Back Pain News and Treatment
Painful Knees Often Tied to Pain in Other Joints
MONDAY, Nov. 22 (HealthDay News) — The pain of knee osteoarthritis is more severe in people who also have foot, elbow and lower back pain, a new study has found.
In the study, researchers asked almost 1,400 knee osteoarthritis (OA) patients, aged 45 to 79, about pain in the lower back, neck, shoulder, elbow, wrist, hand, hip, knee, ankle or foot.
Low back pain was significantly associated with higher knee pain scores. Foot and elbow pain were also significantly associated with a higher knee pain score, the investigators found.
In addition, pain in multiple joints, regardless of location, was associated with greater knee pain, the study authors reported.
The findings were released online in advance of publication in an upcoming print issue of the journal Arthritis Care & Research.
“Our findings show that pain in the low back, foot and elbow may be associated with greater knee pain, confirming that symptomatic knee OA rarely occurs in isolation. Future studies are needed to determine whether treatment of pain occurring elsewhere in the body will improve therapy outcomes for knee OA,” Dr. Pradeep Suri, of Harvard Medical School, New England Baptist Hospital and Spaulding Rehabilitation Hospital in Boston, stated in a news release from the journal’s publisher.
Physician prescribes work as relief for low back pain
Low back pain is the most common cause of job-related injuries and accounts for the majority of workers’ comp claims and costs. But the vast majority of cases are benign and will get better regardless of the treatment provided.
By approaching low back pain as a condition rather than an injury, the workers’ comp system could save unnecessary aggravation for workers and employers, as well as untold thousands of dollars. An approach using evidence-based medicine, proactive measures from employers and an active recovery role by employees may be the answer.
“We follow a biopsychosocial model,” said Dr. John Anderson, senior vice president of medical operations for Concentra Health Services. “The approach is a combination of sports medicine as well as taking into consideration the psychosocial influences that might affect the outcome.”
Sports medicine approach. Traditional medicine typically suggests aggressive, invasive and costly treatment with only marginal outcomes. “The patient will be evaluated and told to go home, rest and follow up with his doctor,” Anderson said “They go home, lie down on the couch, take meds, and watch TV — further deconditioning themselves and detaching themselves from their social support structures.”
Sports medicine takes a completely different approach. “The intervention is timely, the advice is encouraging and supportive — to return to normal activities as soon as possible,” Anderson said. “We try to get them to stay at work in some capacity that will be manageable for them.”
Influencing factors. Part of that process involves identifying and addressing the psychosocial factors. “As a physician we need to be aware of those issues influencing a patient’s willingness and ability to return to work,” Anderson said. “The doctor must be astute enough to pick up on cues, sometimes from the patient or his supervisor. It’s a team of people that have to get these patients back on the road to recovery.”
Work site assessments should be included with questions about the employee’s satisfaction with his job, supervisor, type of work, shift, and potential downsizing. There may also be personal issues.
“It doesn’t have to be negative,” he said. “It can be good things causing them to reevaluate their ability to go to work. A multitude of factors — some that have nothing to do with the workplace and many that do — could influence their mind-set.”
Armed with the psychosocial information and using the sports medicine approach, Anderson said the next step is setting up the injured worker with appropriate treatment that often includes physical therapy.
“We make every effort to get patients into programs designed specifically for them to retain their level of conditioning and retain and improve their mobility and range of motion with appropriate exercises to reduce the spasms or irritability they have,” he said. “Therapists spend a great deal of time educating these patients and reinforcing that the condition is benign; they may have some discomfort, but they’re not worsening their progress.”
It’s important for patients with low back pain to understand that while their pain is real, it is not life threatening or a harbinger of long-term disability or chronic pain. The therapists progressively increase the physical capacity of the injured worker with the goal of getting them back to preinjury status.
The concept is based on a team approach. In addition to the injured worker, the therapists work with physicians and employers.
“They ask, ‘What are their functional demands? How far do they have to walk? How many pounds must they lift?'” he said. “When we know that it’s easier to get them back to that level and they can get back to the job without the risk of reinjuring themselves.”
NP Back Pain Assessment Shortens Wait Time
Nurse practitioners may help reduce wait times without impairing quality of care. Ninety-six percent of patients with back problems were satisfied with the assessment carried out by a specially trained nurse practitioner, according to a study in the December issue of the Journal of Advanced Nursing.
Moreover, the NP came up with exactly the same clinical diagnosis as two orthopedic spine surgeons in all 177 patients she assessed. She also suggested the same management plan as the two surgeons in 95% of cases.
“Nurse practitioners can play an effective and efficient role in delivering care to patients requiring specific disease management in a specialty setting. Although the required skill set in assessing these patients may vary from NP to NP, collaboration and support from the physician can help to develop expertise in a specialty area,” the paper concludes.
The aim of the year-long pilot study, conducted Toronto Western Hospital in Ontario, was to determine whether a clinic led by a nurse practitioner could speed up the diagnosis and management of patients with certain spinal conditions. (Most patients seen by spine surgeons are not surgical candidates, the researchers note; their treatment plan usually consists of education, and non-invasive therapies to help manage their conditions.)
The 96 male and 81 female patients with suspected disc herniation, spinal stenosis, or degenerative disc disease had been referred by their family doctors.
Just under 10% were correctly identified as surgical candidates by the nurse practitioner. In addition, 66 were referred for specific nerve root block, 14 for facet block, and 26 for further radiological imaging.
Overallsatisfaction was very high (96%), and 91% of patients reported that they understood their condition better after seeing the nurse practitioner.
Patients waited10 to 21 weeks to see the NP, with an average wait of 12 weeks. This compared with 10 to 52 weeks to be seen by the surgeons in a conventional clinic, with average waiting times ranging from three to four months for disc herniations to eight to 12 months for spinal stenosis.