: Discussionmentioning

confidence: 99%

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

Petersen¹,

Laslett²,

Juhl

2017

BMC Musculoskelet Disord

139

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BackgroundClinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization.MethodsA sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold of positive likelihood ratio ≥ 2 or negative likelihood ratio ≤ 0.5 were considered for the CDR.ResultsSixty-four studies satisfied our eligible criteria. We were able to construct promising CDRs for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making.ConclusionsThis is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic categories we have sufficient evidence to recommend a CDR. In others, we have only preliminary evidence that needs testing in future studies. Most findings were tested in secondary or tertiary care. Thus, the accuracy of the findings in a primary care setting has yet to be confirmed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1549-6) contains supplementary material, which is available to authorized users.

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“…Moreover, patients with CWP/FMS often report partial or whole work incapacity, increased sick-leave, and poor quality of life and health. [6–8] Clearly, CWP is a major health burden.…”

Section: Introductionmentioning

confidence: 99%