From: FCTY7310@RYEVM.RYERSON.CA (Woodill, Gary)
Newsgroups: misc.handicap
Subject: Bibliography On Pain
Date: 29 Sep 92 15:49:22 GMT
Reply-To: FCTY7310@RYEVM.RYERSON.CA (Woodill, Gary)
X-Fidonet: Split
Originator: wtm@sheldev.shel.isc-br.com

Index Number: 24551

Note from Bill McGarry: This is from the Disability Research
List (DISRES-L@RYERSON.BITNET).

This bibliography on low back pain was sent by:

Elizabeth H. Dow, Ph.D.

E-MAIL ADDRESS: E_DOW@UVMVAX or E_DOW@UVMVAX.UVM.EDU
INSTITUTION: University of Vermont

POSTAL ADDRESS: Vt. REC
                1 S. Prospect St.
                Burlington, VT. 05401

TELEPHONE: (802) 656-4582

FAX: (802) 660-9243

The Vermont Rehabilitation Engineering Center (REC) is a NIDRR
funded research center for low back pain -- the only one in the
country.  I am the information specialist on the team, which
includes biomechanical engineers, orthopaedic surgeons,
rehabilitation engineers and research design specialists.

RECENT PUBLICATIONS ON LOW BACK PAIN DISABILITY:

    Vt. REC Publications: 1991

1. Blann A, Jayson MIV, Pope MH, Kaigle AM, Weinstein JN, Wilder
    D. Postural variations in Von Willebrand factor antigen.
    _British Journal of Rheumatology_

2. Blann AD, Pope MH, Kaigle AM, Weinstein JN, Wilder DG, Jayson
    MIV. Effects of vibration on plasma levels on von Willebrand
    Factor Antigen. _Proceedings_ Society for Back Pain Research;

    Vascular damage is believed to play an important role in many
    back pain syndromes.  Vibration has been implicated in the
    production of low back pain and in vibration white finger has
    been associated with evidence of endothelial cell damage.  We
    have therefore measured plasma levels of von Willebrand
    factor antigen (vWFAg, a marker of endothelial cell injury)
    by ELISA in normal subjects exposed to vibration.  Six males
    and five female healthy controls were studied.  An open
    intravenous line with heparin lock was maintained throughout
    the protocol.  Specimens of blood were drawn at 25 minute
    intervals in the following sequence: 1. Lying down. 2.
    Sitting up. 3. Sitting up after vibration at 5Hz. 4. Sitting
    up with no vibration.  Results indicate that vWFAg increased
    from lying down to sitting up, as a result of vibration, and
    fell in the final sequence due to rest.  Each continuous line
    (on the table included with the original) represents one
    subject; the data is mean and standard deviation.  Statistics
    by Wilcoxon Rank Sum test.  These results suggest vibration
    is associated with endothelial cell damage.  This is in
    accordance with the hypothesis that vascular damage plays an
    important role in the pathogenesis of nerve root problems.

3. Broman H, Svensson M, Pope MH, Hogfors C, Hansson T. Impact
    response of seated subject. _Journal of Orthopaedic Research_
    1991;9:150-154.

4. Cats-Baril WL, Frymoyer JW. Identifying patients at risk of
    becoming disabled because of low-back pain: the Vermont
    Rehabilitation Engineering Center Predictive Model. _Spine_
    1991;16(6):605-607.

    A predictive risk model of low-back pain (LBP) disability was
    developed by a panel of six experts in the fields of chronic
    pain and disability.  It comprised 28 factors organized into
    eight categories:  job, psychosocial, injury, diagnostic,
    demographic, medical history, health behaviors, and
    anthropometric characteristics and was administered as a 15-
    minute written questionnaire.  The model was tested
    prospectively on 250 patients (age range, 18-65 years)
    attending two secondary-care low-back clinics.  Disability,
    as predicted by the model, was compared with 1) actual
    disability assessed 3 and 6 months later; 2) predictions of
    disability made by the attending physicians; and 3)
    predictions obtained from an empirically derived model.
    These results showed that 1) the expert generated risk model
    had a predictive accuracy of 89% and did better in predicting
    disability than the physicians across all samples and 2) the
    empirically weighted model did best of all (91% predictive
    accuracy), suggesting that the expert model used appropriate
    factors but that the weights assigned to these factors by the
    panel of experts could be improved.

 5. Dvorak J, Panjabi MM, Novotony JE. Clinical validation of
    functional flexion/extension X-rays of the lumbar spine.
    _Spine_ In press;:

    The purpose of this study was to determine the clinical
    validity of functional flexion/extension X-rays of the lumbar
    spine in a defined patient population.  One hundred and one
    adults with low back pain or functional disorders underwent
    passive functional flexion/extension examinations.  Their X-
    rays were analyzed using a computer assisted method to
    determine segmental motion parameters such as rotation and
    translation of the lumbar vertebrae.  The patient population
    was broken down into five groups with similar pathologies or
    physical conditions, and their motion parameters compared to
    a normal population and to each other.  It was found that all
    of the patient groups exhibited significantly hypomobile
    motion, spread equally amomg all levels, in comparison to the
    normal population, except for the group of high performance
    athletes who had significant hypermobility.  The uniform
    spread of hypomobility limits the ability to distinguish with
    any confidence between the four pathological groups by their
    motion.  Thus we believe that the analysis of the segmental
    motion of the lumbar spine using passive flexion/extension X-
    rays does not aid in differentiating the underlying pathology
    of patients with low back pain, and that no useful
    information can be derived form this procedure, especially in
    relation to the need for surgical intervention.

 6. Dvorak J, Panjabi MM, Novotny JE, Antinnes JA. In vivo
    flexion/extension of the normal cervical spine. _Journal of
    Orthopaedic Research_ In press;:

    Twenty-two females (age range 25-49, avg. 30.9 years) and
    twenty-two males (age range 23-42, avg. 31.6 years), healthy
    and asymptomatic, underwent passive flexion/extension
    examinations of the cervical spine.  Functional x-rays were
    taken and analyzed, using a computer assisted method which
    quantified intervertebral rotations, translations and
    locations of the centers of rotation for each level C1-C2
    through C6-C7.  The aim of the study was to establish values
    for these parameters for a normal population, as related to
    age and gender.  In the process, a statistically significant
    difference was found in the average value of rotation between
    the male group and the female group at the C5-C6 level.  A
    new parameter, the ratio between translation and rotation was
    also established and may prove useful for clinical diagnoses.
    This parameter has a smaller error associated with it than
    pure translations which may aid the clinician by helping to
    account for the large variation in rotatory ranges of motion
    in the population.  This translation/rotation ratio showed
    highly significant differences between the gender groups in
    the lower segments of the cervical spine.

 7. Frymoyer JW, Cats-Baril WL. An overview of the incidence and
    costs of low back pain. _Orthopedic Clinics of North America_
    April 1991;22(2):263-271.

    No abstract.

 8. Frymoyer JW, Pope MH. Segmental instability. _Seminars in
    Spine Surgery_ June 1991;3(2):109-118.

 9. George DC, Krag MH, Johnson CC, VanHal ME, Haugh LD, Grobler
    LJ. Hole preparation for transpedicle screws: effects on
    pull-out strength from human cadaveric vertebrae. _Spine_ 1991;
    16(2):181-4.

    No abstract.

10. Haig AJ, Moffroid M, Henry S, Haugh L, Pope MH. A technique
    for needle localization in paraspinal muscles with cadaveric
    confirmation. _Muscle & Nerve_ 1991;14:521-526.

    Invasive electromyography (EMG) of the paraspinal muscles is
    useful in clinical and research settings.  No technique for
    localization of the needle in specific fascicles has been
    validated.  Recent descriptions of the segmented innervation
    of the multifidus imply that such a technique would add
    greatly to the EMG determination of root level of a
    radiculopathy.  We have developed a technique for
    localization which relies on palpation of bony structures and
    needle insertion at certain angles and depths.  The technique
    was evaluated by injecting latex dye in 199 locations in 13
    cadavers.  Dissection demonstrated that the technique was
    accurate in 91 of 112 injections into specific fascicles of
    the multifidus (originating from different spinous
    processes), 39 of 43 injections into the longissimus, and 35
    of 44 injections into the iliocostalis.  Certain types of
    errors would not have occurred with the aid of EMG in vivo.
    When these are added to the correct injections, accuracy
    improves 97%, 93%, and 82%, respectively.  The technique
    described here should be useful for kinesiological studies,
    biopsies and injections, as well as for the EMG confirmation
    of a radiculopathy.
11. Hazard RG, Reeves V, Weisman G, Fleming BC, Pope MH. Dynamic
    lifting capacity: the relationship between peak force and
    weight as an indicator of effort. _Journal of Spinal Disorders_
    1991;4(1):63-67.

    Quantification of lifting capacity has become a major
    component in clinical and occupational evaluations of people
    with or at risk for low back pain.  The ideal test of maximum
    acceptable lifting would include an index of subject effort.
    Heart rate response appears to have significant limitations
    as an indicator of effort.  In this study a device that
    records vertical lifting force measured peak force/weight
    ratios (PF/W) and differences (PF-W) for individual lifts.
    Seventeen men without low back pain lifted the device with
    progressively heavier loads.  The PF/W, PF-W, and heart rate
    responses were compared at half-maximum and maximum effort
    levels.  The PF/Ws were higher, while the PF-Ws and heart
    rate responses were lower during half-maximum efforts.  As an
    indicator of subject effort, the relationship between peak
    force and weight may play a key role in isoinertial lifting
    evaluations.

12. Johanning E, Wilder DG, Landrigan PJ, Pope MH. Whole-body
    vibration exposure in subway cars and review of adverse
    health effects. _Journal of Occupational Medicine_ 1991;33(5):
    605-612.

    New York City Transit Authority subway operators have a high
    prevalence of back problems.  To evaluate a possible dose-
    response relationship for whole-body vibration, we studied
    subway car vibrations measured and analyzed according to the
    International Standard Organization 2631 and Verein Deutscher
    Ingenieure 2057 standards.  Vibration transducers in triaxial
    orientation were mounted in a disc pad directly on the subway
    operator's seat.  The relatively high lateral and vertical
    accelerations, primarily the combined effects, may all
    contribute to the high rate of musculoskeletal complaints,
    especially of the lower back.  Other factors aggravating
    whole-body vibrations include primitive ergonomic cab and
    seat design, forced body posture, high noise levels, and
    organizational work stress.

13. Krag MH. "Biomechanics of the cervical spine -- including
    bracing, surgical constructs, and orthoses." Frymoyer JW, ed.
    _The Adult Spine: Principles and Practice_ (New York: Raven
    Press, 1991) 929-965.

    Knowledge of the biomechanics of the cervical spine provides
    an essential framework for understanding the consequences of
    injury and other disorders, as well as intelligent planning
    of operative procedures and conservative treatment of
    orthosis. In this chapter the anatomy of the cervical spine
    will be reviewed from the biomechanical perspective,
    including the issues of kinematics and stability. The
    biomechanics and classification of cervical injury then will
    be reviewed, followed by analysis of surgical constructs and
    orthoses.

14. Krag MH. Biomechanics of thoracolumbar spinal fixation: a
    review. _Spine_ March 1991;16(3S):S84-S99.

    Extensive development of spinal instrumentation has occurred
    recently, benefitted by improved biomechanical knowledge.
    Reviewed here are various devices and the major biomechanical
    issues relevant to them. The devices are categorized by site
    of attachment. The major emphasis is on the most recently
    developed category: devices attached to transpedicular
    screws. Aspects of this last category reviewed here include
    screw design, screw placement, longitudinal linking devices
    (rods, plates), and transverse connectors (cross-linking).
    Emphasis is placed not only on current knowledge, but also on
    unresolved issues.

15. Krag MH. "Spinal fusion: overview of options and posterior
    internal fixation devices." Frymoyer JW, Editor-in-chief. _The
    Adult Spine: Principles and Practice_ (New York: Raven Press,
    1991) 1919-1945.

16. Nachemson A, Pope MH. Concepts in mathematical modeling.
    _Spine_ June 1991;16(6):675-676.

    No abstract.

17. Pope MH. "Physiology and spine mechanics." In: Mayer TG,
    Mooney V, Gatchel RJ, eds. _Contemporary Conservative Care for
    Painful Spinal Disorders_ (Philadelphia: Lea & Febiger, 1991)
    56-66.

18. Reid S, Hazard RG, Fenwick JW. Isokinetic truck-strength
    deficits in people with and without low-back pain: a
    comparative study with consideration of effort. _Journal of
    Spinal Disorders_ 1991;4(1):68-72.

    The purposes of this study were to determine (a) the degree
    and distribution of isokinetic trunk strength deficits in
    people with chronic low-back pain (CLBP) and (b) to what
    degree subject effort during testing affects those deficits.
    We measured the isokinetic trunk strengths of three subject
    groups on the Cybex Trunk Extension/Flexion machine.  Groups
    1 and 2 consisted of 155 men and women with CLBP who were
    divided into maximal (n= 115) and submaximal (n= 40) groups
    according to their torque/position curve variability.  Group
    3 was made up or 32 back-healthy men and women who served as
    controls.  The results demonstrated that men had higher
    flexion and extension torques than women did for all groups.
    The control group had higher flexion and extension torques
    than the maximal-effort CLBP group did.  The extensors had a
    proportionally greater deficit than the flexors did in this
    LBP group.  Comparing the two groups with CLBP, the maximal-
    effort group had higher flexion and extension torques than
    the submaximal effort group did, and the extensors showed a
    greater deficit.  Degree of effort during testing does affect
    the results.  Therapists should consider extensor
    strengthening and reeducation exercises when designing
    exercise programs to restore normal function in people with
    chronic CLBP.

19. Stokes IAF, Gardner-Morse M. Analysis of the interaction
    between vertebral lateral deviation and axial rotation in
    scoliosis. _Journal of Biomechanics_ 1991;24(8):574-579.

    There is a lack of clear biomechanical analyses to explain
    the interaction of the lateral and axial deformity of the
    spine in idiopathic scoliosis. A finite element model which
    represented an isolated ligamentous spine with realistic
    elastic properties and idealized geometry was used to analyse
    this interaction.  Three variations of this model were used
    to investigate two different hypotheses about the etiology of
    scoliosis and to define the forces required to produce a
    scoliosis deformity.  The first hypothesis is that coupling
    within a motion segment produces the interaction between
    lateral deviation and axial rotation.  The second hypothesis
    is that posterior tethering by soft tissues in the growing
    spine produces the observed interaction.  Modeling of both
    hypotheses failed to produce the clinically observed pattern
    of interaction.  Therefore, to find which biomechanical
    forces were required to produce an idealized scoliosis,
    prescribed displacements were applied to the model.
    Production of a double curve scoliosis of 10 degrees Cobb
    angles required lateral forces on the order of  20 N acting
    40 mm anterior to the vertebral body centers.  There do not
    appear to be any anatomic structures capable of producing
    such forces.  Therefore it seems unlikely that scoliosis
    deformity can be explained in terms of forces acting on the
    spine, and understanding of its origins may come from
    examination of other mechanisms sucn as asymmetric thoracic
    growth, or asymmetric vertebral development.

   Vt. REC  Publications, 1992

1. Dvorak J, Panjabi MM, Novotny JE, Chang DG, Grob D. Clinical
    validation of functional flexion-extension roetgenograms of
    the lumbar spine. _Spine_ August 1991;16(8):943-950.

    The purpose of this study was to determine the clinical
    validity of functional flexion-extension roentgenograms of
    the lumbar spine in a defined patient population.  One
    hundred and one adults with low-back pain or functional
    disorders underwent passive functional flexion-extension
    examinations.  Their roentgenograms were analyzed using a
    computer-assisted method to determine segmental motion
    parameters such as rotation and translation of the lumbar
    vertebrae. The patient population was broken into five groups
    with similar pathologies or physical conditions, and their
    motion parameters compared to a normal population and each
    other.  It was found that all the patient groups exhibited
    significantly hypomobile motion, spread equally among all
    levels, in comparison to the normal population, except for
    the group of high-performance athletes, who had significant
    hyermobility.  The uniform spread of hypomobility limits the
    ability to distinguish with any confidence between the four
    pathologic groups by their motion.  Thus, we believe that the
    analysis of the segmental motion of the lumbar spine using
    passive flexion-extension roentgenograms does not aid in
    differentiating the underlying pathologic condition of
    patients with low-back pain, and that no useful information
    can be derived from this procedure, especially in relation to
    the need for surgical intervention.

2. Dvorak J, Panjabi MM, Novotny JE, Antinnes JA. In vivo
    flexion/extension of the normal cervical spine. _Journal of
    Orthopaedic Research_ 9:828-834.

    Twenty-two women (age range 25-49 years, average 30.9 years)
    and twenty-two men (age range 23-42 years, average 31.6
    years), all healthy and asymptomatic, underwent passive
    dlexion/extension examinations of the cervical spine.
    Funtional x-rays were taken and analyzed using a computer-
    assisted method that quantified vertebral rotations,
    translations, and locations of the centers of rotation for
    each level C1-C2--C6-C7.  The aim of the study was to
    establish values for these parameters for a normal population
    as related to age and gender. In the process, a statistically
    significant difference was found in the average value of
    rotation between male and female groups at the C5-C6 level.
    A new parameter, the ratio between translation and rotation,
    was established and may prove useful in clinical diagnoses.
    This translation/rotation ratio indicated highly significant
    differences in the lower segments of the cervical spine
    between gender groups.

3. Hsieh CJ, Phillips RB, Adams AH, Pope MH. Functional outcomes
    of low back pain: comparison of four treatment groups in a
    randomized controlled trial. _Journal of Manipulative and
    Physiological Therapeutics_ January 1992;15(1):4-9.

    The revised Owestry Low Back Pain Questionnaire (ROLBPQ) and
    Roland-Morris Activity Scale (RMAS) were compared in a
    randomized controlled trial of chiropractic manipulation,
    stroking massage, corset and transcutaneous muscular
    stimulation (TMS). This trial employed specific inclusion and
    exclusion criteria, including conspecific low back pain for a
    duration of 3 wk to 6 months and ages between 18 and 55.  We
    had the opportunity to ask 85 patients to answer the
    questionnaires. Sixty-three patients, who completed the
    initial and final evaluations, were used for data analysis.
    Both ROLBPQ and RMAS showed good internal consistency with
    alpha coefficients ranginf grom .77 to .93.  Both instruments
    showed a significant difference between the chiropractic
    manipulation and massage groups (p<.05). RMAS was able to
    further show significant differences between chiropractic
    manipulation and TMS groups, and between the corset and
    massage groups, but the ROLBPQ failed to do so. RMAS also
    showed that chiropractic manipulation had a better but
    nonsignificant result than corset, possibly due to
    insufficient sample size and/or duration of treatment.  WE
    conclude that both instruments are reliable for measuring low
    back pain disability, and chiropractic manipulation has a
    superior short-term benefit when compared to stroking massage
    and TMS in subacute low back pain patients.  In addition, it
    appears that RMAS is preferrable in a clinical trial
    situation for subacute low back pain because it is more
    sensitive than ROLBPQ to detect changes.

4. Pope MH. "A critical evaluation of functional muscle testing."
    Weinstein JN, ed. _Clinical Efficacy and Outcome in the
    diagnosis and Treatment of Low Back Pain_ (New York: Raven,
    1992) 101-114. (Bristol-Myers/Zimmer Orthopaedics Symposium
    Series).

    No abstract.

5. Pope MH, Wilder DG, Krag MH. "Biomechanics of the lumbar
    spine: A. Basic principles." Frymoyer JW, Editor-in-Chief.
    _The Adult Spine: Principles and Practice_ (New York: Raven
    Press, 1991) 1487-1501.

    No abstract.

6. Weisman G. Rehabilitation engineering is key strategy in
    prevention, treatment. _Back Pain Monitor_ January 1992;10(1):
    10-14.

    No abstract.

7. Weisman Gerald. "Rehabilitation engineering applications for
    low-back pain and other disabilities." Greenwood R, ed.
    _Applying Technology in the Work Environment_ (Hot Springs,
    Arkansas: President's Committee on Employment of People with
    Disabilities and the Arkansas Research and Training Center in
    Vocational Rehabilitation, August 1990) 48-55.

    No abstract.