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Environmental polycyclic aromatic hydrocarbon exposure is associated with low back pain

ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2023年第7期45卷 5093-5107页

作者： Chen, Jiang Liao, Yangjie Luo, Mingjiang Tang, Siliang Huang, Jinshan Chen, Rong Xiao, Zhihong Univ South China Affiliated Hosp 2 Hengyang Med Sch Hengyang Peoples R China Cent South Univ Xiangya Hosp 3 Dept Gastroenterol Changsha 410013 Hunan Peoples R China Jishou Univ Jishou Peoples R China

Several studies have assessed the influence of several often-ignored environmental factors on low back pain (LBP), but the effects of environmental polycyclic aromatic hydrocarbon (PAH) exposure on LBP are unclear. During the 2001-2004 cycle of the National Health and Nutrition Examination Survey (NHANES), our study was given to a representative sample of US participants older than 20 (N = 2743). Environmental PAH exposure was calculated using urinary PAH metabolite concentrations. Weighted logistic regression was performed to assess the connection between PAH levels and LBP, with mediation analysis utilised to explore the underlying mechanism. Levels of 1-hydroxynaphthalene (1-OHNa), 2-hydroxynaphthalene (2-OHNa) and total PAHs had a statistically significant positive association with LBP. The odds ratios per 1-unit increase for log-transformed levels of urinary 1-OHNa, 2-OHNa, and total PAHs with LBP were 1.01 (95% CI 1.02-1.19), 1.19 (95% CI 1.04-1.36) and 1.16 (95% CI 1.03-1.32), respectively. The results revealed a strong dose-response association between 1-OHNa, 2-OHNa, total PAHs, and LBP risk. Subgroup analysis indicated that 2&3-OHPh may increase the risk of LBP in the lower family income subgroup. Gamma-glutamyl transaminase (GGT), known as a biomarker of oxidative stress, was strongly related to PAHs. The relationship between total PAHs and LBP was mediated in part by GGT. Our study demonstrates associations between environmental PAH exposure and LBP that need more research to determine the precise effects of various PAH compounds on LBP.

关键词： low back pain Polycyclic aromatic hydrocarbon Gamma-glutamyl transaminase NHANES

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Exposure to Odors Increases pain Threshold in Chronic low back pain Patients

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pain MEDICINE 2020年第10期21卷 2546-2551页

作者： Gossrau, Gudrun Baum, Daniel Koch, Thea Sabatowski, Rainer Hummel, Thomas Haehner, Antje Tech Univ Dresden Univ Pain Ctr Dresden Germany Tech Univ Dresden Dept Otorhinolaryngol Smell & Taste Clin Dresden Germany Tech Univ Dresden Fac Med Carl Gustav Carus Univ Hosp Dept Anesthesiol & Intens Care Med Dresden Germany

Objectives. Structured exposure to odors is an acknowledged therapy in patients with smell loss but has also been shown to be effective in depression. The latter might rely on connections between olfactory and emotional structures, suggesting possible effects of a similar approach in pain patients. Based on neuroanatomy, there are several interfaces between the "pain network" and olfactory system, such as the limbic system, hypothalamus, and medio-dorsal thalamus. We aimed to investigate whether structured exposure to odors may impact perceived pain in patients with chronic low back pain. Design. Randomized controlled parallel-group design. Subjects were tested on two occasions, at baseline and after four weeks. Setting. Ambulatory. Subjects. Forty-two patients with chronic low back pain Methods. For all patients, olfactory function (using the "Sniffin'Sticks" test kit), detection, and pain thresholds for cutaneous electrical stimuli (applied to the forearm) were tested at baseline and after four weeks. Twenty-eight patients exposed themselves to four odors (rose, vanilla, chocolate, peach) every two hours over a period of four weeks (training group). Control patients (N = 14) underwent no such "olfactory training" (nontraining group). Results. pain thresholds were significantly increased in patients who performed olfactory training compared with patients who did not train with odors. Detection thresholds and olfactory function remained unchanged. Conclusions. The present results indicate that regular exposure to odors increases pain thresholds in patients with chronic back pain and could be useful for general pain control in these patients. Furthermore, olfactory training in chronic pain patients might help to reduce chronification of pain by desensitization.

关键词： Odor Training low back pain pain Threshold

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Effect of a waiting room communication strategy on imaging rates and awareness of public health messages for low back pain

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INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE 2021年第4期33卷 mzab129-mzab129页

作者： Sharma, Sweekriti Traeger, Adrian C. Tcharkhedian, Elise Middleton, Paul M. Cullen, Louise Maher, Chris G. Univ Sydney Inst Musculoskeletal Hlth Camperdown NSW 2050 Australia Sydney Local Hlth Dist Camperdown NSW 2050 Australia Univ Sydney Sch Publ Hlth Sydney NSW 2006 Australia Liverpool Hosp Dept Physiotherapy Sydney NSW 2170 Australia Liverpool Hosp South Western Emergency Res Inst Liverpool NSW 2170 Australia Univ Sydney Discipline Emergency Med Sydney NSW 2006 Australia Univ Queensland Royal Brisbane & Womens Hosp Emergency & Trauma Ctr Brisbane Qld 4029 Australia

background Few studies have investigated the effects of waiting room communication strategies on health-care behavior. Objective We aimed to determine the effect of a waiting room communication strategy, designed to raise awareness of potential harms of unnecessary imaging, on lumbar imaging rates in the emergency department (ED). Methods We conducted a controlled experimental study with a replicated time series design. The design included a 6-week run-in time. Following this there were alternating 1-week intervention and control periods. The intervention group received a communication strategy describing the potential harms of unnecessary imaging for low back pain, shown on a 55" LCD screen positioned in the ED waiting room. The communication strategy was designed by a creative innovation agency and included five digital posters and a patient leaflet. The control group received standard messaging for the waiting room at the time, shown on the same 55" LCD screen, and access to the patient leaflet. The primary outcome was the number and proportion of people presenting to ED with low back pain who received at least one lumbar imaging test, measured using routinely collected ED data. Secondary patient-reported outcomes (patient satisfaction and awareness of campaign messages) were collected from a sample of people presenting for any condition who responded to a text-message-based survey. Results For the imaging outcome, 337 people presenting to ED with low back pain were included over a 4-month period (intervention n = 99;control n = 238). All had available data on lumbar imaging. Use of lumbar imaging was 25% in those exposed to the communication strategy [95% confidence interval (CI) = 18% to 35%] compared with 29% in those exposed to the standard waiting room messaging [95% CI = 23% to 35%;odds ratio (OR) = 0.83, 95% CI = 0.49 to 1.41]. For the patient-reported outcomes, 349 patients presenting to ED for any condition responded to the survey (intervention n = 170;c

关键词： low back pain diagnostic imaging emergency department health promotion

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Sports, Smoking, and Overweight During Adolescence as Predictors of Sciatica in Adulthood: A 28-Year Follow-up Study of a Birth Cohort

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AMERICAN JOURNAL OF EPIDEMIOLOGY 2011年第8期173卷 890-897页

作者： Rivinoja, Anni E. Paananen, Markus V. Taimela, Simo P. Solovieva, Svetlana Okuloff, Annaleena Zitting, Paavo Jarvelin, Marjo-Riitta Leino-Arjas, Paivi Karppinen, Jaro I. Finnish Inst Occupat Hlth Oulu 90220 Finland Univ Oulu Dept Phys Med & Rehabil Inst Clin Sci Oulu Finland Univ Helsinki Dept Publ Hlth Helsinki Finland Univ Oulu Inst Hlth Sci Oulu Finland

Lifestyle factors such as smoking, obesity, and level of physical activity predict low back pain (LBP) and sciatica. The authors investigated whether participating in sports, smoking, and being overweight or obese at 14 years of age predicted hospitalizations due to LBP or sciatica in adulthood. In 1980, at the age of 14 years, a total of 11,399 members of the 1966 Northern Finland Birth Cohort returned the postal questionnaire. Patients from the 1966 Northern Finland Birth Cohort who were hospitalized because of LBP or sciatica were followed to the end of 2008 through the Finnish Hospital Discharge Register. Data were analyzed using Cox's proportional hazards multistate model with the Markov clock forward time scale. During follow-up, 119 females (2.7%) and 254 males (5.6%) had been hospitalized at least once because of LBP or sciatica. Among females, overweight was associated with an increased risk of second-time hospitalization for surgical treatment for sciatica (hazard ratio = 7.1, 95% confidence interval: 1.5, 34.4). Among males, smoking was associated with an increased risk of first-time nonsurgical hospitalization (hazard ratio = 1.8, 95% confidence interval: 1.2, 2.7) and second-time surgical hospitalization (hazard ratio = 3.2, 95% confidence interval: 1.2, 8.2). The authors found potentially modifiable risk factors in adolescence that predicted hospital treatments for low back disorders during adolescence and young adulthood.

关键词： adolescent cohort studies exercise hospitalization low back pain risk factors sciatica sports

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The effect of comprehensive group training on cross-sectional area, density, and strength of paraspinal muscles in patients sick-listed for subacute low back pain

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JOURNAL OF SPINAL DISORDERS & TECHNIQUES 2003年第3期16卷 271-279页

作者： Storheim, K Holm, I Gunderson, R Brox, JI Bo, K Norwegian Univ Sport & Phys Educ N-0806 Oslo Norway Natl Hosp Oslo Norway

The effect of exercise on back muscle cross-sectional area (CSA), density, and strength was evaluated in patients sick-listed for subacute low back pain. Twenty-four patients were randomized into an exercise (n = 11) or a control (n = 13) group. Patients in the exercise group followed a biweekly exercise protocol for 15 weeks. Control patients received usual care. Muscle CSA and density were measured by computed tomography before and after intervention. Isokinetic test of back extensors was conducted simultaneously. Results showed a tendency to increased muscle CSA and density in patients in the exercise group, a significant decrease in muscle CSA at L4-L5 in control group patients, and a significant difference in change between groups in muscle CSA at L4-L5. back extension strength increased in patients in the exercise group, but the improvement was not significant compared with control group patients. In conclusion, there was a tendency for reversal of muscle atrophy after exercise.

关键词： low back pain paravertebral muscles cross-sectional area density strength exercise physical therapy

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low back pain and its treatment

TERAPEVTICHESKII ARKHIV

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TERAPEVTICHESKII ARKHIV 2006年第10期78卷 90-93页

作者： Parfenov, V. A. Sechenov Moscow Med Acad Moscow Russia

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Paraspinal Muscle Health is Related to Fibrogenic, Adipogenic, and Myogenic Gene Expression in Patients with Lumbar Spine Pathology

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BMC MUSCULOSKELETAL DISORDERS 2022年第1期23卷 608-608页

作者： Anderson, Brad Ordaz, Angel Zlomislic, Vinko Allen, R. Todd Garfin, Steven R. Schuepbach, Regula Farshad, Mazda Schenk, Simon Ward, Samuel R. Shahidi, Bahar Univ Calif San Diego Dept Orthopaed Surg 350 Dickinson StSuite 121Mail Code 8894 San Diego CA 92103 USA Univ Zurich Balgrist Univ Hosp Dept Orthopaed Forchstr 340 CH-8008 Zurich Switzerland

background Lumbar spine pathology is a common feature of lower back and/or lower extremity pain and is associated with observable degenerative changes in the lumbar paraspinal muscles that are associated with poor clinical prognosis. Despite the commonly observed phenotype of muscle degeneration in this patient population, its underlying molecular mechanisms are not well understood. The aim of this study was to investigate the relationships between groups of genes within the atrophic, myogenic, fibrogenic, adipogenic, and inflammatory pathways and multifidus muscle health in individuals undergoing surgery for lumbar spine pathology. Methods Multifidus muscle biopsies were obtained from patients (n = 59) undergoing surgery for lumbar spine pathology to analyze 42 genes from relevant adipogenic/metabolic, atrophic, fibrogenic, inflammatory, and myogenic gene pathways using quantitative polymerase chain reaction. Multifidus muscle morphology was examined preoperatively in these patients at the level and side of biopsy using T2-weighted magnetic resonance imaging to determine whole muscle compartment area, lean muscle area, fat cross-sectional areas, and proportion of fat within the muscle compartment. These measures were used to investigate the relationships between gene expression patterns and muscle size and quality. Results Relationships between gene expression and imaging revealed significant associations between decreased expression of adipogenic/metabolic gene (PPARD), increased expression of fibrogenic gene (COL3A1), and lower fat fraction on MRI (r = -0.346, p = 0.018, and r = 0.386, p = 0.047 respectively). Decreased expression of myogenic gene (mTOR) was related to greater lean muscle cross-sectional area (r = 0.388, p = 0.045). Conclusion Fibrogenic and adipogenic/metabolic genes were related to pre-operative muscle quality, and myogenic genes were related to pre-operative muscle size. These findings provide insight into molecular pathways associated with mu

关键词： low back pain Skeletal muscle Multifidus Degeneration Atrophy Fatty infiltration Muscle health Lumbar spine pathology Surgery

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Management of a low back pain patient with a prosthesis and a foot drop orthotic

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The Journal of the Canadian Chiropractic Association 2005年第4期49卷 297-300页

作者： Anna Livdans-Forret Palmer College of Chiropractic 100 Brady Street Davenport Iowa 52803 Phone 563-884-5807 E-mail livdans_a@palmer.edu.

INTRODUCTION:The effect of altered gait on body mechanics presents a stress on patient's sacroiliac joints (SIJ). The gait of the patient is this case report is altered because of a transtibial amputation with prosthesis; he also has a foot drop orthotic.CLINICAL FEATURES:A 40-year-old man had left sacroiliac pain. The pain began 3 days before visiting the clinic and has been constant since its onset. It is alleviated by resting on his side. He reported that he had been painting his mother's house for 3 days before the pain started. Past history is significant for a spinal cord injury with resultant right leg foot drop; in addition, he has a left leg prosthesis.INTERVENTION AND OUTCOME:Adjustments to the sacroiliac joint were performed on a Zenith-Thompson Terminal Point adjusting table, utilizing only motion palpation to assess for subluxation. The adjustments consisted of contacting the left posterior superior iliac spine (PSIS) and applying 3 successive high-velocity, low-amplitude thrusts to it. Initial visit schedules were bi-weekly and progresses to bi-monthly as needed.CONCLUSION:Patient with prosthesis can benefit greatly from chiropractic care, to assist them in maintaining proper joint motion and gait patterns that allow them to walk more freely.

关键词： amputation low back pain prosthesis amputation lombalgie prothèse Language of Keywords: English Spanish

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Comparative morphometry of the lower lumbar vertebrae: Osteometry in dry bones and computed tomography images of patients with and without low back pain

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JOURNAL OF INTERNATIONAL MEDICAL RESEARCH 2006年第3期34卷 316-330页

作者： Varol, T. Iyem, C. Cezayirli, E. Erturk, M. Kayalioglu, G. Hayretdag, C. Celal Bayar Univ Fac Med Dept Anat TR-45030 Uncubozkoy Manisa Turkey Ege Univ Fac Med Dept Anat Izmir Turkey

Various factors affect the development of the vertebral canal. The dimensions of the vertebral canal and the intervertebral foramen can be altered by these factors before or after birth. Sex differences in dimensions have also been reported. When there is a stenosis of the vertebral canal or the intervertebral foramen, neural structures confined within them can be affected easily, resulting in symptoms. Using computed tomography images, we compared vertebral canal dimensions in 100 patients with low back pain and/or radiculopathy with those in 40 healthy, non-symptomatic controls. We also measured the dimensions of 275 dry bones. We found significant correlations among the variables in the live subjects. We found significant differences between patients and controls in the variables that were measured. Stenoses were more prevalent in females. Dry bone measurements showed some sex differences, and stenosis mainly in vertebrae L4, L5 and S1.

关键词： low back pain lumbar vertebral allometry osteometry computed tomography spinal stenosis sex differences

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When exposed to challenged ventilation, those with a history of LBP increase spine stability relatively more than healthy individuals

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CLINICAL BIOMECHANICS 2008年第9期23卷 1105-1111页

作者： Grenier, S. G. McGill, S. M. Laurentian Univ Sch Human Kinet Fac Profess Sch Sudbury ON P3C 1N8 Canada Univ Waterloo Dept Kinesiol Fac Appl Hlth Sci Waterloo ON N2L 3G1 Canada

Objective. To determine if spine stability would be affected by the competing demands of simultaneous challenged ventilation and supporting a hand-held load. Design. Subjects were their own controls in a repeated measures design where a single task was repeated, once in a different condition, in a random order. background Muscle stiffness influences spine stability. The same muscles that contribute to spine stability assist in challenged breathing. We hypothesized that a challenged ventilation task would place low back pain (LBP) sufferers at risk of spine instability. Methods. Subjects (14 normal;14 with low back pain) performed two trials with a 22 kg hand-held weight and the trunk angled forward at 30 degrees. One trial was of 60 s duration while breathing ambient air, the other of 70 s duration, while breathing 10% carbon dioxide. Spine stability and compression were quantified, using an EMG assisted optimization model in both trials. Findings. Contrary to expectation, spine stability increased during the challenged breathing trials compared to the ambient air condition for subjects with a history of low back pain when abdominal muscle activity was accounted for as a covariate. Interpretation. Subjects with a history of low back pain had higher stability in challenged breathing trials, indicating that some active mechanism protects the spine for the LBP groups in challenging situations. This may be to provide some margin of safety for damaged passive tissues but could be adversely affected by fatigue in the longer term. (C) 2008 Elsevier Ltd. All rights reserved.

关键词： Spine stability low back pain Motor control Spine load Ventilation

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