Pain as a reason to visit the doctor: a study in Finnish primary health care

Mäntyselkä, Pekka; Kumpusalo, Esko; Ahonen, Riitta; Kumpusalo, Anne; Kauhanen, Jussi; Viinamäki, Heimo; Halonen, Pirjo; Takala, Jorma

doi:10.1016/s0304-3959(00)00361-4

Cited by 397 publications

(294 citation statements)

References 12 publications

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“…Low back pain (LBP) is a common chronic musculoskeletal disorder [19,32] that causes significant disability [2,31,33,40]. Specifically, LBP has been associated with the inability to obtain or maintain employment [31] and lost productivity while still employed [33].…”

Section: Introductionmentioning

confidence: 99%

Psychosocial education improves low back pain beliefs: results from a cluster randomized clinical trial (NCT00373009) in a primary prevention setting

George

Teyhen

et al. 2009

Eur Spine J

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The general population has a pessimistic view of low back pain (LBP), and evidence-based information has been used to positively influence LBP beliefs in previously reported mass media studies. However, there is a lack of randomized trials investigating whether LBP beliefs can be modified in primary prevention settings. This cluster randomized clinical trial investigated the effect of an evidence-based psychosocial educational program (PSEP) on LBP beliefs for soldiers completing military training. A military setting was selected for this clinical trial, because LBP is a common cause of soldier disability. Companies of soldiers (n = 3,792) were recruited, and cluster randomized to receive a PSEP or no education (control group, CG). The PSEP consisted of an interactive seminar, and soldiers were issued the Back Book for reference material. The primary outcome measure was the back beliefs questionnaire (BBQ), which assesses inevitable consequences of and ability to cope with LBP. The BBQ was administered before randomization and 12 weeks later. A linear mixed model was fitted for the BBQ at the 12-week follow-up, and a generalized linear mixed model was fitted for the dichotomous outcomes on BBQ change of greater than two points. Sensitivity analyses were performed to account for drop out. BBQ scores (potential range: 9-45) improved significantly from baseline of 25.6 ± 5.7 (mean ± SD) to 26.9 ± 6.2 for those receiving the PSEP, while there was a significant decline from 26.1 ± 5.7 to 25.6 ± 6.0 for those in the CG. The adjusted mean BBQ score at follow-up for those receiving the PSEP was 1.49 points higher than those in the CG (P \ 0.0001). The adjusted odds ratio of BBQ improvement of greater than two points for those receiving the PSEP was 1.51 (95% CI = 1.22-1.86) times that of those in the CG. BBQ improvement was also mildly associated with race and college education. Sensitivity analyses suggested minimal influence of drop out. In conclusion, soldiers that received the PSEP had an improvement in their beliefs related to the inevitable consequences of and ability to cope with LBP. This is the first randomized trial to show positive influence on LBP beliefs in a primary prevention setting, and these findings have potentially important public health implications for prevention of LBP.

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Section: Introductionmentioning

confidence: 99%

Psychosocial education improves low back pain beliefs: results from a cluster randomized clinical trial (NCT00373009) in a primary prevention setting

George

Teyhen

et al. 2009

Eur Spine J

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“…Of all the painful conditions presented by older adults to doctors, knee pain is the most common (4). Although osteoarthritis is the most likely diagnosis, general practitioners often request plain radiographs in an attempt to help clinical decision making (5,6).…”

Section: Introductionmentioning

confidence: 99%

Estimating the probability of radiographic osteoarthritis in the older patient with knee pain

Peat

Thomas

Duncan

et al. 2007

Arthritis & Rheumatism

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Objective. To determine whether clinical information can practically rule in or rule out the presence of radiographic osteoarthritis in older adults with knee pain. Methods. We conducted a cross-sectional diagnostic study involving 695 adults ages >50 years reporting knee pain within the last year identified by postal survey and attending a research clinic. Potential indicators of radiographic osteoarthritis were gathered by self-complete questionnaires, clinical interview, and physical examination. Participants underwent plain radiography (posteroanterior, skyline, and lateral views). Radiographic osteoarthritis was defined as the presence of definite osteophytes in at least 1 joint compartment of the index knee. Results. Independent predictors of radiographic osteoarthritis were age, sex, body mass index, absence of whole leg pain, traumatic onset, difficulty descending stairs, palpable effusion, fixed-flexion deformity, restricted-flexion range of motion, and crepitus. Using this model, 245 participants had a predicted probability >80% (practical rule in), of whom 231 (94%) actually had radiographic osteoarthritis (specificity 93%). Twenty-one participants had a predicted probability <20% (practical rule out), of whom only 2 (10%) had radiographic osteoarthritis (sensitivity 99.6%). The predicted probability of radiographic osteoarthritis for the remaining 429 participants fell into an intermediate category (20 -79%). Conclusion. Simple clinical information can be used to estimate the probability of radiographic osteoarthritis in individual patients. However, for the majority of community-dwelling older adults with knee pain this method enables the presence of radiographic osteoarthritis to be neither confidently ruled in nor ruled out. Prospective validation and updating of these findings in an independent sample is required.

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“…2 It is typically due to osteoarthritis and associated with declines in physical function. Nonpharmacological approaches are central to managing chronic knee pain.…”

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confidence: 99%

Acupuncture for chronic knee pain: a randomized clinical trial

Hinman¹,

McCrory²,

Pirotta³

et al. 2015

Deutsche Zeitschrift für Akupunktur

124

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IMPORTANCEThere is debate about benefits of acupuncture for knee pain.OBJECTIVE To determine the efficacy of laser and needle acupuncture for chronic knee pain. DESIGN, SETTING, AND PARTICIPANTSZelen-design clinical trial (randomization occurred before informed consent), in Victoria, Australia (February 2010-December 2012. Community volunteers (282 patients aged Ն50 years with chronic knee pain) were treated by family physician acupuncturists. INTERVENTIONSNo acupuncture (control group, n = 71) and needle (n = 70), laser (n = 71), and sham laser (n = 70) acupuncture. Treatments were delivered for 12 weeks. Participants and acupuncturists were blinded to laser and sham laser acupuncture. Control participants were unaware of the trial. RESULTS At 12 weeks and 1 year, 26 (9%) and 50 (18%) participants were lost to follow-up, respectively. Analyses showed neither needle nor laser acupuncture significantly improved pain (mean difference; −0.4 units; 95% CI, −1.2 to 0.4, and −0.1; 95% CI, −0.9 to 0.7, respectively) or function (−1.7; 95% CI, −6.1 to 2.6, and 0.5; 95% CI, −3.4 to 4.4, respectively) compared with sham at 12 weeks. Compared with control, needle and laser acupuncture resulted in modest improvements in pain (−1.1; 95% CI, −1.8 to −0.4, and −0.8; 95% CI, −1.5 to −0.1, respectively) at 12 weeks, but not at 1 year. Needle acupuncture resulted in modest improvement in function compared with control at 12 weeks (−3.9; 95% CI, −7.7 to −0.2) but was not significantly different from sham (−1.7; 95% CI, −6.1 to 2.6) and was not maintained at 1 year. There were no differences for most secondary outcomes and no serious adverse events. MAIN OUTCOMES AND MEASURES CONCLUSIONS AND RELEVANCEIn patients older than 50 years with moderate or severe chronic knee pain, neither laser nor needle acupuncture conferred benefit over sham for pain or function. Our findings do not support acupuncture for these patients.TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12609001001280 JAMA. 2014;312(13):1313-1322. doi:10.1001/jama.2014 Author Audio Interview at jama.com Related article page 1342Supplemental content at jama.com C hronic knee pain affects many people older than 50 years 1 and is the most common pain concern among older people consulting family physicians. 2 It is typically due to osteoarthritis and associated with declines in physical function. Nonpharmacological approaches are central to managing chronic knee pain. 3,4 Patients with joint pain and arthritis frequently use complementary and alternative medicine. 5 Acupuncture is the most popular of alternative medical systems, with use increasing over time. 5 Although traditionally administered with needles, laser acupuncture (low-intensity laser therapy to acupuncture points) is a noninvasive alternative with evidence of benefit in some pain conditions. 6-8 Efficacy of laser acupuncture compared with needles is unknown. Preliminary evidence suggests laser may be superior to needles for myofascial trigger points. 9 A meta-analysis supports needle acupuncture for osteoart...

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Pain as a reason to visit the doctor: a study in Finnish primary health care

Cited by 397 publications

References 12 publications

Psychosocial education improves low back pain beliefs: results from a cluster randomized clinical trial (NCT00373009) in a primary prevention setting

Psychosocial education improves low back pain beliefs: results from a cluster randomized clinical trial (NCT00373009) in a primary prevention setting

Estimating the probability of radiographic osteoarthritis in the older patient with knee pain

Acupuncture for chronic knee pain: a randomized clinical trial

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