Back Pain: Lahad A

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.

Sahar T, Cohen MJ, Ne'eman V, Kandel L, Odebiyi DO, Lev I, Brezis M, Lahad A. · Hebrew University Jerusalem Israel, Department of Family Practice, 1/4 Ya'ari st., Jerusalem, ISRAEL, 93843. · Cochrane Database Syst Rev. · Pubmed #17943845 No free full text.

Abstract: BACKGROUND: There is lack of theoretical and clinical knowledge of the use of insoles for prevention or treatment of back pain. The high incidence of back pain and the popularity of shoe insoles call for a systematic review of this practice. OBJECTIVES: To determine the effectiveness of shoe insoles in the prevention and treatment of non-specific back pain compared to placebo, no intervention, or other interventions. SEARCH STRATEGY: We searched the following databases: The Cochrane Back Group Trials Register and The Cochrane Central Register of Controlled Trials (CENTRAL) to March 2005, and MEDLINE, EMBASE, and CINAHL to February 2007; reviewed reference lists in review articles, guidelines and in the included trials; conducted citation tracking; contacted individuals with expertise in this domain. SELECTION CRITERIA: We included randomized controlled trials that examined the use of customized or non-customized insoles, for the prevention or treatment of back pain, compared to placebo, no intervention or other interventions. Study outcomes had to include at least one of the following: self-reported incidence or physician diagnosis of back pain; pain intensity; duration of back pain; absenteeism; functional status. Studies of insoles designed to treat limb length inequality were excluded. DATA COLLECTION AND ANALYSIS: One review author conducted the searches and blinded the retrieved references for authors, institution and journal. Two review authors independently selected the relevant articles. Two different review authors independently assessed the methodological quality and clinical relevance and extracted the data from each trial using a standardized form. MAIN RESULTS: Six randomized controlled trials met inclusion criteria: Three examined prevention of back pain (2061 participants) and three examined mixed populations (256 participants) without being clear whether they were aimed at primary or secondary prevention or treatment. No treatment trials were found. There is strong evidence that the use of insoles does not prevent back pain. There is limited evidence that insoles alleviate back pain or adversely shift the pain to the lower extremities. Limitations: This review largely reflects limitations of the literature, including low quality studies with heterogeneous interventions and outcome measures, poor blinding and poor reporting. AUTHORS' CONCLUSIONS: There is strong evidence that insoles are not effective for the prevention of back pain. The current evidence on insoles as treatment for low-back pain does not allow any conclusions.High quality trials are required for stronger conclusions.

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.

Finestone AS, Raveh A, Mirovsky Y, Lahad A, Milgrom C. · Department of Orthopaedics, Assaf HaRofeh Medical Center, Zeriffin, Israel. · Spine (Phila Pa 1976). · Pubmed #19564770 No free full text.

Abstract: STUDY DESIGN: Comparative knowledge survey. OBJECTIVE: This study compared the knowledge of orthopaedic surgeons and family practitioners in managing simple low back pain (LBP) with reference to currently published guidelines. SUMMARY OF BACKGROUND DATA: LBP is the most prevalent of musculoskeletal conditions. It affects nearly everyone at some point in time and about 4% to 33% of the population at any given point. Treatment guidelines for LBP should be based on evidence-based medicine and updated to improve patient management and outcome. Studies in various fields have assessed the impact of publishing guidelines on patient management, but little is known about the physicians' knowledge of the guidelines. METHODS: Orthopedic surgeons and family practitioners participating in their annual professional meetings were requested to answer a questionnaire regarding the management of simple low back pain. Answers were scored based on the national guidelines for management of low back pain. RESULTS: One hundred forty family practitioners and 253 orthopaedists responded to the questionnaire. The mean family practitioners' score (69.7) was significantly higher than the orthopaedists' score (44.3) (P < 0.0001). No relation was found between the results and physician demographic factors, including seniority. Most orthopaedists incorrectly responded that they would send their patients for radiologic evaluations. They would also preferentially prescribe cyclo-oxygenase-2-specific nonsteroidal anti-inflammatory drugs, despite the guidelines recommendations to use paracetamol or nonspecific nonsteroidal anti-inflammatory drugs. Significantly less importance was attributed to patient encouragement and reassurance by the orthopaedists as compared with family physicians. CONCLUSION: Both orthopaedic surgeons' and family physicians' knowledge of treating LBP is deficient. Orthopedic surgeons are less aware of current treatment than family practitioners. Although the importance of publishing guidelines and keeping them up-to-date and relevant for different disciplines in different countries cannot be overstressed, disseminating the knowledge to clinicians is also very important to ensure good practice.

Sahar T, Cohen MJ, Uval-Ne'eman V, Kandel L, Odebiyi DO, Lev I, Brezis M, Lahad A. · Family Medicine Department, Hebrew University, Jerusalem, Israel. · Spine (Phila Pa 1976). · Pubmed #19359999 No free full text.

Abstract: STUDY DESIGN: A systematic review of randomized controlled trials. OBJECTIVE: To determine the effectiveness of shoe insoles in the prevention and treatment of nonspecific back pain compared with placebo, no intervention, or other interventions. SUMMARY OF BACKGROUND DATA: There is lack of theoretical and clinical knowledge of the use of insoles for prevention or treatment of back pain. METHODS: We searched electronic databases from inception to October 2008. We reviewed reference lists in review articles, guidelines, and in the included trials; conducted citation tracking; and contacted individuals with expertise in this domain. One review author conducted the searches and blinded the retrieved references for authors, institution, and journal. Two review authors independently selected the relevant articles. Two different review authors independently assessed the methodological quality and clinical relevance and extracted the data from each trial using the criteria recommended by the Cochrane Back Review Group. RESULTS: Six randomized controlled trials met inclusion criteria: 3 examined prevention of back pain (2061 participants) and 3 examined mixed populations (256 participants) without being clear whether they were aimed at primary or secondary prevention or treatment. No treatment trials were found. There is strong evidence that the use of insoles does not prevent back pain. There is limited evidence that insoles alleviate back pain or adversely shift the pain to the lower extremities. CONCLUSION: There is strong evidence that insoles are not effective for the prevention of back pain. The current evidence on insoles as treatment for low back pain does not allow any conclusions.

Reis S, Lahad A. · Department of Family Medicine, The R& B Rappaport Faculty of Medicine, Technion-Israel Institute of Technology and Clalit Health Services. · Harefuah. · Pubmed #18935766 No free full text.

Abstract: The purpose of clinical practice guidelines is to delineate an evidence-based common approach to a prevalent medical problem. Guidelines for Chronic Low Back Pain (CLBP) care were never published in Israel previously, contrary to the Acute Low Back Pain (ALBP) guidelinges. This year, such guidelines are disseminated sponsored by the IMA. In the present paper a summary of the new CLBP care guideline is reported. To each recommendation an evidence level is attached, enabling the practitioner to examine his deliberations against the existing evidence. The guidelines are adapted from a recent European multidisciplinary document and will stay valid with periodic updating. Clinical practice guidelines are not intended to replace careful clinical judgment and personal acquaintance with the patient in. They may support decisions by bringing a summary of the existing evidence in the domain.

Reis S, Lahad A. · Department of Family Medicine, The R& B Rappaport Faculty of Medicine, The Technion - Israel Institute of Technology. · Harefuah. · Pubmed #17853562 No free full text.

Abstract: The purpose of clinical practice guidelines is to delineate an evidence-based common approach to a prevalent medical problem. A decade ago, Guidelines for Acute Low Back Pain (ALBP) care were published in Israel. This year, updated and upgraded guidelines were disseminated, sponsored by the IMA. In the present paper a summary of the new ALBP is reported, as well as a comparison with the prior 1996 guidelines. An evidence tag is attached to each recommendation, enabling the practitioner to examine his deliberations against the existing evidence. The guidelines are adapted from a recent European multidisciplinary document and will remain valid with periodic updating. Clinical practice guidelines are not intended to replace your careful clinical judgment and personal acquaintance with the patient in front of you. They may support your decisions by bringing you a summary of the existing evidence in the domain.

Lahad A, Sarig-Bahat H, Anonymous00355. · Department of Family, Hebrew University, Jerusalem, Israel. · Harefuah. · Pubmed #17476927 No free full text.

Abstract: INTRODUCTION: Due to the lack of international consensus regarding the efficiency of various methods for prevention of low back pain (LBP), this article describes the Israeli guidelines for prevention of L.B.P., based on the recommendations of the European Commission, COST Action B13. OBJECTIVE: Consolidation of Israeli guidelines for prevention of L.B.P. METHOD: In September 2004, the Israeli low back pain work group gathered in Haifa, to discuss and reach a consensus relating to the LBP prevention guidelines. The forum was sponsored by the Israeli Medical Association. LITERATURE SEARCH: The recommendations of the European committee, COST B13, served as the main source of information. The European group based its conclusions on systematic reviews mainly from the Cochrane, Embase, and Medline databases, and other smaller databases for more specific topics. The search covered the years 1966-2003. Information was also gathered through personal contacts with experts in the field. Additional searches were conducted for recent RCT's, published following the most recent systematic reviews. The final recommendations were sent to be reviewed by international experts in LBP. Summary of recommendations for the general population: Physical exercise is recommended for prevention of sick leave due to LBP and for the occurrence or duration of further episodes (Level A). There is insufficient consistent evidence to recommend for or against any specific type or intensity of exercise (Level C). Information and education on back problems, if based on bio-psychosocial principles, should be considered (Level C), but information and education focused principally on a biomedical or biomechanical model cannot be recommended (Level C). Back schools based on traditional biomedical/biomechanical information, advice and instruction are not recommended for prevention in LBP (Level A). High intensity programs, which comprise both an educational/skills program and exercises, can be recommended for patients with recurrent and persistent back pain (Level B). Lumbar supports or back belts are not recommended (Level A). There is no robust evidence for or against recommending any specific chair or mattress for prevention in LBP (Level C), though persisting symptoms may be reduced with a medium-firm rather than a hard mattress (Level C). There is no evidence to support recommending manipulative treatment for prevention in LBP (Level D). Shoe insoles are not recommended for the prevention of back problems (Level A). There is insufficient evidence to recommend for or against correction of leg length (Level D). Despite the intuitive appeal of the idea, there is no evidence, at this time, that attempts to prevent LBP in schoolchildren will have any impact on LBP in adults (Level D).

Milgrom C, Finestone A, Lubovsky O, Zin D, Lahad A. · Department of Orthopaedics, Hadassah University Hospital, Jerusalem, Israel. · Spine (Phila Pa 1976). · Pubmed #15682005 No free full text.

Abstract: STUDY DESIGN: Randomized controlled trial. OBJECTIVES: To determine if the use of custom shoe orthoses can lessen the incidence of weight bearing-induced back pain. SUMMARY OF BACKGROUND DATA: The scientific basis for the use of orthoses to prevent back pain is based principally on studies that show that shoe orthoses can attenuate the shock wave generated at heel strike. The repetitive impulsive loading that occurs because of this shock wave can cause wear of the mechanical structures of the back. Previous randomized studies showed mixed results in preventing back pain, were not blinded, and used orthoses for only short periods of time. METHODS: A total of 404 eligible new infantry recruits without a history of prior back pain were randomly assigned to received either custom soft, semirigid biomechanical, or simple shoe inserts without supportive or shock absorbing qualities. Recruits were reviewed biweekly by an orthopaedist for back signs and symptoms during the course of 14 weeks of basic training RESULTS: The overall incidence of back pain was 14%. By intention-to treat and per-protocol analyses, there was no statistically significant difference between the incidence of either subjective or objective back pain among the 3 treatment groups. Significantly more recruits who received soft custom orthoses finished training in their assigned orthoses (67.5%) than those who received semirigid biomechanical orthoses (45.5%) or simple shoe inserts (48.6%), P = 0.001. CONCLUSIONS: The results of this study do not support the use of orthoses, either custom soft or semirigid biomechanical, as prophylactic treatment for weight bearing-induced back pain. Custom soft orthoses had a higher utilization rate than the semirigid biomechanical or simple shoe inserts. The pretraining physical fitness and sports participation of recruits were not related to the incidence of weight bearing-induced back pain.

Hermoni D, Borkan JM, Pasternak S, Lahad A, Van-Ralte R, Biderman A, Reis S, Anonymous00043. · Department of Family Medicine, Technion, Institute of Technology, Bruce Rappaport Faculty of Medicine, Haifa, Israel. · Br J Gen Pract. · Pubmed #11127171 links to  free full text

Abstract: Doctor-patient concordance and patient initiative were examined in a prospective network interview study, with telephone follow-up, of a cohort of 100 patients presenting with low back pain to their family physician. The average overall rate of concordance was 60% (95% CI = 53 to 66), with the highest rates for radiographic imaging studies and sick leave. No correlation was found between concordance and patient parameters. Subjects initiated an average of two (95% CI = 1.7 to 2.3) diagnostic or therapeutic procedures, the most common of which were for medications (40%), followed by bed rest (26%) and back school (22%). One out of every six subjects initiated a referral to a complementary therapist. Positive correlation was found between patient initiatives and pain severity (P = 0.022) and disability (P = 0.02). There was a negative correlation between the subjects' initiatives and their belief that the physician understood the cause of their pain and its influence on their life (P = 0.02). Overall, those patients who described more pain or disability sought more types of diagnostic and therapeutic measures, while those who felt they had been understood sought less.