Journal of Back and Musculoskeletal Rehabilitation - Volume 9, issue 2

Authors: Rucker, Karen S.

Article Type: Editorial

DOI: 10.3233/BMR-1997-9201

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 9, no. 2, pp. 97-97, 1997

Authors: Johnson, Ernest W.

Article Type: Editorial

DOI: 10.3233/BMR-1997-9202

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 9, no. 2, pp. 99-99, 1997

Authors: Harden, R. Norman | Bruehl, Stephen | Siegler, John | Cole, Patricia A.

Article Type: Research Article

Abstract: Long-term opioid therapy for chronic benign pain remains controversial. Most studies on the effectiveness of such regimens have been case series or case comparisons and very few randomized placebo-controlled studies are available. Overall, this research has produced mixed results. The current study sought to further explore issues regarding the effectiveness of opioids for chronic pain and to examine the use of adjunctive medications in these patients. A random sample of 100 patients taking daily opioids (Opioid) and 100 taking no opioids (Non-opioid) at evaluation were selected from the patient population of a tertiary care multidisciplinary pain program. Statistical analyses revealed …that the two groups did not differ regarding pain type, duration, location, or surgical history. Non-Caucasians were less likely to be taking opioids than Caucasians (p<0.05). Relative to the Non-opioid group, Opioid patients were less frequently taking non-steroidal anti-inflammatories (p<0.01) and were more often taking anxiolytics (p<0.05) and muscle relaxants (p<0.01). Opioid patients reported higher (p<0.05) current pain and more frequently (p<0.05) reported current or past clinical depression or anxiety. No other significant differences were noted on measures of pain, psychological status, or functioning. Statistical removal of the effects of pain differences did not alter the pattern of results for psychological and functional measures. Although the study design employed did not allow determination of causality, it is consistent with previous work which has failed to reveal any advantage to use of daily opioids in the chronic pain population with regard to analgesia, decreased adjunctive medication use, or functional recovery. Well-designed, prospective, randomized studies are needed, but the current results suggest continued caution in the use of daily opioids until such studies become available. Show more

Keywords: Chronic pain, Opioids, Psychological status, Functional recovery, Rehabilitation

DOI: 10.3233/BMR-1997-9203

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 9, no. 2, pp. 101-108, 1997

Authors: Aronoff, Gerald M. | DuPuy, David N.

Article Type: Research Article

Abstract: Musculoskeletal pain has become a major public health problem with medical, occupational and socioeconomic implications. This paper reviews the problem of musculoskeletal back pain, impairment and implications for disability with specific reference to recent meta-analyses such as those performed by the Agency for Health Care Policy and Research (1994) and the IASP Task Force on Pain in the Workplace (1995). Data from these and other studies are consistent with our clinical findings suggesting that most cases of low back pain are idiopathic with an obscure etiology. As such they should be classified as non-specific low back pain (NSLBP) or back …pain of undetermined etiology. The authors suggest that despite a paucity of objective findings many patients receive diagnoses difficult to justify and extensive diagnostic evaluation, some of which may be inappropriate and contribute to iatrogenic disability. Principles for appropriate diagnostic and therapeutic management are discussed with specific attention to risk factors likely to adversely influence treatment outcome and contribute to unnecessary disability. Show more

Keywords: Back pain, Impairment, Disability, Occupational back pain

DOI: 10.3233/BMR-1997-9204

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 9, no. 2, pp. 109-124, 1997

Authors: Kreutzer, Jeffrey S. | Seel, Ronald T. | Witol, Adrienne D.

Article Type: Research Article

Abstract: Information regarding traumatic brain injury sequelae in a sample of 503 traumatic brain injury patients was obtained using the Neurobehavioral Functioning Inventory (NFI). Data revealed that motor dysfunction was more frequently reported than somatic difficulties. Analyses of variance indicated that unemployed patients experienced significantly more motor problems than patients working 40 or more hours per week. No differences in the incidence of somatic complaints, headaches, or muscular pain were found between employed and unemployed patients. Data suggests that long-term, interdisciplinary rehabilitation may be cost effective, especially when viewed in the context of successful employment.

Keywords: Neuromuscular, Somatic, Traumatic brain injury, Unemployment, Employment

DOI: 10.3233/BMR-1997-9205

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 9, no. 2, pp. 125-133, 1997

Authors: Torg, Joseph S. | Ramsey-Emrhein, Julie A.

Article Type: Research Article

Abstract: Conditions involving the cervical spine in the athlete requiring management decisions are numerous. The purpose of this paper is to present appropriate guidelines for return to collision activities in those with congenital, developmental, or post-injury lesions. Collision activities include boxing, football, ice hockey, lacrosse, rugby and wrestling. Information compiled from over 1200 cervical spine lesions documented by the National Football Head and Neck Injury Registry, an extensive literature review, as well as an understanding of injury mechanisms have resulted in reasonable management guidelines. Each of the congenital, developmental and post-traumatic conditions presented are identified as either no contraindication, relative contraindication, …or an absolute contraindication on the basis of a variety of parameters. Conditions involved in the discussion include: odontoid anomalies, spina bifida occulta, atlanto-occipital fusion, K1ippel-Feil syndrome, cervical canal stenosis, spear tackler's spine; and traumatic conditions of the upper, middle and lower cervical spine including ligamentous injuries and fractures, intervertebral disc injuries and post-cervical spine fusion. It should be emphasized that the proposed guidelines should be used in the decision making process and in conjunction with other such factors as age, experience, ability of the individual, level of participation, position played, as well as the attitude and desires of the athlete and his parents, where applicable following an informed discussion of the problem with particular regard to potential risk. Show more

Keywords: Cervical cord injuries, Spinal injury, Management guidelines for cervical injury

DOI: 10.3233/BMR-1997-9206

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 9, no. 2, pp. 135-154, 1997

Authors: Harden, R. Norman | Bruehl, Stephen | Backonja, Misha-Miroslav

Article Type: Research Article

DOI: 10.3233/BMR-1997-9207

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 9, no. 2, pp. 155-180, 1997

Authors: Olson, Variek L.

Article Type: Case Report

Abstract: The subject of this case report is a 43-year-old woman who suffered a whiplash associated disorder as a result of a motor vehicle accident (15 October, 1993). Within several hours she developed neck pain and the next day head pain, earache and a sore throat which became chronic, creating significant disability and a poor quality of life. A variety of diagnostic tests, medications and physical therapy from October 1993 to December 1994 were unsuccessful in determining a cause or relieving her complaint. In January 1995, the patient was a very angry, frustrated woman, reluctant to trust another trial of physical …therapy. After observing her cervical motion, a home program of cervical traction and exercise was implemented. She was followed by the same physical therapist for 19 months (21 visits). This systematic, consistent and clearly defined program allowed her to gain control of her condition. The result of this treatment may benefit other patients suffering chronic whiplash associated disorder. Show more

Keywords: Whiplash associated disorder, Cervical spine, Cervical traction, Conservative treatment

DOI: 10.3233/BMR-1997-9208

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 9, no. 2, pp. 181-190, 1997

Authors: Pavelis, K.W.

Article Type: Research Article

Abstract: As you have seen, this issue of the Journal has a particular focus on chronic pain. As the issue of how to assess the impact of chronic pain from one individual to another continues to be one of uncertainty and controversy, we present this commentary to you to emphasize the many factors involved in the assessment of pain, including the psychological and emotional factors. This commentary peers into the perseverance factor of those suffering from disabling pain and disease. It is presented simply as food for thought. To what extent we, as clinicians, want to consider factors such as this, …is left up to our own thinking and background. Show more

DOI: 10.3233/BMR-1997-9209

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 9, no. 2, pp. 191-193, 1997

Authors: Draut, Melissa

Article Type: Research Article

DOI: 10.3233/BMR-1997-9210

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 9, no. 2, pp. 195-196, 1997