Back Pain: Balagué F

Burton AK, Balagué F, Cardon G, Eriksen HR, Henrotin Y, Lahad A, Leclerc A, Müller G, van der Beek AJ, Anonymous00001. · No affiliation provided · Eur Spine J. · Pubmed #16550446 No free full text.

This publication has no abstract.

Balagué F, Ochoa Amaya G, Genevay S. · Service de rhumatologie Hôpital fribourgeois-site hôpital cantonal, Fribourg. · Rev Med Suisse. · Pubmed #19405270 No free full text.

Abstract: An overview of the recent literature on chronic low back pain is presented from a general practitioner's perspective. Several drugs are available however the magnitude of their effect is low and they should be tailored to patient's preference. The cost-benefit ratio of strong opioid is controversial. Different types of exercises have favourable effect on function and quality of life. Graded activity, taking into account kinesio-phobia, may be more important than any specific type of exercise. Spinal infiltration should only be used in much selected patients. In case of unfavourable evolution, multidisciplinary approaches should be the next step. Caring for low back pain patients is a difficult exercise. There is no universal recipe. The emphasis should be put on tailoring treatment approaches to patient perspective.

Mannion AF, Balagué F, Pellisé F, Cedraschi C. · Spine Center, Schulthess Klinik, Zürich, Switzerland. · Nat Clin Pract Rheumatol. · Pubmed #17968331 No free full text.

Abstract: Pain is a multidimensional experience that is a prominent feature of many musculoskeletal disorders. Despite its subjective nature, pain is a highly relevant complaint; hence, nothing should deter physicians from attempting to formally assess it. This Review summarizes the main aspects of pain measurement from a practical standpoint, with a specific focus on low back pain. On balance, for the assessment of pain intensity, categorical scales with verbal descriptors or numerical rating scales seem to be preferable to traditional visual analogue scales, although no single best measure can be recommended. Pain per se should be assessed, rather than surrogate measures such as analgesic use. Back and leg pain should be evaluated separately in patients in whom these conditions coexist. For assessing change, prospective measurements are preferable to retrospective reports. Pain is not synonymous with function or quality of life, and other tools covering these important outcome dimensions should complement the assessment of pain, especially in patients with chronic symptoms. Clinicians should be aware of the psychometric properties of the tool to be used, including its level of imprecision (random measurement error) and its minimum clinically important difference (score difference indicating meaningful change in clinical status).

Balagué F, Cedraschi C. · Clinic of Rheumatology and Service of Physical Medicine and Reeducation, Fribourg Cantonal Hospital, 1708 Fribourg, Switzerland. · Joint Bone Spine. · Pubmed #16563842 No free full text.

Abstract: A review of the recent literature shows that guidelines on the management of low back pain (LBP) have little impact on the use of radiological imagery. Among the factors which might account for the use of radiological examination, a review of the literature points to some that refer to the patient, others to the clinician and still others to the therapeutic interaction. This leads one to question the importance of radiological examination for both the patient and the physician. The matter at stake in this review is the relationship that may exist between this type of examination and the patient's and/or the physician's anxiety. If these aspects are associated or causally related, this relationship can be two-sided and is thus susceptible to affect the patient, the physician, or both. Some possible keys which emphasize the central role of the therapeutic relationship in this predicament are also reviewed.

Nordin M, Balagué F, Cedraschi C. · Occupational and Industrial Orthopaedics Center, Department of Orthopaedics, NYU Hospital for Joint Diseases, New York University Medical Center, New York, NY 10014, USA. · Clin Orthop Relat Res. · Pubmed #16462440 No free full text.

Abstract: We review evidence-based treatments for patients seeking care for lower-back pain and patients who have been diagnosed with nonspecific lower-back pain. The review is based on selected systematic reviews and national and international guidelines for the treatment of lower-back pain. Additional randomized controlled trials (ie, possibly those not previously included in the latest systematic reviews) were reviewed and added based on recommended procedures for the evaluation of methodological quality (ie, strong, moderate, and weak). In acute nonspecific lower-back pain (0-4 weeks duration of pain) there is moderate to strong evidence that self-care with over-the-counter medication and maintaining activity as tolerated or treatment with a limited number of sessions of manipulative therapy is effective for pain relief. In subacute nonspecific lower-back pain (4-12 weeks duration of pain) there is weak to moderate evidence that a graded activity program including exercises and cognitive behavioral treatment in combination is more efficient than usual care with regard to return to work. There is strong evidence that these programs reduce work absenteeism. In cases of chronic nonspecific lower-back pain (> 12 weeks duration of pain) a variety of treatments are available with limited and similar efficacy on pain and disability reduction. There is moderate evidence that surgery in chronic nonspecific lower-back pain is as effective as cognitive behavioral treatment with regard to pain, function, mood and return to work. Surgical indications for chronic nonspecific lower-back pain remain ill defined. LEVEL OF EVIDENCE: Level V (expert opinion). See the Guidelines for Authors for a complete description of levels of evidence.

Burton AK, Balagué F, Cardon G, Eriksen HR, Henrotin Y, Lahad A, Leclerc A, Müller G, van der Beek AJ, Anonymous00032. · Centre for Health and Social Care Research, University of Huddersfield, 30 Queen Street, Huddersfield HD1 2SP, UK. · Best Pract Res Clin Rheumatol. · Pubmed #15949775 No free full text.

Abstract: This chapter summarizes the European Guidelines for Prevention in Low Back Pain, which consider the evidence in respect of the general population, workers and children. There is limited scope for preventing the incidence (first-time onset) of back pain and, overall, there is limited robust evidence for numerous aspects of prevention in back pain. Nevertheless, there is evidence suggesting that prevention of various consequences of back pain is feasible. However, for those interventions where there is acceptable evidence, the effect sizes are rather modest. The most promising approaches seem to involve physical activity/exercise and appropriate (biopsychosocial) education, at least for adults. Owing to its multidimensional nature, no single intervention is likely to be effective at preventing the overall problem of back pain, although there is likely to be benefit from getting all the players onside. However, innovative studies are required to better understand the mechanisms and delivery of prevention in low back pain.

Cardon G, Balagué F. · Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, 9000, Gent, Belgium. · Eur Spine J. · Pubmed #15662541 No free full text.

Abstract: Given the high prevalence rates of back pain, as early as in childhood, there has been a call for early preventive interventions. To determine which interventions are used to prevent back problems in schoolchildren, as well as what the evidence is for their utility, the literature was searched to locate all investigations that used subjects under the age of 18 and not seeking treatment. Included investigations were specifically designed as an intervention for low back pain (LBP) prevention. Additionally, a literature search was performed for modifiable risk factors for LBP in schoolchildren. The literature-update search was performed within the scope of the "COST Action B13" of the European Commission, approved for the development of European guidelines for the management of LBP. It was concluded that intervention studies in schoolchildren focusing on back-pain prevention are promising but too limited to formulate evidence-based guidelines. On the other hand, since the literature shows that back-pain reports about schoolchildren are mainly associated with psychosocial factors, the scope for LBP prevention in schoolchildren may be limited. However, schoolchildren are receptive to back-care-related knowledge and postural habits, which may play a preventive role for back pain in adulthood. Further studies with a follow-up into adulthood are needed to evaluate the long-term effect of early interventions and the possible detrimental effect of spinal loading at young age.

Dudler J, Balagué F. · Department of Rheumatology, CHUV, Lausanne, Switzerland. · Best Pract Res Clin Rheumatol. · Pubmed #11987931 No free full text.

Abstract: A problem that is encountered in patients with low back pain is that a definite diagnosis is rare. The heart of our clinical dilemma is how best to diagnose those rare patients with severe disease as early as possible. The main reasons for diagnostic errors have been summarized in this chapter. Numerous guidelines have been developed to help in the approach to this difficult problem. However, the limitations of such an approach are highlighted. History and clinical examination are the best single test for diagnostic purposes and neither questionnaires nor computers can replace the clinician. However, the values of clinical abilities should not be overestimated. Finally, the clinical application of guidelines needs to be re-evaluated for each individual patient.

Balagué F, Troussier B, Salminen JJ. · Department of Rheumatology, Physical Medicine and Rehabilitation, Hôpital Cantonal, 1708 Fribourg, Switzerland. · Eur Spine J. · Pubmed #10664299 No free full text.

Abstract: Low back pain (LBP) among children and adolescents has become the subject of an increasing amount of literature over the last 15 years. This topic, which was considered almost insignificant less than two decades ago, was the focus of a recent international meeting organised in Grenoble (France) in March 1999. This review paper is the result of an literature update search performed by members of three groups which have been active in this field for many years. Current epidemiological data on LBP is summarized as well as the role of the major risk factors according to studies published in the principal peer reviewed journals interested in the topic.

Pellisé F, Balagué F, Rajmil L, Cedraschi C, Aguirre M, Fontecha CG, Pasarín M, Ferrer M. · Spine Unit, Hospital Universitari de Traumatologia I Rehabilitació Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain. · Arch Pediatr Adolesc Med. · Pubmed #19124706 No free full text.

Abstract: OBJECTIVES: To assess the prevalence of low back pain (LBP) in adolescents and the clinical features of LBP in 2 European countries and to evaluate the effect of LBP on health-related quality of life (HRQOL) using standardized validated generic and disease-specific instruments. DESIGN: Cross-sectional study. SETTING: Secondary schools of Barcelona, Spain, and Fribourg, Switzerland. PARTICIPANTS: Representative sample of adolescents from the 2 cities. Intervention Selected adolescents completed a questionnaire including a generic HRQOL (KIDSCREEN-52) and 2 LBP-specific instruments. MAIN OUTCOME MEASURES: Results of KIDSCREEN-52, the Roland-Morris Disability Questionnaire, and the Hanover Functional Ability Questionnaire. RESULTS: A total of 1470 adolescents (52.6% male) with a mean (SD) age of 15.05 (1.17) years completed the questionnaires (response rate, 85.1%). Low back pain was reported by 587 adolescents (39.8%): isolated LBP in 250 (42.6%), LBP plus other pain in 271(46.2%), LBP plus whole-body pain in 50 (8.5%, and unclassifiable LBP in 16 (2.7%). Five hundred adolescents (34.7%) reported no pain, and 369 (25.6%) reported other pain without LBP. In those with isolated LBP, the percentage of adolescent boys was higher (54.6%; P < .001) and the LBP was mildest. In those with LBP plus whole-body pain, the percentage of adolescent girls was higher (62%; P < .001) and LBP was most severe. All KIDSCREEN scores in the group with LBP plus whole-body pain were significantly lower than in the other groups (effect size, 0.52-1.24). No differences were found between the groups who reported isolated pain, no pain, or other pain with no LBP. On the LBP-specific instruments, adolescents who reported LBP plus other pain had significantly poorer scores (P < .001) compared with those with isolated LBP but better scores (P < .001) than those with LBP plus whole-body pain. CONCLUSIONS: Low back pain in adolescents is a prevalent symptom with overall low associated disability and little effect on health-related quality of life. A subset of adolescents in whom LBP is associated with whole-body pain report significant impairment and deserve more attention.

Balagué F, Mannion AF, Pellisé F, Cedraschi C. · Department of Rheumatology, Physical Medicine and Rehabilitation, Cantonal Hospital, 1708 Fribourg, Switzerland. · Lancet. · Pubmed #17336636 No free full text.

This publication has no abstract.

Finckh A, Zufferey P, Schurch MA, Balagué F, Waldburger M, So AK. · Section of Clinical Sciences, Division of Rheumatology, Immunology & Allergy, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, USA. · Spine (Phila Pa 1976). · Pubmed #16481946 No free full text.

Abstract: STUDY DESIGN: Double-blinded randomized controlled trial. OBJECTIVE: To test the short-term efficacy of a single intravenous (IV) pulse of glucocorticoids on the symptoms of acute discogenic sciatica. SUMMARY OF BACKGROUND DATA: The use of glucocorticoids in the treatment of acute discogenic sciatica is controversial. A potential advantage of the IV pulse therapy is the ability to distribute high glucocorticoid concentrations to the area surrounding the prolapsed disc without the risks and inconveniences of an epidural injection. METHODS: Patients with acute sciatica (<6-week duration) of radiologically confirmed discogenic origin were randomized to receive either a single IV bolus of 500 mg of methylprednisolone or placebo. Clinical evaluation was performed in a double-blind manner on days 0, 1, 2, 3, 10, and 30. The primary outcome was reduction in sciatic leg pain during the first 3 days following the infusion; secondary outcomes were reduction in low back pain, global pain, functional disability, and signs of radicular irritation. The analysis was performed on an intent-to-treat basis using a longitudinal regression model for repeated measures. RESULTS: A total of 65 patients were randomized, and 60 completed the treatment and the follow-up assessments. A single IV bolus of glucocorticoids provided significant improvement in sciatic leg pain (P = 0.04) within the first 3 days. However, the effect size was small, and the improvement did not persist. IV glucocorticoids had no effect on functional disability or clinical signs of radicular irritation. CONCLUSIONS: Although an IV bolus of glucocorticoids provides a short-term improvement in leg pain in patients with acute discogenic sciatica, its effects are transient and have small magnitude.

Prista A, Balagué F, Nordin M, Skovron ML. · Faculty of Medicine, Universidade Eduardo Mondlane, C.P. 2017, Maputo, Mozambique. · Eur Spine J. · Pubmed #15034774 No free full text.

Abstract: Recent literature shows that the prevalence of low back pain (LBP) in adolescents living in Western countries approaches that of adults 18-55 years of age. Moreover, epidemiological studies have also shown that the frequency of different rheumatic disorders in developing countries is similar to that found in Western industrialized regions. The purpose of this study was to ascertain the prevalence of LBP and to explore some risk factors among adolescents living in different zones of Mozambique. A previously validated questionnaire was distributed to schoolchildren of grades 6 and 7 living in three different residential/social regions of the country. Two hundred four (204) children participated in the survey. Median age was 13 years (age range 11-16 years) and 46% were boys. Several episodes of LBP interfering with usual activities during the previous year were reported by 13.5% of the sample. Living in the wealthier urban center (as compared with the peripheral regions) and walking >30 min per day to and from school were associated with an increased risk of LBP (OR 3.1, 95% CI 0.99-9.48, and OR 4.8, 95% CI 1.61-14.28, respectively).

Balagué F, Dudler J, Nordin M. · Service de Rhumatologie, Médecine Physique et Réhabilitation, Hôpital Cantonal, 1708, Fribourg, Switzerland. <> · Lancet. · Pubmed #12727390 No free full text.

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Szpalski M, Gunzburg R, Balagué F, Nordin M, Mélot C. · Department of Orthopedics, Centre Hospitalier Molière Longchamps, Brussels, Belgium. · Eur Spine J. · Pubmed #12384754 No free full text.

Abstract: There is increasing evidence that non-specific low back pain (LBP) is common among children and adolescents, but there are few longitudinal studies on this subject. This is a longitudinal prospective study aimed at finding factors associated with the prediction of low back pain in schoolchildren aged 9-12 years, which is a younger age group than has previously been studied. This study was performed on school children in the city of Antwerp, Belgium. A total of 287 children filled out a questionnaire and were examined at the beginning of the study (T1) and 2 years later (T2). The questionnaire asked about back pain, general health, health perceptions, quality of life perceptions, sports, leisure, daily life, school life (weight of satchel.) and some issues related to parents (smoking, LBP). The questionnaire reliability was tested. Logistic regression was used to analyse the data. No predictors for LBP in children could be identified. Using logistic regression techniques, we analysed the children who reported no lifetime episode of LBP at both T1 and T2, the children who did report a lifetime episode at both T1 and T2 and also those who reported a history of LBP at T2 only (New LBP). At T2 there were 51 children (17.8%) reporting suffering at least one lifetime episode of LBP who had not reported such an episode at T1. Only one parameter showed a statistical difference: New LBP was observed significantly more frequently in children who do not walk to school ( P<0.0001). An interesting point of this study is that a number of children who had reported a history of LBP at T1 did not do so at T2. It may be that LBP in children is so benign and its natural history so favourable that the memory of the episode fades away. It is extremely interesting to note that among the few significant variables, those related to general well-being and self-perception of health, are prominent. It appears, therefore, that psychological factors play a role in the experience of LBP in a similar way to what has been reported in adults. Poor self-perception of health (health belief) could be a factor behind the reporting of LBP. Some variables linked to consequences of LBP (absence from school or from gym and visit to a doctor) play a significant role in reporting LBP, which suggests that those "health care" factors may reinforce a feeling of disease severity.

Waldburger M, Stucki RF, Balagué F, Wittig R. · Service de rhumatologie, Médecine physique et Rééducation, Hôpital cantonal, Hôpital Daler, Fribourg. · Rev Med Suisse Romande. · Pubmed #11565220 No free full text.

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Gunzburg R, Balagué F, Nordin M, Szpalski M, Duyck D, Bull D, Mélot C. · Eeuwfeestkliniek, Harmoniestraat 68, 2018 Antwerp, Belgium. · Eur Spine J. · Pubmed #10664300 No free full text.

Abstract: A study was undertaken to analyse the prevalence of low back pain (LBP) and confounding factors in primary school children in the city of Antwerp. A total of 392 children aged 9 were included in the study. All children completed a validated three-page questionnaire and they all underwent a specific lumbar spine oriented medical examination during their annual routine medical school control. This examination was performed by the city school doctors. The questionnaire was composed of easy "yes/no" questions and visual analogue scales. Statistical analysis was performed using Student's t-test and chi-squared test at the significance level P < 0.05. The prevalence of LBP was high. No gender difference was found. A total of 142 children (36%) reported having suffered at least one episode of LBP in their lives. Of these, 33 (23%) had sought medical help for LBP from a doctor or physiotherapist. Sixty-four percent of children reporting LBP said that at least one of their parents suffered from or complained of LBP. This was significantly higher than for the children who did not report having suffered LBP. The way in which the school satchel was carried (in the hand, on the back) had no bearing on the incidence of LBP. There was significantly more LBP in children who reported playing video games for more than 2 h per day, but this was not so for television watchers. The visual analogue scales concerning general well-being were all very significantly correlated with self-reported LBP, with children who reported LBP being more tired, less happy, and worse sleepers. Of the 19 clinical parameters taken down during the medical examination, only one was significantly more prevalent in the group of children reporting LBP: pain on palpation at the insertion site on the iliac crest of the ilio-lumbar ligament. From this study we can establish that there are few clinical signs that can help to single out school children with LBP.

Cardon GM, Balagué F. · No affiliation provided · Spine (Phila Pa 1976). · Pubmed #15864169 No free full text.

This publication has no abstract.