Back Pain: Leclerc 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.

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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.

Ozguler A, Loisel P, Boureau F, Leclerc A. · Inserm U88, Hôpital National de Saint-Maurice, 14, rue du Val-d'Osne, 94410 Saint-Maurice. · Rev Epidemiol Sante Publique. · Pubmed #15138396 links to  free full text

Abstract: BACKGROUND: Return to work is considered as a major effectiveness criterion for interventions dedicated to subacute or chronic low-back-pain sufferers. Moreover, return to work, beyond the economic and social Issues, is regarded more and more as having a therapeutic dimension. This review aims to describe the various interventions which are effective in returning patients to work. METHODS: The presentation is based on existing reviews supplemented by a selection of recent studies. RESULTS: "Cognitive-behavioral therapy", "reassurance" and "back exercises" are some suggested approaches. Some of these techniques are geared specifically towards work. Others, such as "back schools" or "multidisciplinary interventions" combine different approaches. CONCLUSION: Promoting return to work at an appropriate stage (subacute stage) could help low-back-pain sufferers to avoid prolonged disability.

Leclerc A, Gourmelen J, Chastang JF, Plouvier S, Niedhammer I, Lanoë JL. · INSERM, U687, Villejuif, France. · Int Arch Occup Environ Health. · Pubmed #18956210 No free full text.

Abstract: PURPOSE: To investigate the pathways from level of education to low back pain (LBP) in the adult population, especially concerning the role of physical working constraints, and personal factors (overweight, tobacco consumption, and tallness). METHODS: The study population consisted of 15,534 subjects from the National Health Survey, with data on LBP, level of education, personal factors, and physical working constraints. Logistic models for LBP (pain more than 30 days during the previous 12 months) were compared in order to check the consistency of the data with specific causal pathways. RESULTS: Low back pain was strongly associated with level of education. This association was almost completely explained if present or past exposure to tiring work postures and handling of heavy loads were taken into account. For men, the OR for "no diploma", adjusted only for age, was 1.75; it was 1.02 after additional adjustment on physical work factors. Personal factors played also a role, especially overweight for women. Among them, the OR associated with a body mass index = 27 or more was 1.58 after adjustment on all the other factors. CONCLUSIONS: In this national population the main pathways from education to LBP were through occupational exposure and lifestyle factors.

Plouvier S, Renahy E, Chastang JF, Bonenfant S, Leclerc A. · INSERM, U 687 Hopital National Saint Maurice, 14 rue de val d'Osne, 94410 Saint-Maurice, France. · Occup Environ Med. · Pubmed #17928384 links to  free full text

Abstract: OBJECTIVE: To assess the effects of duration of exposure to biomechanical strains on various types of low back pain (LBP). METHODS: The population study was a random sample from the GAZEL cohort. Durations of exposure to selected biomechanical strains during subjects' working lifetime and potential confounders were assessed in 1996 by self-administered questionnaires. Data on LBP in the previous 12 months were collected in 2001. Relations between various dimensions of LBP and durations of exposure to the biomechanical strains were analysed with multivariate regression models. Polytomous models were built to determine whether some biomechanical strains were specifically associated with some types of LBP. RESULTS: Analyses were performed separately for men (n = 2218) and women (n = 383). Significant associations were observed (ORs reported are those for 20 years of exposure) between LBP and durations of driving and bending/twisting for men (OR 1.24 and 1.37 respectively); LBP for more than 30 days and duration of exposure to bending/twisting for men and women (OR 2.20 and 2.00 respectively) and duration of driving for women (OR 3.15); LBP radiating to the leg and duration of driving for men (OR 1.43) and bending/twisting for women (OR 1.95); LBP radiating below the knee and duration of exposure to pulling/pushing/carrying for men (OR 1.88). Bending/twisting in both men and women, and driving for women appeared to be stronger risk factors for LBP for more than 30 days. Pulling/pushing/carrying heavy loads appeared to be a risk factor specific for LBP radiating below the knee for men. CONCLUSION: This study suggests that exposure to biomechanical strains has long-term effects and a dose-response relation with duration of exposure and specific effects for some types of LBP.

Gourmelen J, Chastang JF, Ozguler A, Lanoë JL, Ravaud JF, Leclerc A. · Inserm, unité 687 IFR69, 14, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France. · Ann Readapt Med Phys. · Pubmed #17631977 No free full text.

Abstract: INTRODUCTION: In France, most studies of low back pain (LBP) have been carried out among workers or patients. Until very recently, the frequency of LBP in the general population was not known, because National Health Surveys did not include questions on LBP. OBJECTIVE: To estimate the prevalence of LBP in the French population aged 30 to 64 years. MATERIALS AND METHODS: The main data were from the National Health Survey 2002-2003 (n=14,248). LBP was assessed by an accompanying self-administered questionnaire asking details about duration of LBP in the previous 12 months. Weights were used to estimate the prevalence of LBP in the French population, with two definitions of LBP. Additional results dealing with chronic LBP, from another national survey (Handicap, Disability and Dependence), are also briefly presented. RESULTS: More than half of the French population in this age group experienced LBP at least one day in the previous 12 months (LBP1), with 17% experiencing LBP for more than 30 days in the previous 12 months (LBP30); prevalence differed between men and women and that of LBP30 increased with age. DISCUSSION-CONCLUSION: The prevalence of LBP as assessed by the National Health Survey is similar to that found in countries other than France. These estimates can be used as a reference for surveys in specific populations, provided that comparable methodologies are used.

Griffith LE, Hogg-Johnson S, Cole DC, Krause N, Hayden J, Burdorf A, Leclerc A, Coggon D, Bongers P, Walter SD, Shannon HS, Anonymous00131. · Program in Occupational Health and Environmental Medicine, McMaster University, HSC 3H57, Hamilton, Ontario, Canada L8N 3A5. · J Clin Epidemiol. · Pubmed #17493522 No free full text.

Abstract: OBJECTIVE: To determine which literature-based definitions of low back pain (LBP) could be combined to produce sufficiently similar sets for use in a meta-analysis. STUDY DESIGN AND SETTING: A group of six international experts participated in an e-mail-administered Delphi process. Literature-based LBP definitions were preliminarily classified into 14 sets within four outcome types: pathology, symptoms and care-seeking, functional limitations, and participation. Experts independently rated their level of agreement that each outcome definition belonged in its assigned set using a seven-point Likert scale. After each round, results were synthesized and revised classifications were fed back to the experts who were asked to consider them before rerating the outcome definitions. RESULTS: The experts completed three Delphi rounds and reached consensus on the categorization of 115/119 (97%) of the outcome definitions. There were 20 final sets of outcomes identified: three sets of pathology outcomes, two sets each of functional limitation and participation outcomes, and 13 sets of symptom and care-seeking outcomes. CONCLUSIONS: In a research area that currently lacks uniformly accepted definitions of outcomes, we successfully used a Delphi consensus process to reach substantial agreement on combinable LBP outcomes that would be combinable for a meta-analysis.

Leclerc A, Chastang JF, Ozguler A, Ravaud JF. · U88 INSERM-IFR69, Saint Maurice, France. · Spine (Phila Pa 1976). · Pubmed #16481962 No free full text.

Abstract: STUDY DESIGN: A national population-based survey focusing on disability. OBJECTIVE: To describe the frequency of chronic back conditions among those aged 30 to 64 years, the consequences on their daily lives, their employment status, and source of income. SUMMARY OF BACKGROUND DATA.: Descriptive data from community-based surveys are sparse. METHODS: In the French Handicap, Disability and Dependence survey, 1,289 subjects with chronic back problems were compared with the general population. RESULTS: The estimates for prevalence of chronic back problems were 7.9% for men (95% confidence interval, 7.2-8.5) and 7.5% for women (95% confidence interval, 7.0-8.1). Despite functional limitations, most people in France who had back problems were employed in a ordinary work: 71.5% among men (77.7% in the general population), 53.5% among women (60.2% in the general population). Among them, blue-collar workers were overrepresented. Of the subjects with back conditions, a very small proportion had a source of permanent income related to their health problems. CONCLUSIONS: The results from this national population-based survey emphasize the weight of chronic back problems in the community, in a country where the legislation offers few alternatives to ordinary work for those who suffer from chronic limitations due to low back pain.

Tubach F, Beauté J, Leclerc A. · INSERM U88, Hôpital National de Saint Maurice, 94415 Saint-Maurice Cedex, France. · J Clin Epidemiol. · Pubmed #15125627 No free full text.

Abstract: OBJECTIVE: Sciatica is thought to have a good clinical outcome, but in fact, its natural history is not well known. STUDY DESIGN AND SETTING: We studied a prospective cohort of 3,164 workers from the French national electricity and gas company. In this cohort, 622 subjects suffered from sciatica in 1991. The predictive factors of the persistence or recurrence of sciatica after 2 years were identified by multivariate analysis (logistic regression). RESULTS: Of the 622 subjects with sciatica in 1991, 55% still reported its symptoms in 1993 and 53% in 1995. Of those who had recovered from sciatica in 1993, 61% still had low back pain and 27% of them long-lasting low back pain in 1993. The factors predictive of the persistence or recurrence of sciatica in 1993, identified by multivariate analysis, were: driving at least 2 hr/day, carrying heavy loads at work, a high level of psychosomatic problems, and sciatica symptoms the year before study inclusion. CONCLUSION: Recovery from sciatica is less frequent than expected. Attention should be given to occupational and personal factors associated with persistence or recurrence of sciatica.

Leclerc A, Tubach F, Landre MF, Ozguler A. · INSERM U88-IFR69, Hôpital National de Saint-Maurice, St-Maurice, France. · Occup Med (Lond). · Pubmed #14514905 links to  free full text

Abstract: BACKGROUND: The objectives of this prospective study were to investigate personal and occupational predictors of sciatica and to compare the risk factors for sciatica and those for low back pain without sciatica. METHODS: The study analysed data from 841 men, initially free from low back pain, who were followed for 2 years. Subjects were participants in the French GAZEL cohort of employees of the national electricity and gas company. The predictive factors for sciatica and low back pain without sciatica were compared with a polytomous model. RESULTS: Height and driving were predictors only for sciatica, and bending forward and backward at work was a predictor only for low back pain without sciatica. The odds ratio (OR) for sciatica associated with 'height >180 cm' was 3, with a 95% confidence interval (CI) of 1.4-6.5; for driving >2 h daily it was 2 (CI = 0.94-4.10) and for driving >2 h several days a week 2.7 (CI = 1.20-6.10). CONCLUSION: This study confirmed that height and driving are risk factors for sciatica and that sciatica has specific predictors different from those for other types of low back pain. Future studies should consider sciatica separately from these.

Ozguler A, Guéguen A, Leclerc A, Landre MF, Piciotti M, Le Gall S, Morel-Fatio M, Boureau F. · Centre d'Evaluation et de Traitement de la Douleur, Hôpital Saint-Antoine, INSERM Unité 88, France. · Spine (Phila Pa 1976). · Pubmed #12195072 No free full text.

Abstract: STUDY DESIGN: Individuals with low back pain were classified by cluster analysis of their responses to the Dallas Pain Questionnaire. These results enabled development of an alternative simple classification tool that yielded results close to those obtained by the cluster analysis. OBJECTIVES: To use the Dallas Pain Questionnaire to classify workers with low back pain, and to develop a practical classification tool for physicians. SUMMARY OF BACKGROUND DATA: The severity of low back pain is important information for patient management. Questionnaires exploring the multidimensional aspect of low back pain have been used to classify individuals with low back pain. The Dallas Pain Questionnaire is a short self-administered questionnaire that explores the functional and emotional aspects of chronic low back pain. It was tested in a population still at work using a simplified scoring system. METHODS: The study included 765 persons with low back pain still at work who completed the self-administered questionnaire. Of these patients, 732 could be classified by cluster analysis according to their answers to the Dallas Pain Questionnaire. A classification tool was developed to categorize them. Using external variables, the groups thus formed were compared. RESULTS: Respondents were classified into four classes: class 1 (minor disability), class 2 (intermediate disability), class 3 (disability for some physical activities), and class 4 (physical disability and emotional disturbance). External pain-related variables were clearly associated with increasing low back pain severity as measured by this classification tool. CONCLUSIONS: The Dallas Pain Questionnaire discriminated between different groups of persons with low back pain. The proposed classification uses a short, simple practical tool to assess different levels of low back pain.

Tubach F, Leclerc A, Landre MF, Pietri-Taleb F. · INSERM U88, Hôpital National de Saint-Maurice, 14 rue du Val d'Osne, 94415 Saint-Maurice, France. · J Occup Environ Med. · Pubmed #12024690 No free full text.

Abstract: The objectives of this prospective study were to identify predictive factors for sick leave of 8 days or more due to low back pain (LBSL) and to compare them with predictive factors for low back pain with no or shorter sick leave (LB) in a cohort of French workers. The predictive factors for LBSL were a past history of low back pain (odds ratio [OR], 7.2; 95% confidence interval [CI], 4.1 to 13), a low employment grade (OR, 4.3; 95% CI, 1.7 to 11), heavy smoking (OR, 5.5; 95% CI, 2.3 to 13), a pain score different from zero (OR, 4.9; 95% CI, 2.5 to 9.7), required bending backward or forward at work every day repetitively (OR, 7.4; 95% CI, 2.3 to 23), overall social integration (OR, 2.0; 95% CI, 1.3 to 3.3), and low social support at work (OR, 3.4; 95% CI, 1.6 to 7.3). Low social support at work and bending backward or forward at work were more strongly associated with LBSL than with LB (P = 0.02 and P < 0.01, respectively). The implications of the results of this prospective study are that both the level of biomechanical exposure and the psychosocial work environment, especially social support, represents important dimensions to consider in the reduction of work absenteeism.

Ozguler A, Leclerc A, Landre MF, Pietri-Taleb F, Niedhammer I. · INSERM U88, Hôpital National de Saint-Maurice, France. · J Epidemiol Community Health. · Pubmed #10746116 links to  free full text

Abstract: OBJECTIVES: To test associations between non-specific low back pain and several risk factors when definitions of low back pain vary. DESIGN/SETTING/PARTICIPANTS: A cross sectional study was set up in 1991, 725 workers from four occupational sectors answered a self administrated questionnaire including the Nordic questionnaire and questions about intensity of pain and individual and occupational factors. MAIN RESULTS: Prevalence of low back pain varied from 8% to 45% according to the definition used. Psychosomatic problems, bending or carrying loads were often associated to low back pain, whereas other risk factors were related to some specific dimensions of the disorder. CONCLUSIONS: Risk factors of low back pain vary with the definition. This could explain inconsistencies found in literature reviews. To be able to compare data, it seems important to be precise what definition is used and to use comparable questionnaires.

Leclerc A, Niedhammer I, Landre MF, Ozguler A, Etore P, Pietri-Taleb F. · INSERM U88, Hôpital National de Saint-Maurice, Saint-Maurice, France. · Spine (Phila Pa 1976). · Pubmed #10423791 No free full text.

Abstract: STUDY DESIGN: A longitudinal epidemiologic study conducted over 12 months among active workers in different occupations. The study was primarily designed to evaluate intervention for prevention of low back and other spinal disorders. OBJECTIVE: To determine factors that predict incidence, recurrence, and persistence of neck disorders (ND), taking into account various dimensions of ND. SUMMARY OF BACKGROUND DATA: Neck pain is often supposed to have essentially the same risk factors as back pain; however, there is comparatively little data relevant to this issue. Moreover, there is a lack of prospective studies that take into account a diversity of predictive factors. METHODS: The Nordic questionnaire for the analysis of musculoskeletal symptoms was completed twice at a 12-month interval by 568 workers. Predictive factors were studied with logistic models for four dimensions of ND from the second questionnaire: 1) any ND in the past 6 months; 2) ND for more than 30 days; 3) treatment for ND; and 4) visit to a health care professional for ND. The predictive factors were obtained from the first questionnaire and included gender, age, occupational group, level of psychological distress and psychosomatic problems, and ND at baseline. RESULTS: Female gender and older age were predictors of ND. Headaches or pain in the head, psychological distress, and psychosomatic problems were predictors for all dimensions of ND. These effects were observed for both incidence and persistence of ND. CONCLUSIONS: The results emphasize the role of psychosomatic and psychological factors in the occurrence and course of ND for various dimensions of the disorder.