Balneotherapy in elderly patients: effect on pain from degenerative knee and spine conditions and on quality of life
From: Isr Med Assoc J. 2008 May;10(5):365-9
Balneotherapy is an established treatment modality for musculoskeletal disease, but few studies have examined the efficacy of spa therapy in elderly patients with degenerative spine and joint diseases. To assess the effects of balneotherapy on chronic musculoskeletal pain, functional capacity, and quality of life in elderly patients with osteoarthritis of the knee or with chronic low back pain. The 81 patients in the study group underwent a 1 day course of 30 minute daily baths in mineral water. Changes were evaluated in the following parameters: pain intensity, functional capacity, quality of life, use of non-steroidal anti-inflammatory or analgesic drugs, subjective disease severity perceived by the patients, investigator-rated disease severity, and severity of pain perceived by the patients. We analyzed the results of 76 subjects as 5 did not complete the study.
Compared to baseline, all monitored parameters were significantly improved by balneotherapy in both investigated groups. Moreover, the favorable effect was prolonged for 3 months after treatment. This study showed that balneotherapy is an effective treatment modality in elderly patients with osteoarthritis of the knee or with chronic low back pain, and its benefits last for at least 3 months after treatment.
Common Chronic Pain Conditions in Developed and Developing Countries: Gender and Age Differences and Comorbidity With Depression and Anxiety Disorders
From: J Pain. 2008 Jul 3; [Epub ahead of print]
Although there is a growing body of research concerning the prevalence and correlates of chronic pain conditions and their association with mental disorders, cross-national research on age and gender differences is limited. The present study reports the prevalence by age and gender of common chronic pain conditions (headache, back or neck pain, arthritis or joint pain, and other chronic pain) in 10 developed and 7 developing countries and their association with the spectrum of both depressive and anxiety disorders. It draws on data from 18 general adult population surveys using a common survey questionnaire (N = 42,249).
Results show that age-standardized prevalence of chronic pain conditions in the previous 12 months was 37.3% in developed countries and 41.1% in developing countries, with back pain and headache being somewhat more common in developing than developed countries. After controlling for comorbid chronic physical diseases, several findings were consistent across developing and developed countries. There was a higher prevalence of chronic pain conditions such as; headaches, back pain, neck pain, arthritis or joint pain among females and older persons; and chronic pain was similarly associated with depression and anxiety spectrum disorders in developed and developing countries. However, the large majority of persons reporting chronic pain did not meet criteria for depression or anxiety disorder. We conclude that common pain conditions affect a large percentage of persons in both developed and developing countries.
Chronic pain conditions including headache, back or neck pain, arthritis or joint pain are common in both developed and developing countries. Overall, the prevalence of pain is greater among females and among older persons. Although most persons reporting pain do not meet criteria for a depressive or anxiety disorder, depression and anxiety spectrum disorders are associated with pain in both developed and developing countries.
Mechanical or inflammatory low back pain. What are the potential signs and symptoms?
From: Manual Therapy Journal. In Press - published online 16 June 2008
Non specific low back pain is commonly conceptualised and managed as being inflammatory and/or mechanical in nature. This study was designed to identify common symptoms or signs that may allow discrimination between inflammatory low back pain and mechanical low back pain. Experienced health professionals from five professions were surveyed using a questionnaire listing 27 signs/symptoms.
Morning pain on waking demonstrated high levels of agreement as an indicator of inflammatory low back pain. Pain when lifting demonstrated high levels of agreement as an indicator of mechanical low back pain. Constant pain, pain that wakes, and stiffness after resting were generally considered as moderate indicators of inflammatory low back pain, while intermittent pain during the day, pain that develops later in the day, pain on standing for a while, with lifting, bending forward a little, on trunk flexion or extension, doing a sit up, when driving long distances, getting out of a chair, and pain on repetitive bending, running, coughing or sneezing were all generally considered as moderate indicators of mechanical low back pain.
This study identified two groups of factors that were generally considered as indicators of inflammatory low back pain or mechanical low back pain. However, none of these factors were thought to strongly discriminate between inflammatory low back pain and mechanical low back pain.
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Current understanding of lumbar intervertebral disc degeneration: a review with emphasis upon etiology, pathophysiology, and lumbar magnetic resonance imaging findings
From: Journal of Orthopedic Sports Physical Therapy. 2008 Jun;38(6):329-40. Epub 2008 Mar 12
The term disc degeneration encompasses a wide array of morphologic and biochemical descriptions that can involve specific regions within the intervertebral disc or its entire structure. In recent work, Adams and Roughley have proposed that the most meaningful definition of disc degeneration should be, an aberrant, cell-mediated response to progressive structural failure. This can be conceptualized as follows: the hydraulic mechanism necessary to absorb and transmit loads through the intervertebral disc is based upon the hydration of the nucleus and the structural stability of the surrounding structures (the inner and outermost annulus and the vertebral endplate). In this mechanism, the nucleus acts to reduce stress on the vertebral endplate and the surrounding structures act as a restraining mechanism of the nucleus. Intact discs spread loads evenly; however, any disturbance in the interplay between the nucleus and surrounding structures can lead to compromised function.
Adams and Roughley further illustrate this process as follows: a young, healthy intervertebral disc has high water content in the nucleus and in the inner annulus. This allows the intervertebral disc to behave like a waterbed, with the outermost portion of the annulus acting as a restraining mechanism (the cover of the waterbed). In older discs, the water content decreases, forcing most of the annulus to resist compression directly, by acting as a solid restraint. In discs that have undergone structural disruption the nucleus is poorly supported by the annulus, resulting in a reduced or absent hydrostatic capacity of the nucleus. This causes the annular fibers to resist loads in a disorganized or irregular fashion. This can result in micromotion and loss of internal stability, resulting in further strain upon the disc structures.
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Serious Psychological Distress in U.S. Adults with Arthritis
From: Journal of General Internal Medicine. 2006 November; 21(11): 1160–1166
Arthritis and mental health disorders are leading causes of disability commonly seen by health care providers. Several studies demonstrate a higher prevalence of anxiety and depression in persons with arthritis versus those without arthritis.
In this study, we found the national prevalence of both serious psychological distress and frequent anxiety or depression to be significantly higher in adults with arthritis than in those without arthritis, with serious psychological distress prevalence 3 times higher and frequent anxiety or depression prevalence 2.5 times higher. Frequent anxiety and depression in the past year (frequent anxiety or depression) was common, with 1 in 4 adults with arthritis reporting frequent anxiety or depression. After adjustment for covariates, serious psychological distress in the past 30 days was significantly associated with younger age, lower socioeconomic status, being divorced or separated, having recurrent pain, being physically inactive, and having more limitations or medical comorbidities in adults with arthritis.
These findings are consistent with other smaller studies of specialized populations that have found higher rates of anxiety, major depression, and depressive symptoms in persons with arthritis. One large community-based study found the prevalence of frequent mental distress mentally unhealthy days in the past 30 days to be 13.4% among adults with arthritis who were 45 years and older. Although the results of that study are not directly comparable because different definitions of mental health and arthritis and a state-based data source were used, it corroborates the higher prevalence of mental distress in adults with arthritis compared with adults without arthritis.
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A cross-sectional study correlating cervical radiographic degenerative findings to pain and disability
From: Spine. 1996 Dec 1;21(23):2747-51
Study design to correlate cervical radiographic findings of spinal degeneration to neck pain and disability. The results were correlated to assess the clinical importance of radiographic spinal degeneration of the neck. Past investigations suggest little association between clinical findings and radiographic evidence of spinal degeneration. However, changes in activities of daily living and chronicity of complaint have not been investigated.
Over a 5-month period, data were collected on 700 consecutive patients referred for cervical radiographic examination as part of their clinical evaluation. While in the radiology department, all subjects completed a visual analog pain scale, neck disability index, and short questionnaire, all of which quantified various aspects of any neck complaint. Relationships between indices of patient complaint and the number of cervical degenerative intervertebral discs were evluated using regression analysis.
A significant relationship was noted between the number of levels of cervical intervertebral disc degeneration and the chronicity of neck complaint. No significant relationship was found between cervical degeneration and past trauma or gender. Multiple-regression analysis of visual analog pain scale scores revealed a significant two-way interaction with chronicity and past trauma and a significant main effect with gender. Cervical degeneration was not significant as a main effect or interaction with other factors.
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The association between cervical spine curvature and neck pain
From: European Spine Journal. 2007 May; 16(5): 669–678
Degenerative changes of the cervical spine, evident on radiographic examination, are part of the normal physiologic ageing process. The most typical changes observed include osteoarthritis of the facets with reduced joint space and disc space narrowing. In contrast to radicular symptomatology, which is anatomically defined and can usually be explained by the presence of osteophytes or narrowing of the intervertebral foramen at the corresponding vertebral level, there is still uncertainty as to whether more widespread clinical symptoms such as axial neck pain can be attributed to observed radiographic changes.
The prevalence of neck pain in the normal population aged over 40 is approximately 20% and hence the question of the clinical significance of such radiological changes is of great importance. The finding that degenerative changes of the cervical spine are common in asymptomatic individuals has challenged the notion of cause and effect; on the other hand, systematic reviews reveal that degeneration shows a consistent (albeit weak) association with pain, at least for the lumbar spine. Fewer studies have examined this phenomenon in the cervical spine: some have identified a relationship between the number of levels of cervical spine degeneration and the chronicity of the complaint or (in women only) the associated disability; others have shown that asymptomatic individuals with degenerative changes of C6/7 are significantly more likely to develop neck pain in the future (10 years later); whilst others, still, have failed to find any significant relationship between degenerative changes and pain.
Degenerative changes of the cervical spine are often accompanied by a shortening of the anterior or posterior vertebral column, which results in an alteration of the sagittal profile of the cervical spine. The latter may occur on a segmental basis or may involve the whole cervical spine. There is much discussion in the literature as to whether, from a biomechanical point of view, the loss of the physiological lordosis could be a possible cause of pain, due to muscular imbalance or, in the case of kyphotic deformities, due to structural overload of the anterior parts of the spine. Most of these studies have been in vitro experiments, although a recent study showed that, in individuals of around 40 years of age and with no kyphotic deformity, the mean cervical lordotic curve was lowest in a group with chronic neck pain and greatest in normal controls, with acute pain patients lying somewhere between the two.
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