Radioprotective gowns are an essential part of operating in orthopaedicse. As we are aware from the evidence, surgeons, and in particular orthopaedic surgeons, are at risk of developing chronic neck and back pain. This is likely a result of the combination of of long operations, heavy equipment, radioprotective gowns and poor ergonomic set up. Women are a minority in orthopaedics. Amongst trainees there has been an improvement with 20–25% of current trainees are women, however at consultant level this percentage is a lot lower at 5–7%. Radioprotective gowns worn by trainees are frequently not well fitted and few surgeons have access to bespoke fitted gowns. A questionnaire given to 32 trainees in the region found a significant burden of back pain in trainees and 57% of surgeons felt their gowns were not appropriately fitted. In this study every woman questioned reported back pain as a result of operating and 87% felt the gowns used exacerbated back pain, this figure was 56% in men. 80% of surgeons felt that surgeons would benefit from bespoke fitted gowns, even those that did not themselves have severe back pain. 45% of trainees felt their pain was moderate to severe. In surgery we have the responsibility to protect ourselves and our colleagues from work based injury and illness. Back pain should not be ignored as a symptom and radioprotective gowns is a good place to start. Overall the majority the gowns exacerbated their back pain during or after procedures, worse in women as described above. We can use this data and do what we can to provide trainees with a range of sizes whilst working in hospitals during their training. Anectodally women sizes were less available in the departments and we can work to improve this and reduce the burden of pain amongst surgeons

To determine the clinical efficacy of vitamin-D supplementation on pain intensity and functional disability in patients with chronic lower back pain. This prospective cohort study was conducted from 20th March 2017 to 19th March 2019. The inclusion criteria were patients of CLBP aged between 15 to 55 years. Exclusion criteria included all the patients with Disc prolapse, Spinal stenosis, Any signs of neurological involvement, Metabolic bone disease (Hypo- or Hyperparathyroidism) and Chronic kidney disease/Chronic liver disease. Patients were supplemented with 50,000 IU of oral vitamin-D3 every week for 8 weeks (induction phase) and 50,000 IU of oral vitamin-D3 once monthly for 6 months (maintenance phase). Efficacy parameters included pain intensity and functional disability measured by VAS and modified Oswestry disability questionnaire (MODQ) scores at baseline, 2, 3 and 6 months post-supplementation. Vitamin-D3 levels were measured at baseline,2,3 and 6 months. A total of 600 patients were included in the study. The mean age of patients was 44.2 ± 11.92 years. There were 337 (56.2%) male patients while 263 (43.8%) female patients. Baseline mean vitamin-D levels were 13.32 ± 6.10 ng/mL and increased to 37.18 ± 11.72 post supplementation (P < 0.0001). There was a significant decrease in the pain score after 2nd, 3rd& 6th months (61.7 ± 4.8, 45.2 ± 4.6 & 36.9 ± 7.9, respectively) than 81.2 ± 2.4 before supplementation (P < 0.001). The modified Oswestry disability score also showed significant improvement after 2nd, 3rd & 6th months (35.5, 30.2 & 25.8, respectively) as compared to baseline 46.4 (P < 0.001). About 418 (69.7%) patients attained normal levels after 6 months. Vitamin-D supplementation in chronic lower back pain patients may lead to improvement in pain intensity and functional ability

Previous studies revealed the close relation of anxiety and low back pain. Among people with chronic low back pain, anxiety is the most commonly reported mental disorder. Thus, in the literature, there are several studies considering the anxiety as a risk factor for chronic low back pain. The authors also documented a significant differences between sexes in anxiety and quality of life due to low back pain. US National Institute of Mental Health reports that the lifetime prevalence of an anxiety disorder is 60 % higher in women than in men and that the onset, severity, clinical course, and treatment response of anxiety disorders differ significantly in women. In addition, literature has showed that women may have a worse quality of life when they have low back pain. University students may undergo an undue amount of stress, with negative outcomes in terms of academic resuşts and personal, emotional or health, consequences. Moreover, stress can be experienced at different time periods, not only during university life, but also before, during the transition from undergraduate to professional level, and after, during the transition to the life work. After all these literature knowledge, we designed the study to compare the anxiety and quality of life levels of female and male specifically university students with low back pain aged between 18–26. In this study, 100 female and male university students with low back pain aged between 18–26 were included. The low back pain level were measured by Visual Analogue Scale (VAS) and the disability level due to the pain was measured by Revised Oswestry Low Back Pain Disability Questionnaire (ODI). Beck Anxiety Inventory (BAI) was used to evaluate the anxiety level and also, Short Form 36 survey (SF-36) was used to understand the quality of life for subjects. These questionnaires were asked to participants on online platform via Google Forms between March 2020 and May 2020. SPSS Version 25.0 program was used for statistical analyses. The result of the study showed that there was a statistically significant difference between female and male students on anxiety levels (p<0.05). There were no statistically differences between female and male students on ODI and VAS (p>0.05). In female group, BAI and “Physical function” and “General Health” subgroups of SF-36 have negative correlations (p<0.05). When we correlated BAI and all subgroups of SF-36 in male group, the statistical results were showed that negative correlation with all subgroups (p<0.05) except “Energy and Fatigue” subgroup (p>0.05). We conclude that female university students with low back pain have higher anxiety levels than male students. Future studies can work on young students to cope with the psychological problems for well-being

Aims. 1. To develop a decision aid - Decision Support Package (DSP) - that will provide low back pain (LBP) patients, and their treating physiotherapists with information on the treatment options available to the patients. 2. To develop a training package for physiotherapists on how to use the DSP. 3. To encourage and evaluate the informed shared decision making (ISDM) process between patients and physiotherapists during consultation. Method. We developed a DSP informed by existing research and collaboration with physiotherapists, patients and experts in the field of decision aids and LBP. We did six pieces of exploratory work: literature review; 2009 NICE LBP guidelines review; qualitative screening of transcripts of interviews of LBP patients; focus groups (patients); nominal group (physiotherapists), and Delphi study (experts). We collated these data to develop the DSP. We also developed a training package for physiotherapists. Results. We developed a LBP patient resource for use prior to their first consultation and a training package for physiotherapists. The DSP contained information on acupuncture, structured group exercise, manual therapy and cognitive behavioural approach. LBP patients would expect these treatment options to be offered to them at their initial consultation. The training package for physiotherapists was on DSP use and communication skills during consultation. Conclusion. We have developed an evidence and theory informed Decision Support Package and physiotherapists training. We are currently piloting its use in one NHS Trust prior to running a pilot RCT (N=150) to test is effect on improving patient satisfaction with LBP patients' treatment choices. Conflicts of Interest. None. Source of Funding. National Institute for Health Research- Research for Patient Benefit (NIHR-RfPB). This abstract has not been previously published in whole or substantial part nor has it been presented previously at a national meeting

In the last decades, the use of artificial intelligence (AI) has been increasingly investigated in intervertebral disc degeneration (IDD) and chronic low back pain (LBP) research. To date, several AI-based cutting-edge technologies, such as computer vision, computer-assisted diagnosis, decision support system and natural language processing have been utilized to optimize LBP prevention, diagnosis, and treatment. This talk will provide an outline on contemporary AI applications to IDD and LBP research, with a particular attention towards actual knowledge gaps and promising innovative tools

Background. Back pain is a common orthopaedic problem which results in hospital admissions in severe cases. The aim of our study was to identify the reasons for back pain admissions and role of further investigations in the treatment of severe back pain. Methods. We collected data prospectively for all admissions between January and March 2011. Demographic details were recorded along with the reasons for admissions, time of admission, further investigations and treatment offered. Results. Total admissions were 850 and 58 (6.8%) had severe back pain.13 patients (22%) had fractures (Group-A); 16 patients (27%) did not require MRI scan (Group-B); 27 patients (50%) needed MRI scan of the lumbosacral spine (Group-C). The mean age of Group-A was 67 years (15–93). 3 were male and 10 females. 10 patients had lumbar and 3 had thoracic spine fractures. The mean age of Group-B was 59 years (32–87). 8 were male and 8 females. The mean age of Group-C was 47 years (23–79). 9 were male and 18 females. The mean hospital stay for Group-C was 5days (0–29). 16 patients (59%) were referred by GP, 5(18%) by emergency department and 3(11%) by physiotherapist. 9(43%) were admitted for pain control, 8(38%) with suspected Cauda Equina syndrome and 2(9%) for further investigations. 20 patients (83%) were admitted during the day, 3(12%) in the evening and 1(4%) during the night. No patient had Cauda equina syndrome on clinical and radiological examination. 12 patients(44%) had nerve root compression on the MRI scan and 7(58%) were offered surgery. Conclusions. Patients were older in group-A with a mean age of 67 years. 27% did not require MRI scan. 67% females admitted with back pain required an MRI scan. No patient had Cauda Equina Syndrome. 55% patients had no nerve root compression. MRI scan was performed to reassure the patients and clinicians with negative results in the presence of severe back pain and unclear neurological signs. Conflicts of interest. None. Sources of funding. None

With the coronavirus disease 2019 (COVID-19) pandemic, remote working has been ubiquitously implemented to reduce disease transmission via minimization of in-person interactions. Low back pain (LBP) is the first cause of disability worldwide and is frequently reported by workers with sedentary occupations. This cross-sectional study aimed to assess the role of remote working in a population of adults affected by LBP through an online questionnaire. We enrolled 136 teleworkers affected by LBP. A total of 101 responses were received and 93 suitable questionnaires were included in the final analysis. Demographic data, remote working features and tasks, and LBP burden were analysed. The psychological burden of remote working was evaluated with the World Health Organization Five Well-Being Index (WHO-5) and the Patient Health Questionnaire-2 (PHQ-2). LBP severity was evaluated using a visual analog scale (VAS). LBP-related disability was assessed using the Oswestry Disability Index (ODI). The effect of LBP on working capacity was examined with the Occupational Role Questionnaire (ORQ). Independent risk factors related to LBP worsening were identified using a multivariate logistic regression model. LBP severity was significantly higher compared to previous in-person working (p<0.0001) as well as average weekly work hours (p<0.001). Furthermore, the risk of LBP deterioration was associated with being divorced (OR: 4.28, 95% CI: 1.27-14.47; p=0.019) or living with others (OR: 0.24, 95% CI: 0.07-0.81; p=0.021), higher ill-being (OR: 0.91, 95% CI: 0.83-0.99; p=0.035) and depression scores (OR: 1.38, 95% CI: 1.00-1.91; p=0.048), as well as having reported unchanged (OR: 0.22, 95% CI: 0.08-0.65; p=0.006) or decreased job satisfaction (OR: 0.16, 95% CI: 0.05-0.54; p=0.003) and increased stress levels (OR: 3.00, 95% CI: 1.04-8.65; p=0.042). These findings highlight key factors to consider for improving remote workers’ physical and mental wellbeing and decrease their LBP burden

Introduction and Objective. The coronavirus (Covid-19) pandemic, first identified in China in December 2019, halted daily living with mandatory lockdowns imposed in Israel in March 2020. This halt induced a sedentary lifestyle for most citizens as well as a decreased physical activity time. These are both common risk factors for the development of low back pain (LBP) which is considered a major global medical and economical challenge effecting almost 1 in 3 people and a leading cause of Emergency Department (ED) visits. It is hypothesized that prevalence of minor LBP episodes during the first total lockdown should have increased compared to previous times. However, due to “Covid-19 fear” we expect a decrease in ED visits. We also speculate that rate of visits due to serious spinal illness (causing either immediate hospitalization or spinal surgery within 30-days of presentation) did not change. Materials and Methods. Retrospective study based on patients visiting the ED in Tel Aviv Sourasky Medical Center During the first pandemic stage in 2020 compared to parallel periods in 2018 and 2019 due to LBP. Results. During the first lockdown period on March 11th-April 21st, only 171 patients attended the ED due to non-traumatic LBP compared to more than 330 patients in the corresponding time during the years 2018 and 2019. This represents a statistically significant drop of 52.5% (p-value < 0.01) and 48.7% (p-value < 0.01) in LBP ED visits during the first pandemic lockdown of 2020 compared to 2019 and 2018, respectively. Additionally, there was no significant drop in immediate hospitalization or spine surgeries within 30 days following the ED visit (p-value >0.10 for all analysis types). Conclusions. “Covid-19 fear” was probably the main reason for patients with an LBP episode to stay at home during the Covid-19 massive outbreak. Since no significant change was shown in the more severe cases, it seems that the minor LBP patients were able to contain the episode outside hospital walls. This presents an opportunity for clinicians and policy decisions makers to learn and find ways to improve our care of back pain in the community and to reduce unnecessary burden on EDs and the healthcare system

Low back pain admission to orthopaedics, aged >55, routinely received a myeloma screen (protein electrophoresis and urinary Bence Jones proteins). Myeloma association guidelines outline the symptoms that should trigger investigation. Acute admissions for back pain alone do not form part of this. We aimed to establish the number of emergency back pain admissions, >55, in our unit over two years. We wished to identify all patients who had protein electrophoresis and/or urinary Bence Jones proteins taken, the number of positive results and diagnoses of myeloma. From our database all patients >55 admitted with back pain in 2009 and 2010 were identified. Using the electronic laboratory reporting system we recorded FBC/ESR/Electrophoresis/Urinary Bence-Jones Proteins. There were 7682 admissions from January 2009–December 2010. 87 were for back pain (1.4%). 55 patients were aged >55 years. Within this group – 22 had protein electrophoresis and 23 had Bence-Jones Proteins. All were negative. 36 patients had an ESR taken, 9 were elevated. None were subsequently found to have haematological malignancy. 53 patients had an FBC taken (5 were anaemic, 8 had leucocytosis and 3 had thrombocytopenia). 20 patients had a vertebral fracture (36.4%). There were no documented cases of myeloma. The Information & Statistics Division of NHS Scotland published figures that demonstrate in 2006–2010, in patients > 55, there were 716 new cases of myeloma in the West of Scotland. Extrapolating this to our unit, on average, we would expect 24 new cases / year in this age group from all presentations. Performing myeloma screens on all back pains does not fulfil recognised screening criteria. We propose myeloma screens are not performed routinely in patients >55 admitted with back pain. It would be reasonable to do so where there is evidence of bone marrow failure, or plasmocytoma on Xray, associated with non-mechanical back pain

Purposes of the study and background. Smaller studies indicate that yoga may be an effective treatment for chronic low back pain. We conducted a randomised trial to evaluate if yoga compared to usual care improves back function in patients with chronic or recurrent low back pain. Summary of the methods used and the results. Outcomes were assessed by postal questionnaires. The setting was 13 non-National Health Service premises. We recruited 313 adults with chronic or recurrent low back pain from primary care. 157 were randomised to usual care. 156 were randomised to a 12-class, gradually-progressing programme of yoga delivered by 12 teachers over three months. All received The Back Book. Primary outcome was back function (Roland Morris Disability Score) at three months. Secondary outcomes: back function at six and 12 months, back pain, pain self-efficacy and general health. Back function improved more in the yoga group: mean difference in changes from baseline at three (−2.17, 95% CI −3.31 to −1.03, p<0.001), six (−1.48, 95% CI −2.62 to −0.33, p=0.011) and 12 months (−1.57, −2.71 to −0.42, p=0.007). Improvement in pain self-efficacy at three and six months in the yoga group. No differences in general health and pain reduction. Two adverse events were reported by controls and 12 by the yoga group – 8 out of 12 reported pain which may have been due to yoga. 63 (40%) were not fully compliant with treatment and 23 (15%) did not attend any yoga classes. Conclusion. At all time points Yoga was more effective than usual care at improving back function. Conflicts of Interest. AT, AS and JDA are self-employed yoga practitioners and may benefit if there is a demand for the yoga programme. AT, AS, the funders and the University of York would share any royalties from the future sale of the yoga manuals and CD.” AT, AS AND JDA had no involvement in the collection of data and in the analysis of the trial. Source of funding. Arthritis Research UK

Background. Individual illness perceptions have been shown to be important influences on both clinical and work outcomes for those with back pain, yet the influence of ‘significant others’ (spouse/partner/close family member) illness perceptions is rarely explored, particularly in relation to work participation. Method. Semi-structured interviews based on the Illness Perceptions Questionnaire were conducted with two purposive samples of chronic back pain patients (working and work disabled), along with their significant others (n=28). Data were analysed using template analysis. Results. The significant others of patients who were work disabled tended to reinforce the patients' limitations and negative consequences of the back pain condition on every aspect of their lives. They believed that patients needed to be pain-free in order to resume work, and equated treatment success with complete removal of pain. Overall, they perceived patients to be blameless victims. In contrast, the significant others of patients who had managed to remain at work despite persistent back pain focused instead on what the patient could still do, were more accepting of treatment as providing pain management rather than a cure, and tended to describe patients as being stoical and heroic. Conclusions. This exploratory in-depth research reveals novel and interesting insights about the illness beliefs of significant others in relation to persistent back pain, and highlights the wider social circumstances that may act as barriers/facilitators to work participation. No conflicts of interest. Sources of funding: BackCare and the BUPA foundation. This abstract has not been previously published in whole or substantial part nor has been presented previously at a national meeting

Background. Fear avoidance (FA) has been identified as a risk factor for poor prognosis and a target for intervention in patients with low back pain (LBP), but the mechanisms involved need clarification. Experimental studies would benefit from the use of carefully developed and controlled stimuli representing avoided movements in back pain, and matched stimuli of movements to provide a credible control stimuli. Existing stimuli depicting avoided movements in LBP are static, do not include a set of control stimuli, and do not control for possible systematic observer biases. Method and results. Two studies were carried out aiming to develop and test LBP patients' responses to videos of models depicting commonly avoided movements associated with back pain, and those associated with a control condition, wrist pain. Two samples of LBP patients rated how much pain and harm each movement would cause them. They also reported how often they avoided the movement. The findings from the first study (N = 99) indicate that using videos of commonly avoided movements in low back pain is viable, and that movements associated with wrist pain provide an acceptable control stimuli. Participants in the second study (N=85) consistently rated movements depicted by females as causing more harm, and more frequently avoided than the same movements depicted by males. Conclusion. The use of video stimuli could advance research into the processes associated with fear avoidance through experimental paradigms. However, although small, the model gender effects should be carefully considered. No Conflict of interest. No funding obtained. This abstract has not been previously published in whole or substantial part nor has it been presented previously at a national meeting

Background. A wide array of measures has been developed to assess the role of psychological factors in the development and persistence of pain. Yet there is likely to be considerable conceptual overlap between such measures, and consequently a lack of clarity about the importance of psychological factors. Purpose. To investigate whether conceptual overlap exists within psychological measures used in back pain research. Methods. An observational cohort study of 1591 back pain primary care consulters provided data on anxiety, depression, self-efficacy, coping, illness perceptions, fear avoidance and catastrophising. Exploratory and confirmatory factor analysis (EFA and CFA) was carried out at the sub-scale level (n=20) to investigate factor structure. Derived factors were then tested using hierarchical linear regression in relation to clinical outcomes (pain intensity and disability). Results. EFA derived 4 factors from the sub-scale measures. Factors were termed ‘distress’ (comprising depression, anxiety, pain self-efficacy, fear avoidance, catastrophising), ‘cognitive’ (cognitive coping strategies), ‘causes’ (psychological, immunity, risk factors) and ‘future’ (expectancies of potential treatment and recovery), and accounted for 65.5% of the data. CFA confirmed the validity of these factors. The distress factor was found to have the strongest association with patients' outcomes, accounting for 28.7% of the variance in pain intensity, and 53.6% in disability. Conclusion. Considerable overlap exists in psychological measures used in back pain research. Most measures tap in to patients' emotional distress; this factor was shown to have the greatest association with clinical outcomes. These findings have implications for the way psychological measures are used in back pain research. No conflicts of interest. Source of funding: Programme Grant awarded by the Arthritis Research UK [13413] and Dr KM Dunn's Wellcome Trust Grant [083572]. This abstract has not been previously published in whole or substantial part nor has it been presented previously at a national meeting

Background. People with back pain often experience long-term pain with recurrences and fluctuations. However, few studies have considered which factors predict long-term outcomes. Purpose. To determine the prognostic factors, measured around the time of a primary care back pain consultation, that predict clinically significant pain in both the short (6 months) and long-term (5 years). Methods. Back pain consulters at 8 GP practices received a questionnaire shortly after consultation. Information was collected on potential prognostic factors: demographics (age, gender, educational, social class), physical (pain, disability, pain duration, distal leg pain), psychological (illness perceptions, coping, fear avoidance, pain self-efficacy, depression, anxiety) and occupational (work status). Patients were followed-up by postal questionnaire 6 months and 5 years later. The Chronic Pain Grade was used to define clinically significant pain at outcome. Results. Baseline pain intensity (Relative Risk (RR) 1.12, 95% CI 1.03, 1.20) and a strong patient belief that their LBP would last a long time (RR 1.04, 95% CI 1.01, 1.07) predicted outcome at 6 months. Outcome at 5 years was best predicted by a similar model: pain intensity (RR 1.09, 95% CI 0.997, 1.20) and a strong belief that their back pain would persist (RR 1.06, 95% CI 1.03, 1.09). Conclusion. Pain intensity and a belief by the patient that their back pain will last a long time predicted clinically significant pain in both the short and long-term. Both predictors have the potential for clinical intervention at the consultation stage. No conflicts of interest. Source of funding: The baseline and 6-month follow-up phases of this study was supported financially by a Programme Grant awarded by the Arthritis Research UK [13413] and the 5-year follow-up phase was completed as part of Dr KM Dunn's Wellcome Trust Grant [083572]. This abstract has not been previously published in whole or substantial part nor has it been presented previously at a national meeting

Background. Back pain has become a worldwide problem and excessive, repetitive rotation has been shown to cause tissue damage. A sleeping posture similar to that of the foetal position has been suggested to limit unnecessary rotation of the lumbar spine. The Rophi™ cushion, utilises this theory to provide spinal alignment and improved sleeping posture. This study aims to assess the subjective experience and biomechanical effects of the Rophi™ cushion in participants with simple mechanical lower back pain (LBP). Methods & Results. Fifteen participants (aged 44 ± 9.7 years) with simple mechanical LBP were recruited using the Red Flags screening form. The kinematics of the pelvis, lower limbs, lumbar and thoracic spine were analysed in six degrees of freedom whilst the participants lay in a semi-foetal position. Visual analogue scales were used to measure participant pain and discomfort levels during sleep pre and post a one week cushion intervention. Kinematic results show the main significant difference in joint angles occurred at the hip in all three planes, and between the lower lumbar region and the pelvis in the coronal plane. Subjective experience showed a reduction in the number of days with poor sleep quality and a significant reduction in frequency and intensity of lower back pain and stiffness when waking. Conclusions. Through repositioning of the hips and lower lumbar spine, overall it appears the individual is moved towards a more neutral position when using the Rophi™ cushion and a one week intervention shows a significant improvement in lower back pain on waking. Conflicts of Interest. None. Source of Funding. Funded by the NWDA Innovation voucher scheme. This abstract has not been previously published in whole or substantial part and has not been previously presented at a national meeting

Background and purpose. Over the past decade, it has become apparent that more often than not musculoskeletal pain occurs in more than one site in an individual, and traditional approaches, where pain has been studied as a narrow site-specific problem, are often not feasible. The overall aim of this study is to describe clusters of pain using a large population-based sample. This presentation will focus specifically on musculoskeletal co-complaints in back pain sufferers. Methods and results. The Danish National Institute of Public Health has since 1987 conducted national representative health interview surveys of the adult Danish population some of which have included questions on musculoskeletal complaints. We used latent class analysis to identify latent classes of musculoskeletal complaints that occurred alongside a primary complaint of back pain. In addition, probabilities that specific sites occurred as co-complaints were determined. Three latent classes were identified and they exhibited quite different patterns of musculoskeletal co-complaints. The most commonly occurring class had a low probability of any co-complaints, the second most commonly occurring class had a high probability of pain in the neck, shoulders and mid-back, while the least commonly occurring class had very high probabilities of pain at all other body sites. Conclusions. Latent class analysis can be used to identify distinctly different groups of pain patterns in persons primarily complaining of back pain. The three groups identified likely have very different prognoses. Conflicts of Interest. None. Source of Funding. None. This abstract has not been previously published in whole or substantial part nor has it been presented previously at a national meeting

The relationship of degeneration to symptoms has been questioned. MRI detects apparently similar disc degeneration and degenerative changes in subjects both with and without back pain. We aimed to overcome these problems by re-annotating MRIs from asymptomatic and symptomatic groups onto the same grading system. We analysed disc degeneration in pre-existing large MRI datasets. Their MRIs were all originally annotated on different scales. We re-annotated all MRIs independent of their initial grading system, using a verified, rapid automated MRI annotation system (SpineNet) which reported degeneration on the Pfirrmann (1-5) scale, and other degenerative features (herniation, endplate defects, marrow signs, spinal stenosis) as binary present/absent. We compared prevalence of degenerative features between symptomatics and asymptomatics. Pfirrmann degeneration grades in relation to age and spinal level were very similar for the two independent groups of symptomatics over all ages and spinal levels. Severe degenerative changes were significantly more prevalent in discs of symptomatics than asymptomatics in the caudal but not the rostral lumbar discs in subjects < 60 years. We found high co-existence of degenerative features in both populations. Degeneration was minimal in around 30% of symptomatics < 50 years. We confirmed age and disc level are significant in determining imaging differences between asymptomatic and symptomatic populations and should not be ignored. Automated analysis, by rapidly combining and comparing data from existing groups with MRIs and information on LBP, provides a way in which epidemiological and ‘big data’ analysis could be advanced without the expense of collecting new groups

Aims. A systematic review of the available literature comparing the outcomes of radiofrequency denervation to sham procedure in treating chronic low back pain caused by lumber zygapophysial joint pathology. Methods. Medline and EMBASE databases were searched for English language articles from 2005 to July 2010. Articles were considered for review if they satisfied the inclusion criteria: Randomised Controlled Trials(RCT) comparing radiofrequency neurotomy(RFN) to a ‘placebo’ procedure in patients with chronic low back pain caused by facet joint osteoarthritis. Adult patients of both sexes above 17 years of age who complained of continuous low back pain for more than 6 months with focal tenderness over the facet joints. Outcome measures of interest are pain improvement, physical activity, analgesic use, quality of life variables, range of motion of the lumbar spine and hip movement. Critical appraisal of the selected studies was carried out using the CASP appraisal tool for RCT. Results. Two articles were identified. Both demonstrated a statistically significant improvement in the pain (p<0.05) using a visual analogue scale in the RFN group compared to the sham procedure. Only one trial demonstrated a corresponding reduction in analgesic use. There was no consensus of improvement of quality of life factors in either study as compared to placebo. Conclusion. Radiofrequency denervation is better than sham procedure in treating pain caused by facet joint osteoarthritis with minimal adverse effects in the short term. A higher powered trial using a larger cohort and longer follow up is required to resolve some of the equivocal results. Conflicts of Interest. None. Source of Funding. None

The objective of this trial was to investigate the efficacy of a Comfrey root extract cream in patients with acute upper or lower back pain. The study was conducted as a double-blind, multi-centre, parallel group design RCT over a period of 5 ± 1 days. The patients (n=120, mean age 36.9 years, 46.7 % female) were treated three times a day, 4 g cream per application. The trial included four visits. The primary efficacy variable was the area-under-the-curve (AUC) of the Visual Analogue Scale (VAS) on active standardised movement values at visits 1 to 4. Among the secondary objectives were back pain at rest (VAS), pressure algometry (pain-time curve; AUC over 5 days), global assessment of efficacy by the patient and investigator, and functional impairment measured with the Oswestry Disability Index. There was a significant treatment difference between verum and placebo. In the course of the trial the primary variable decreased on average (median) about 95,2 % in the Comfrey extract group and 37.8 % in the placebo group. The results separated by pain location show an equivalent effect of comfrey extract: Regarding pain at rest, in lower back pain a reduction of 98% were observed, in upper back pain 96.9%. The results of this RCT were clear-cut and consistent across all variables. Comfrey root extract cream showed a remarkably potent and clinically relevant effect in reducing acute back pain. For the first time a fast-acting effect of the ointment (1 hour) was also witnessed in this trial. Conflicts of interest and sources of funding. CS and MT are employees of Merck Selbstmedikation GmbH, the sponsor of the presented clinical trial. BMG is CEO of CRM Pharmaberatung GmbH, the CRO of the presented clinical trial

Abstract. Objectives. To determine the effects of self-management interventions (SMIs) including an exercise component (EC) on low back pain (LBP) and disability and to determine whether SMIs with tailored exercises (TEs) have superior outcomes compared to SMIs with general exercises (GEs). Methods. An electronic systematic search of randomized controlled trials (RCTs) was performed in 5 electronic databases. RCTs compared SMIs with an EC to control interventions. Data were extracted at 3 follow-up points (short-term, intermediate and long-term) and meta-analyses were performed. Reviewed RCTs were divided into subgroups based on whether the EC was tailored or generic. A subgroup meta-analysis was performed at the short-term follow-up to assess whether the SMIs with TEs have superior outcomes compared to SMIs with GEs. Results. 12 original RCTs were included in the review (six including SMIs with TEs) and were of moderate quality. The pooled results revealed the effect sizes (ESs) of −0.26,-0.32 and −0.21 for short, intermediate and long-term pain intensity, respectively and −0.26,-0.22 and −0.21 for short, intermediate, and long-term disability, respectively (negative value indicates a mean difference in favour of SMIs) indicating a moderate but significant reduction in pain and disability compared to controls. Subgroup meta-analysis at the short-term follow-up revealed that SMIs with TEs had ES of –0.19(p=0.004) for pain and –0.20(p=0.002) for disability compared to SMIs with GEs demonstrating positive but not significant improvement in pain (ES −0.48, p=0.09) and disability (ES −0.45, p=0.10). Conclusions. There is moderate quality evidence for SMIs with an EC to have moderate but significant positive effect on pain and disability in people with LBP. The subgroup analysis revealed that SMIs with exercises tailored to person's needs are superior in reducing pain and disability. These results indicate the importance of developing TE solutions supporting self-management to improve its effect on pain and disability in LBP patients. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project