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The course of pain drawings during a 10-week treatment period in patients with acute and sub-acute low back pain
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
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2006 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 7, 65- p.Article in journal (Refereed) Published
Abstract [en]

Background: Pain drawings are widely used as an assessment of patients' subjective pain in lowback pain patients being considered for surgery. Less work has been done on primary health carepatients. Moreover, the possible correlation between pain drawing modalities and other painassessment methods, such as pain score and functional variables needs to be described. Thus, theobjectives were to describe the course of pain drawings during treatment in primary health carefor low back pain patients.Methods: 160 primary health care outpatients with acute or sub-acute low back pain were studiedduring 10 weeks of a stay active concept versus manual therapy in addition to the stay activeconcept. The patients filled out 3 pain drawings each, at baseline and after 5 and 10 weeks oftreatment. In addition the patients also reported pain and functional variables during the 3measurement periods.Results: The proportion of areas marked, the mean number of areas marked (pain drawing score),mean number of modalities used (area score), and the proportion of patients with pain radiationall decreased during the 10-week treatment period. Most of the improvement occurred during thefirst half of the period. The seven different pain modalities in the pain drawing were correlated topain and functional variables. In case of no radiation some modalities were associated with morepain and disability than others, a finding that grew stronger over time. For patients with painradiation, the modality differences were smaller and inconsistent.Conclusion: Pain modalities are significantly correlated with pain and functional variables. Thereis a shift from painful modalities to less painful ones over time.

Place, publisher, year, edition, pages
2006. Vol. 7, 65- p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-83627DOI: 10.1186/1471-2474-7-65ISI: 000240737600001PubMedID: 16901354OAI: oai:DiVA.org:uu-83627DiVA: diva2:111535
Available from: 2007-03-21 Created: 2007-03-21 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Low Back Pain: With Special Reference to Manual Therapy, Outcome and its Prognosis
Open this publication in new window or tab >>Low Back Pain: With Special Reference to Manual Therapy, Outcome and its Prognosis
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objectives. To assess outcome of manual therapy in addition to stay-active care in sub-acute low back pain patients and to investigate the predictive power of pain drawing sketch variables for return to work.

Materials and methods. The study was designed as a randomised controlled trial with a factorial design, and included 160 patients with acute or sub-acute low back pain allocated to one of the four treatment groups during 10 weeks. Group 1 received stay-active care only, Group 2 the same treatment as in Group 1 + muscle stretching, Group 3 the same treatment as in Group 2 plus manual therapy, and Group 4 the same treatment as Group 3 plus steroid injections. Outcome included pain intensity, pain extension, functional and health related quality of life variables and return to work.

Results. Pain intensity and disability rating improved faster in Groups 3 and 4 than in Groups 1 and 2 (p<0.05 and p<0.05). Also health related quality of life was affected by the treatments given; the more treatment options the better the effect (trend across the groups p<0.05). Pain extension as described on a pain drawing sketch decreased in all groups across the study period. The pain modality ‘numbness’ was the most painful one among patients with no pain radiation. Pain radiation according to the pain drawing sketch was the strongest predictor for return to work (p=0.03, Wald χ2=4.56).

Conclusions. The manual therapy concept used in this study reduced pain intensity and disability rating better than the stay active concept. The effects on health related quality of life were greater the larger the number of treatment modalities available. Pain drawing information was significantly correlated with pain and functional variables. Pain radiation according to the pain drawing adds significant information to the prediction of return to work.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2011. 79 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 691
Keyword
Low Back Pain, Manual therapy, Stay active care, Mobilisation, Manipulation, Pain drawing, Return to work, Prognosis, Disability rating, Pain
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
urn:nbn:se:uu:diva-156739 (URN)978-91-554-8122-3 (ISBN)
Public defence
2011-09-30, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskölds väg 20, Uppsala Science Park, Uppsala, 13:15 (Swedish)
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Available from: 2011-09-09 Created: 2011-08-08 Last updated: 2011-11-03Bibliographically approved

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Grunnesjö, Marie IBogefeldt, Johan PBlomberg, Stefan I ESvärdsudd, Kurt F

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