Dissertations / Theses on the topic 'Pain associated with the spine'
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Lu, Shao-chen, and ILLEGIBLE. "Acupuncture for Quality of Life in Patients Having Pain Associated with the Spine: a Systematic Review." RMIT University. Health Science, 2008. http://adt.lib.rmit.edu.au/adt/public/adt-VIT20080724.122432.
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Background: Pain associated with the spine (PAWS) refers to pain in the neck, thorax, lower back or sacrum. It impacts on patients' Quality of Life (QoL), including working ability, daily functioning, sleep and psychological well-being. A number of clinical trials have demonstrated that acupuncture was beneficial for patients with PAWS. However the overall effect of acupuncture on these patients' QoL is unknown. Aims: The current study aimed to conduct a systematic review (SR) of clinical trials to determine the effect of acupuncture on QoL and pain for patients with PAWS. In addition, a narrative review (NR) was conducted to compare patients' perceived changes (PCC) with the standard QoL instruments used in acupuncture clinical trials for pain. Methods: For the SR, PubMed, Embase (via ScienceDirect), CINAHL (Via EBSCO) and Cochrane Central Register of Controlled Trials were searched. Randomised controlled trials (RCTs) of acupuncture for PAWS condition(s) that include both QoL and pain assessments with a Jadad score of three or greater were included. For the NR, PubMed was searched to identify studies reporting PPC after acupuncture and/or traditional Chinese medicine. Extracted data were grouped and compared with domains of the QoL instruments. Results: In total, 21 RCTs were included and 17 of them had sufficient data for analysis. QoL was measured using 15 different instruments. Randomisation procedures and dropouts were adequately reported in all 17 studies. Four studies compared acupuncture with wait-list or usual-care. Two demonstrated that acupuncture had a superior effect on improving physical and mental components of QoL measured by Short Form-36 health survey questionnaire and pain at the three month follow-up. Studies comparing acupuncture with sham/placebo acupuncture or placebo-TENS found either no difference between the treatments or conflicting results. When acupuncture was compared with active interventions, there was no difference except that at the intermediate-term follow-up massage was better for disability and pain and physiotherapy was better for Northwick Park Neck Pain Questionnaire. Acupuncture was also better than TENS for pain. The combined therapy of acupuncture and an active intervention showed a superior result than the latter alone in the short-term. Six studies were identified for the NR. Patients reported 11 categories of changes after acupuncture, such as reduced reliance on other therapies, enhanced spirituality, prevention of disease. However, these clinical outcomes were not included in any of the QoL instruments used in the included RCTs. Conclusion: There is moderate to strong evidence that acupuncture is more effective than wait-list or usual-care at the short-term follow-up in improving QoL of patients with PAWS. When acupuncture is combined with another therapy, the combined therapy seems to produce a better outcome. Acupuncture is not better than sham/placebo acupuncture or placebo-TENS. Surprisingly, the commonly used QoL instruments do not measure all the changes perceived by patients as a result of acupuncture and/or traditional Chinese medicine. There is a pressing need to design QoL assessments that are suitable for acupuncture research. Further studies should have larger sample sizes and additional validated outcome assessments are required to detect effects of acupuncture.
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Kalezic, Ivana. "Experimental studies of spinal mechanisms associated with muscle fatigue." Doctoral thesis, Umeå : Idrottsmedicinska enheten, Kirurgisk och perioperativ vetenskap, Umeå universitet, Belastningsskadecentrum, Högskolan i Gävle, Umeå, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-332.
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Ord, Jonathan S. "Biopsychosocial Factors in Chronic Spine-Related Pain: Contributions to Pain Intensity and Perceived Disability." ScholarWorks@UNO, 2010. http://scholarworks.uno.edu/td/1112.
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Psychological and contextual factors play an important role in the development and maintenance of chronic spine-related pain, and effective treatment of pain-related conditions requires an understanding of how these factors contribute to pain and disability. The present study examined the relative contributions of spine pathology, psychological complications, and demographic factors to perceived pain intensity and disability in patients with chronic spine-related pain. Because most patients were assessed in the context of a compensable injury, exaggeration of symptoms and disability was systematically controlled for using multiple validity indicators. A high prevalence of psychological complications was observed in the present sample. Analysis indicated that psychological factors were not significantly related to pain intensity, but were significantly related to reported pain-related disability. Further, psychological factors were found to predict pain-related disability beyond demographics, medical findings, and pain intensity. Clinical implications of these findings are discussed.
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Mihcin, Senay. "Spine modelling for lifting." Thesis, Loughborough University, 2007. https://dspace.lboro.ac.uk/2134/8065.
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Mathematical modelling is widely used in the field of biomechanics. The traditional approach to investigate spine related injuries is to check the strength of the components of the spine. Spinal stability approach focuses on the force polygons formed by the body weight, muscle forces, ligament forces and external load. This force polygon is expected to stay within the boundaries of the spine to ensure stability. Proving the possibility of one force polygon within the spine boundaries proves the stability of the spine. This study focuses on the full curvature of the spine for spinal stability investigations in a lifting activity. An experiment has been designed to investigate the postural differences in males and females by measuring the full spinal curvature with a skin surface device. Distributed body weight force, with increased detail of muscle and ligament forces acting on the spine have been modelled by writing a code in Visual Basic, while lifting a load from the boot of a car in the sagittal plane. This model is flexible enough to reflect changes in body weight parameter. Results show that there is a difference between male and female postures during the full span of lifting activities. Application of individual muscle forces provides greater control of stability at each vertebral level. By considering the elongation of the ligaments and the force requirements of the muscle groups, it is possible to diagnose soft tissue failure. The differences in posture result in different moment arms for muscles and ligaments causing different loading on the spine. Most critical postures have been identified as the fully flexed postures with external load acting on the spine. Conceptual design ideas have been proposed to assist lifting a load from the boot of a car to eliminate the excessive flexion and loading on the spine.
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Hulbert, Pamela Ann. "The physiological management of cervical spine pain in whiplash injury." Thesis, University of Manchester, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.488654.
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The purpose of this study was to examine the concept of the physiological management of pain following acute Grade 2 whiplash injury while facilitating recovery and maintenance of a full range of cervical spine movement. In a series of studies a statistically significant effect was demonstrated on the improved and sustained range of cervical movement p<0.0005 and on the effective control of pain p<0.0005 generated by movement to relieve post injury stiffness. In an Audit study there was a beneficial effect on the improvement in patient confidence in selfmanagement of their condition 84% following attendance at an educational neck school. The effective use of soft collars on the available range of cervical movement p<0.025 and on the balance of the body showed a statistically significant result p
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Hasnie, Fauzia Shams. "Zoster-associated pain in rodents." Thesis, Imperial College London, 2007. http://hdl.handle.net/10044/1/12042.
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Kardouni, Joseph. "Effects of Thoracic Spinal Manipulative Therapy on Thoracic Spine and Shoulder Kinematics, Thoracic Spine Flexion/Extension Excursion, and Pressure Pain Sensitivity in Patients with Subacromial Pain Syndrome." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/3304.
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EFFECTS OF THORACIC SPINAL MANIPULATIVE THERAPY ON THORACIC SPINE AND SHOULDER KINEMATICS, THORACIC SPINE FLEXION/EXTENSION EXCURSION, AND PRESSURE PAIN SENSITIVITY IN PATIENTS WITH SUBACROMIAL PAIN SYNDROME By Joseph R. Kardouni, Ph.D., PT A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy, at Virginia Commonwealth University. Virginia Commonwealth University, 2013. Major Director: Lori A. Michener, PhD, PT, ATC, Professor, Department of Physical Therapy In patients with shoulder pain, the use of manual therapy directed at the spine and shoulder have been reported to provide superior outcomes to exercise based interventions or usual care without the use of manual therapy. Clinical trials have also reported improved pain and disability after thoracic spinal manipulative therapy (SMT) as a stand-alone treatment for shoulder pain. Although clinical efficacy is reported for the use of thoracic SMT for the treatment of shoulder pain, the mechanisms underlying the clinical benefits are not well understood. This limits the directed use of SMT. The benefits could be due to changes in spine or shoulder motion or neurophysiologic mechanisms of pain modulation. Elucidating the mechanism of manual therapy will aid the directed use of thoracic SMT for treating patients with shoulder pain. The research described in chapters 3 and 4 was performed to assess the effects of thoracic SMT in patients with subacromial pain syndrome with regard to biomechanical changes at the thoracic spine and shoulder and effects on central and peripheral pain sensitivity. Subjects with shoulder impingement pain symptoms were randomly assigned to receive 1 visit of thoracic SMT or sham SMT, applied to the lower, middle, and upper (cervicothoracic junction) thoracic spine. A 3-dimensional electromagnetic tracking system was used to measure thoracic and scapular kinematics during active arm elevation, and thoracic excursion at end-range of flexion and extension pre- post-treatment. Pressure pain threshold (PPT) was measured at the painful shoulder (deltoid) and unaffected regions (contralateral deltoid and bilateral lower trapezius areas) immediately pre- and post-treatment. PPT measures at the painful shoulder were used to assess peripheral and/or central pain sensitivity, and PPT at unaffected regions measured central pain sensitivity. Patient-rated outcomes measures of pain (Numeric Pain Rating Scale-NPRS), function (Pennsylvania Shoulder Score-Penn), and global rating of change (GROC) were used to assess changes in clinical symptoms following treatment. No significant differences were found between treatment groups for the thoracic kinematics or excursion, shoulder kinematics, PPT measures, or patient-rated outcomes. No differences were noted pre- to post-treatment in either group for thoracic kinematics or excursion or PPT measures. In both groups, there was a decrease in mean scapular external rotation over time during ascending arm elevation, but the change was less than measurement error. Outcome measures of NPRS, Penn and GROC indicated clinical improvements in both groups following treatment, but there were no differences between the thoracic SMT or sham SMT groups. There were no meaningful correlations between thoracic and scapular kinematics or thoracic excursion with the outcome measures of NPRS, Penn, or GROC. There was a significant positive correlation (r=0.52 , p=0.009) between change in PPT at the lower trapezius on the unaffected side and baseline Penn scores. Biomechanically, thoracic spine extension and excursion did not change following thoracic SMT, and the SMT group had no greater changes in shoulder kinematics or patient-rated pain and function than the sham SMT group. Additionally, thoracic SMT did not improve peripheral or central pain sensitivity as measured by PPT. Furthermore, improvements in patient-rated outcomes were not found to be related to changes in thoracic spine mobility, or shoulder kinematics with SMT. The single correlation between change in PPT and baseline Penn may indicate a neurophyciologic effect of SMT in patients with higher baseline function scores, but the since no other significant relationships between PPT and outcome were seen, the implications of this finding are limited. Overall, alterations in thoracic spine mobility and pressure pain sensitivity do not appear to be responsible for improved outcomes in patients with subacromial pain syndrome. Future studies should explore the effects of SMT using other measures of thoracic spine motion and experimental pain modalities, as well as greater dosing of SMT over a longer follow-up.
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Cornick, Courtney Racquel. "Effectiveness of hypnosis interventions in a spine rehabilitation program." Diss., University of Iowa, 2014. https://ir.uiowa.edu/etd/1443.
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Chronic back pain has a profound impact on an individual and society. Over the past two decades individuals have become increasingly interested in Complimentary and Alternative Medicine (CAM) as a treatment for medical conditions. One of the most common uses of CAM is to treat back pain. There are a variety of CAM interventions to treat pain, and clinical hypnosis is one treatment that serves to help individuals to better manage their symptoms of chronic pain. In many cases, clinical hypnosis is used as an adjunct to treatment rather than a treatment alternative. Additionally, clinical hypnosis is included as part of relaxation treatments within chronic pain rehabilitation programs across the country. There remains a lack of information on hypnosis as a treatment for chronic back pain within chronic pain rehabilitation programs. The present study assessed pain intensity, disability, and quality of life for individuals who received hypnosis and those who did not in a chronic pain rehabilitation program. Descriptive data were presented for all participants and between groups and within group comparisons were made. Results of this study showed that prior to treatment, pain caused severe disability, was discomforting or distressing, and caused moderate to severe mental and physical impact. When patients returned 6-12 weeks later, all patients reported a decrease in disability and pain and an increase in physical and mental health quality of life. Groups did not vary significantly on measures of pain intensity, disability, and health status.
Results of this study suggest that more research should be done on the usefulness of various treatments within interdisciplinary chronic pain rehabilitation programs. Additionally, more research will allow clinicians to gain a better understanding of thetypes of interventions utilized within psychological portions of chronic pain rehabilitation.
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Kramarczuk, Barbara Maria. "Pain and associated factors in Australian and Polish groups /." Title page, contents and abstract only, 1990. http://web4.library.adelaide.edu.au/theses/09PM/09pmk89.pdf.
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Hines, M. "Hip-spine interaction in low back pain : the role of the hip extensors." Thesis, London South Bank University, 2017. http://researchopen.lsbu.ac.uk/2757/.
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Despite the high prevalence and global burden of low back pain (LBP), the pathogenesis is poorly understood. Without a better understanding of what structures are involved in the development and chronicity of LBP, the value and efficacy of clinical assessments and physical therapy interventions are limited. Although there is a clear link between the lumbar spine, pelvis and hip extensors during movement in both LBP and healthy subjects, there is limited evidence regarding whether it is passive or active components that are influenced. There is a need for improved prognostic evaluation of patients with LBP, including whether altered hip biomechanics are the result of structural, passive elements, or neuromuscular, active components of movement. Such evaluations will be beneficial for researchers, clinicians and physical therapists. The purpose of the present investigation is initially to demonstrate how a handheld measuring device can be adapted for use in measuring passive hip moments during supine leg raising. Comparisons are then made between subjects with LBP and healthy controls. A validated dynamic biomechanical model is used to calculate passive hip moments at a variety of knee angles, from which a predictive equation is derived, which is specific to each subject. Following a gait analysis protocol, the predictive equation is used to calculate passive hip extensor moments during the hip flexion component of gait. Comparisons are made between passive hip extensor moments, total hip moments, power and work done, in subjects with and without LBP. The present investigation demonstrated the high accuracy of a handheld force transducer for the measurement of passive hip moments. There were no statistically significant differences in passive hip extensor biomechanical properties between subjects with LBP and healthy controls. However, assessment during walking demonstrated significant differences in passive hip extensor moments between subjects with LBP and controls. Further differences were identified in total hip moments, power and work done, despite no differences in gait parameters. It is plausible that the passive and active components of movement interact, although further research is required to determine whether such interactions are consistent and predictable. It was observed that the passive contribution to hip biomechanics during the swing phase of gait is considerable, and should be incorporated into dynamic modelling. Differentiating between passive and active components may be particularly useful for researchers, clinicians and physical therapists, for evaluating which components are influenced by LBP and for assessing the efficacy of component-specific interventions. Future research should expand on this research to include a wider range of LBP patients, with different severity and disability of LBP, to develop a more complete range of data on how passive and active components are influenced and the range of interactions during common movements. Other research should attempt to determine which interventions are most appropriate for targeting changes to passive and active components independently, and in accordance with patient adaptations to LBP. The modelling, experimental procedures and customised equipment used in the present investigation are appropriate for use in assessing passive contributions to joint biomechanics during movement.
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Holm, Lena. "Epidemiological aspects on pain in whiplash-associated disorders /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-083-1/.
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Lemming, Dag. "Experimental Aspects on Chronic Whiplash-Associated Pain." Doctoral thesis, Linköpings universitet, Rehabiliteringsmedicin, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-10693.
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Introduction: Chronic pain after whiplash trauma (chronic WAD) to the neck is still a common clinical problem in terms of pain management, rehabilitation and insurance claims. In contrast to the increased knowledge concerning mechanisms of chronic pain in general, no clinical guidelines exist concerning assessment, pain control and rehabilitation of patients with chronic WAD. Aim: The general aim of this thesis was to use experimental techniques to better understand the complex mechanisms underlying chronic pain after whiplash trauma. The specific aims of papers I and II were mainly to use analgesic drugs with different target mechanisms alone or in combinations to assess their effects on pain intensity (VAS). Experimental pain techniques were used in all studies to assess deep tissue sensitivity (electrical, mechanical and chemical stimuli). Paper IV aimed at assessing deep tissue sensitivity to mechanical and chemical stimulation. The aim in paper III was to investigate if biochemical changes in interstitial muscle tissue (trapezius muscle) could be detected in WAD patients. Materials and Methods: The thesis is based on three different groups of patients with chronic WAD. In paper III and IV two different groups of healthy controls also participated. All patients were initially assessed in the pain and rehabilitation centre. In paper I (30 patients) and II (20 patients) two different techniques of drug challenges were used. In paper I: morphine, ketamine and lidocaine were used as single drugs. In paper II: remifentanil, ketamine and placebo were used in combinations and together with experimental pain assessments. Microdialysis technique was used in paper III (22 patients from study IV and 20 controls). In paper IV (25 patients and 10 controls) a new quantitative method, computerized cuff pressure algometry, was used in combination with intramuscular saline. In all papers, experimental pain techniques for deep tissue assessment (except cutaneous electrical stimulation in paper I) were used in different combinations: intramuscular hypertonic saline infusion, intramuscular electrical stimulation and pressure algometry. Results and Conclusion: There are multiple mechanisms behind chronic whiplash-associated pain, opioid sensitive neurons, NMDA-receptors and even sodium channels might play a part. A significant share of the patients were pharmacological non-responders to analgesic drugs targeting the main afferent mechanisms involved in pain transmission, this implies activation of different pain processing mechanisms (i.e. enhanced facilitation or changes in the cortical and subcortical neuromatrix). Experimental pain assessments and drug challenges together indicate a state of central hyperexcitability. Ongoing peripheral nociception (paper III), central sensitization and dysregulation of pain from higher levels in the nervous system may interact. These findings are likely to be present early after a trauma, however it is not possible to say whether they are trauma-induced or actually represents pre-morbid variations. Clinical trials with early assessments of the somatosensory system (i.e., using experimental pain) and re-evaluations, early intervention (i.e. rehabilitation) and intensified pain management could give further knowledge.
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Miller, Emily Michele. "Exercise-Induced Low Back Pain and Neuromuscular Control of the Spine - Experimentation and Simulation." Diss., Virginia Tech, 2012. http://hdl.handle.net/10919/37507.
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Low back pain (LBP) is associated with altered neuromuscular control of the trunk, as well as impaired performance during functional tasks highly dependent upon trunk neuromuscular control. Comparing measurements between individuals with and without LBP does not distinguish whether the LBP individual exhibits altered neuromuscular control only while experiencing LBP versus at all times. Additional insight was gained on the relationship between trunk neuromuscular control and LBP by investigating individuals who experience recurrent exercise-induced LBP (eiLBP). To differentiate the effects of LBP from individual differences, comparisons were made between episodes of pain and no pain within eiLBP individuals, and between eiLBP individuals while pain free and a group of healthy controls. Three studies were completed based on repeated measurements from both eiLBP and healthy individuals. Study 1 investigated effects of eiLBP on fundamental measures of neuromuscular control, including intrinsic trunk stiffness and the paraspinal reflex delay using a series of pseudo-random position perturbations. eiLBP individuals exhibited increased stiffness compared to healthy controls unaffected by the presence of pain, and increased reflex delays concurrent only with pain. Study 2 investigated effects of eiLBP on seated sway during a functional task involving maintaining balance. Seat and trunk kinematics were obtained while participants balanced on a wobble chair at two difficulty levels. eiLBP individuals exhibited impaired seat measures at all times, with altered trunk measures only while in pain and when the task was not challenging. Study 3 investigated effects of eiLBP on the underlying control of seated sway using a model of wobble chair balance. Quantified neuromuscular control indicated increases in proportional and noise gains for a challenging level compared to an easy level, more so for eiLBP individuals compared to controls and while experiencing pain compared to pain free. Overall, fundamental measures, seated sway measures, and identified control parameters using a model of wobble chair balance were all affected by the presence of pain within the eiLBP individuals and/or the eiLBP individuals compared to healthy controls. Therefore, this study shows that some characteristics appear to be inherent to the LBP individual, while others are only concurrent with pain.Ph. D.
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Freddolini, Marco. "Dynamic properties of the lumbar spine in people with non-specific low back pain." Thesis, University of Roehampton, 2014. https://pure.roehampton.ac.uk/portal/en/studentthesis/dynamic-properties-of-the-lumbar-spine-in-people-with-non-specific-low-back-pain(9589eabf-ee40-4fa5-843f-86d543332723).html.
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Non-specific low back pain (LBP) has been associated with alterations in the biomechanical properties and muscle activities of the trunk, but it is unclear how these changes are related to the dynamic stability of the trunk. During sitting, the structures of the trunk stabilise the upper body counterbalancing external moments acting on the trunk. The aim of this research was to evaluate a range of biomechanical variables including the hip and lumbar spine joints range of motions, moments and powers the viscoelastic properties of the trunk, and the role of the muscles while a participant was performing a balancing task in sitting and to compare results between healthy and LBP subjects. A custom-made swinging chair was used to perform the balancing task. It was designed to challenge primarily the trunk and to minimise the effect of the lower limbs so that the role of the trunk could be examined in isolation. Twenty-four participants with LBP and thirty healthy participants were requested to sit on the custom-made swinging chair and to regain the balance after tilting the chair backward for 10° and 20º. Electromagnetic motion track system sensors were placed on the participants’ back, one at the sacrum level and one at the first lumbar vertebral level to measure hip and lumbar kinematics. One further sensor was placed on the chair to track its rotation, which was also the rotation of the lower limbs. Forces data were taken from a force-plate which was mounted at the bottom of the chair. Inverse dynamic equations were used to derive the muscle moment acting at the hip and lumbar spine joints using data from the force platform and the motion tracking system. Muscle power was then calculated by multiplying the muscle moment and the corresponding joint angular velocity. Trunk viscoelastic parameters were derived using a second order linear model combine trunk moment and motion. Chair motion and trial duration were used to evaluate dynamic stability and task performance, in particular, the angular displacement of the chair was fitted in an equation describing the underdamped second-order response to a step input to derive natural frequency and damping ratio and to evaluate possible differences between groups. Activities, reaction times and co-contraction of the trunk muscles were evaluated using surface electromyography (EMG). The surface electrodes were placed bilaterally on the erector spinae , rectus abdominus, external and internal oblique. Kinematic analysis showed that the hip range of motion increased whereas spine range of motion angle decreased in participants with LBP for both tilt angles (p. < 0.05). No significant differences were found in muscle moment and power between healthy and LBP subjects (p > 0.05). The duration of contraction of various trunk muscles and co-contraction were significantly longer in the LBP subjects (p < 0.05) when compared to healthy subjects, and the reaction times of the muscles were also significantly reduced in LBP subjects (p<0.05). Trunk stiffness was found increased for LBP subjects (p < .05) while no difference was found for damping coefficient. There were no significant differences between the 2 subject groups in the time required to regain balance, and in the dynamic stability parameters, the natural frequency and damping ratio. The present study showed LBP was associated with alterations in biomechanical variables; in particular stiffness, hip and lumbar spine joints kinematic and muscle responses were altered in subjects with LBP when compared with healthy group. However, these alterations did not affect dynamic stability and moment developed at joints level, suggesting that LBP subjects adopted a different strategy to maintain balance but with the same effectiveness as the healthy subjects without any worsening of the symptoms. This may suggest to clinicians to encourage patients to remain active rather than to avoid movements. On the other hand, compensatory strategies were achieved with increased co-contraction at the expenses of muscle efficiency. This may lead to muscle fatigue and increase in spinal stress. Future research should clarify if the observed biomechanical alterations in this study are consequences or causes of LBP; or if the biomechanical changes and pain operate in a vicious circle, reinforcing each other leading to chronic conditions. This would help achieve our ultimate goal of developing effective treatment strategies, and it is hoped that the work of this thesis has helped us take a significant forward towards this goal.
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Segar, Anand Hari. "The effect of obesity upon the lumbar spine." Thesis, University of Oxford, 2015. http://ora.ox.ac.uk/objects/uuid:0db5f091-0f6f-4686-957e-22c5390232b0.
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Back pain is a massive global public health problem with multiple contributing factors including obesity. Obesity is thought to be linked to back pain through mechanical factors. However, obesity also causes a systemic low-grade inflammatory milieu. This would suggest a possible biochemical link between obesity, intervertebral disc degeneration, and back pain. Furthermore, the relationship between obesity and the clinical presentation of spine patients is unclear. This thesis aims to examine the effect of and relationship between obesity, the intervertebral discs, and back pain from biochemical, clinical, and epidemiological perspectives. In this thesis, an in vitro study assessed the effect of leptin, a fat-specific cytokine, upon the intervertebral disc. The bovine intervertebral disc was used as a model in a cell culture system. An ex vivo study examined leptin and pro-inflammatory cytokines produced by paraspinal adipose tissue taken during routine surgical procedures from spinal patients. Plasma taken from patients presenting with low back pain was analysed by mass spectrometry and multiplex immunoassay to identify possible protein biomarkers. At an epidemiological level, statistical modelling of the Genodisc patient population was conducted. This was a pan-European study of 2636 patients presenting to tertiary spinal units. Analyses were performed to examine relationships between obesity, quantified by body mass index (BMI), and pain, clinical diagnosis, and spinal degeneration identified on magnetic resonance imaging (MRI). Leptin was shown to increase the production of and expression of degradative and pain-generating molecules by disc cells. A pro-inflammatory environment, especially IL-6, potentiated this response. Leptin and pro-inflammatory cytokines produced by paraspinal fat were unrelated to clinical symptoms. However, levels of the pro-inflammatory cytokines, TNF-α and IL-6, were raised in the plasma of patients with greater pain or those with spinal stenosis. Furthermore, clusterin and complement were identified, by mass spectrometry, as potential biomarkers for spine patients. Epidemiological analyses revealed that obesity was associated with greater back pain, although the magnitude of this association was small. Similarly, obesity was associated with a diagnosis of spinal stenosis. Finally, increased BMI was found to be an independent predictor of disc degeneration, spinal stenosis, and disc herniation on MRI. In summary, this thesis has furthered the clinical understanding of lumbar spine pathology and back pain. It will provide clinicians with a better framework to assess spine patients. These results show that obesity is associated with lumbar spine degeneration and pain. Leptin could be a factor mediating this relationship. Further studies should concentrate on clarifying the mechanism of action of leptin upon the intervertebral disc and assessing the longitudinal effect of obesity upon the lumbar spine. In this thesis, an in vitro study assessed the effect of leptin, a fat-specific cytokine, upon the intervertebral disc. The bovine intervertebral disc was used as a model in a cell culture system. An ex vivo study examined leptin and pro-inflammatory cytokines produced by paraspinal adipose tissue taken during routine surgical procedures from spinal patients. Plasma taken from patients presenting with low back pain was analysed by mass spectrometry and multiplex immunoassay to identify possible protein biomarkers. At an epidemiological level, statistical modelling of the Genodisc patient population was conducted. This was a pan-European study of 2636 patients presenting to tertiary spinal units. Analyses were performed to examine relationships between obesity, quantified by body mass index (BMI), and pain, clinical diagnosis, and spinal degeneration identified on magnetic resonance imaging (MRI). Leptin was shown to increase the production of and expression of degradative and pain-generating molecules by disc cells. A pro-inflammatory environment, especially IL-6, potentiated this response. Leptin and pro-inflammatory cytokines produced by paraspinal fat were unrelated to clinical symptoms. However, levels of the pro-inflammatory cytokines, TNF-α and IL-6, were raised in the plasma of patients with greater pain or those with spinal stenosis. Furthermore, clusterin and complement were identified, by mass spectrometry, as potential biomarkers for spine patients. Epidemiological analyses revealed that obesity was associated with greater back pain, although the magnitude of this association was small. Similarly, obesity was associated with a diagnosis of spinal stenosis. Finally, increased BMI was found to be an independent predictor of disc degeneration, spinal stenosis, and disc herniation on MRI. In summary, this thesis has furthered the clinical understanding of lumbar spine pathology and back pain. It will provide clinicians with a better framework to assess spine patients. These results show that obesity is associated with lumbar spine degeneration and pain. Leptin could be a factor mediating this relationship. Further studies should concentrate on clarifying the mechanism of action of leptin upon the intervertebral disc and assessing the longitudinal effect of obesity upon the lumbar spine.
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Prowse, Tracy. "Intrinsic risk factors associated with patellofemoral pain syndrome." Master's thesis, University of Cape Town, 2003. http://hdl.handle.net/11427/2992.
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Kless, Jack Robert. "FACTORS ASSOCIATED WITH MODERATE AND SEVERE POSTOPERATIVE PAIN." Case Western Reserve University School of Graduate Studies / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=case1264081658.
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Sparks, Cheryl L. "Using fMRI to determine if hemodynamic responses to pain change following thoracic spine thrust manipulation." Diss., NSUWorks, 2012. https://nsuworks.nova.edu/hpd_pt_stuetd/50.
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Masaracchio, Michael. "Short-term combined effects of thoracic spine thrust manipulation and cervical spine non-thrust manipulation in patients with mechanical neck pain : a randomized clinical trial." Diss., NSUWorks, 2011. https://nsuworks.nova.edu/hpd_pt_stuetd/43.
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Matsuyama, Ayako. "New insights into pain mechanisms through the study of genes associated with monogenic pain disorders." Thesis, University College London (University of London), 2017. http://discovery.ucl.ac.uk/10040307/.
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Pain is an intrinsic mechanism that promotes our survival by helping us to avoid injury. However, chronic pain remains a significant clinical burden and remains poorly treated. The development of new analgesic drugs may significantly improve quality of life for chronic pain patients. This thesis investigates the mechanisms of pain sensation and also suggests some novel analgesic drug targets by using molecular, genetic, and transgenic approaches. Firstly, a novel function of sodium channel Nav1.7 is explored. Microarray data showed that gene expression profiles are dramatically altered in dorsal root ganglia from Nav1.7 null mice. These changes were confirmed by real-time qRT-PCR. Altered expression of preproenkephalin (Penk) and carcinoembryonic antigen-related cell adhesion molecule 10 (Ceacam10) may contribute to the pain insensitive phenotype seen in Nav1.7 nulls. The gene expression changes were further explored using in vitro cell based assays, showing a potential role of sodium ions in controlling transcription of Penk. Secondly, we study a family with six members affected with a pain insensitive phenotype characterized by multiple painless bone fractures and frequent painless lesions caused by burning stimuli. A novel point mutation in ZFHX2, encoding a putative transcription factor expressed in small diameter sensory neurons, was identified. By analysing Zfhx2 knockout and BAC transgenic mice bearing the orthologous mutation, we confirm that ZFHX2 is crucial for normal pain perception. We study how the mutation disrupts ZFHX2 function, resulting in altered downstream expression of pain-related genes. Thirdly, a patient with small fibre neuropathy and erythromelalgia-like symptoms was genetically analysed. Using exome sequencing and detailed bioinformatics analyses, I have shortlisted three missense mutations in the genes CWC22, TMEM8B and ATL3 that are potentially pathogenic. By studying genes mutated in families with rare inherited pain disorders, this thesis broadens our understanding of pain sensation and highlights new routes to develop better analgesic drugs.
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Souvlis, Tina. "Characteristics of spinal manual therapy induced hypoalgesia /." St. Lucia, Qld, 2003. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe17338.pdf.
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Rogers, Ellen Louise. "Prolonged Lumbar Flexion Disturbs Paraspinal Reflex Behavior." Thesis, Virginia Tech, 2005. http://hdl.handle.net/10919/31247.
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The neuromuscular response to prolonged lumbar flexion has recently been extensively studied in felines but has not been examined in humans. Animal studies suggest that prolonged lumbar flexion disturbs neuromuscular control of paraspinal muscles. This disturbance was linked to creep deformation of passive spinal tissues. Past research indicates that disturbance of paraspinal reflexes may limit spinal stability. The current study aimed to examine this behavior in humans. We hypothesized that prolonged lumbar flexion will disturb paraspinal reflex behavior in human subjects.
Reflex behavior was quantified following a fifteen minute period of static flexion. There was a trend suggesting an increase in reflex magnitude after flexion (p = 0.055). This trend was only significant in female subjects (p < 0.003). Increased reflex following flexion was associated with a transient period of EMG hyperexcitability similar to felines.
A second study was performed to quantify reflex behavior and creep deformation during flexion and recovery. Results indicated that creep occurred during prolonged flexion (p < 0.001). Reflexes were inhibited following flexion (p < 0.03). Both creep deformation and paraspinal reflex (p > 0.05) failed to exhibit significant recovery during the length of the test.
Inhibited paraspinal reflexes may contribute to spinal instability and risk of low back pain for workers using flexed postures, due to the inability of the neuromuscular system to coordinate an appropriate muscle response following an unexpected loading event. Future studies must examine appropriate work/rest intervals for workers using flexed postures to limit reflex disturbance from prolonged ligament strain.Master of Science
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Williams, Mark A. "The role of cervical spine range of motion in recovery from whiplash associated disorders." Thesis, University of Warwick, 2011. http://wrap.warwick.ac.uk/49214/.
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This thesis investigates the role of cervical spine Range of Motion in the recovery from Whiplash Associated Disorders. In clinical practice, Health Care Professionals attach value to measurements of cervical spine Range of Motion for diagnostic, prognostic and treatment evaluation purposes. A systematic literature review found conflicting evidence as to whether cervical spine Range of Motion was a prognostic factor following a whiplash injury. Greater understanding of prognostic factors such as this may facilitate improvements in patient management. A second systematic literature review investigated the reliability and validity of methods for measuring cervical spine Range of Motion. The Cervical Range Of Motion (CROM) device was found to be the most rigorously tested and clinimetrically promising method and was subsequently investigated for intra- and inter-observer reliability in a group of whiplashinjured individuals and found to be substantially reliable. The CROM device was utilised in a longitudinal cohort study of 599 whiplash-injured patients to investigate the prognostic value of cervical spine Range of Motion for neck painrelated disability and patient-reported recovery at short, medium and long-term follow-up. A patient-reported version of cervical spine Range of Motion was also evaluated as a prognostic factor. Although useful for explaining disability at the time of measurement, active, passive and patient-reported forms of cervical spine Range of Motion were not significant prognostic factors for poor outcome when other physical and psychosocial factors were accounted for. The clinical implication of this research is that if patients are experiencing reduced cervical spine Range of Motion a few weeks after their whiplash injury they will not necessarily have a poor outcome in the longer term as is commonly believed at present.
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Colbrunn, Robb William. "A Robotic Neuro-Musculoskeletal Simulator for Spine Research." Cleveland State University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=csu1367977446.
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Suwandinata, Ferdhy Suryadi. "Endometriosis-associated pain, social impact, and information through internet survey." Giessen : VVB Laufersweiler, 2006. http://deposit.d-nb.de/cgi-bin/dokserv?idn=981059775.
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O'Callaghan, Karen Ann. "The control of pain associated with lameness in dairy cattle." Thesis, University of Liverpool, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.274427.
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Fayaz, Alan. "Chronic pain in the United Kingdom and associated cardiovascular disease." Thesis, Imperial College London, 2017. http://hdl.handle.net/10044/1/61345.
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Prior to the studies presented in this thesis there was no widely accepted estimate for the prevalence of chronic pain in the United Kingdom, little understanding of the biological consequences of chronic pain (as compared to its psychological and social impact), and unresolved issues about the possible influence of chronic pain on cardiovascular outcomes. I have used meta-analysis to summarise prevalence estimates for a range of chronic pain phenotypes, demonstrating that just over 43% of the adult population experience pain with a duration of 3 months or greater. This figure is considerably higher than estimates often quoted in public and scientific forums. I have also outlined the impact of chronic pain on cardiovascular health through a systematic review of existing evidence, suggesting that chronic pain may be associated with cardiovascular disease and cardiovascular mortality. However, existing studies took an inconsistent and incomplete approach in their adjustment for potentially confounding factors, so it cannot be concluded that these associations are causal. I have therefore supplemented existing evidence with analysis of data from a large national survey of the population of England, adjusting for a comprehensive list of potentially confounding variables. My study shows that participants reporting chronic pain are 55% more likely to experience cardiac disease than those without pain, and that this risk increases systematically in-line with increasing chronic pain intensity. In summary, I have demonstrated that chronic pain affects a much greater proportion of the adult population on the United Kingdom than previously estimated. Furthermore, adults reporting chronic pain, in particular those most severely affected, may be at significantly increased risk of cardiac disease. Future studies should focus on determining whether reducing the impact of chronic pain can improve cardiac health.
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Enomoto, K. "Psychological factors associated with pain 24 hours post-tooth extraction." Thesis, University College London (University of London), 2012. http://discovery.ucl.ac.uk/1356884/.
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Background: There is a considerable variation in dental patients’ post-operative pain experience and analgesic requirements following identical surgical procedures. This has been related to a variety of psychological factors. Pain is one of the most commonly cited factors that is strongly associated with dental fear. Surgical removal of a third molar, the most common procedure in oral surgery and generally associated with dread, has received limited research attention. It is, therefore, essential to understand factors likely to influence the pain experience of patients in such a stressful setting. Such an understanding will not only help patients cope with fear and pain, but also will assist clinicians create a less stressful environment. This study investigated psychological factors predicting heightened pain perception in tooth extraction: dental anxiety; dental control; pain catastrophizing; expectation of pain; social desirability (defensiveness); trait anxiety and monitor-blunter style coping. Methods: The sample consisted of 306 participants (144 male and 162 female aged between 18 and 62 years with the mean age of 31.82) who were referred by their local dental practitioners for the surgical removal of tooth/teeth under local anaesthetic at the unit of Oral and Maxillofacial surgery at UCL Eastman Dental Institute. The tooth/teeth which needed extraction were not limited to the third molars. The variables were measured at four different time points: on recruitment (baseline: T0), before (T1), after (T2) and the following day (T3) of the dental surgery. The variables assessed were: dental anxiety; dental control; pain catastrophizing; social desirability; trait anxiety; monitor-blunter style coping; sensory intensity of pain, affective quality of pain, state anxiety and mood states. After the surgery, the dental surgeons rated the complexity of the surgical procedure and the perception of their patients’ distress levels. Results: It was found that pain 24 hours post-tooth extraction was best predicted by the levels of expected sensory pain together with post-surgery state anxiety, trait anxiety and expected affective pain. Expected sensory pain, in turn, was predicted by dental anxiety, monitoring and felt (perceived) control (i.e., the dental pain predictors). Moreover, dental anxiety was found to be a precursor to all the dental pain predictors. Furthermore, pain catastrophizing did not make to the primary dental pain predictors. Nevertheless, it contributed to heightened levels of trait anxiety and expected affective pain which sequentially helped to intensify perception of dental pain. In addition, it was revealed that dental surgeons underevaluated their patients’ treatment pain.
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Mikkonen, P. (Paula). "Low back pain and associated factors in adolescence:a cohort study." Doctoral thesis, Oulun yliopisto, 2015. http://urn.fi/urn:isbn:9789526209524.
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Abstract Low back pain (LBP) is a common condition already in adolescence and seems to predict future symptoms. Most of the previous longitudinal studies on LBP have been conducted in adult populations. Among adolescents, LBP has been linked most convincingly to psychosocial factors and smoking. We are not aware of any previous studies on clustering of potential risk factors in adolescent LBP. The main objective of this study was to analyze the potential associations of mainly modifiable psychosocial and lifestyle factors with LBP in adolescence. The factors evaluated were overweight, smoking, physical workload, family’s socioeconomic status, and the co-occurrence of psychosocial and lifestyle factors. The present study used the database of the 16- to 18-year-old adolescent subcohort, Oulu Back Study (n=1,987), of the Northern Finland Birth Cohort 1986. Moreover, we evaluated whether the associations differ depending on the presence of LBP symptoms at baseline of the two-year follow-up period. LBP was common among cohort adolescents as, on average, every second adolescent reported LBP, girls reporting more symptoms. As a whole, more associations were found among girls than boys. Overweight was associated with new LBP in the follow-up, but the association was not strong. Prolonged habitual smoking was associated with LBP, particularly with symptoms at baseline and follow-up. High exposure to awkward trunk postures and an overall physically demanding job were especially associated with new LBP in the follow-up. Family’s socioeconomic status was not consistently associated with LBP. At 16 years, four latent class clusters of psychosocial and lifestyle factors were found in both genders. Clusters characterized by behavioural problems were associated with LBP among both genders. Especially girls with the combination of emotional and behavioural problems were at the greatest risk of seeking care for new LBP. The results of this study indicate that LBP in adolescence is associated with both psychosocial and lifestyle factors. The information obtained may be utilized for improving preventive measures and individual care for adolescent LBPTiivistelmä Alaselkäkipu on yleistä jo nuorilla, ja varhain koetut oireet ennustavat myöhempiä selkäkipuoireita. Suurin osa alaselkäkivun seurantatutkimuksista on tehty aikuisväestöllä. Nuorten alaselkäkivun on esitetty vakuuttavimmin liittyvän psykososiaalisiin ongelmiin ja tupakointiin. Alaselkäkipuun liittyvien tekijöiden mahdollista kasautumista ei ole nuorilla tutkittu aiemmin. Tämän väitöstutkimuksen tarkoituksena oli selvittää, ovatko pääasiassa muunneltavissa olevat psykososiaaliset ja elämäntapatekijät yhteydessä nuoruudessa esiintyvään alaselkäkipuun. Arvioitavina tekijöinä olivat ylipaino, tupakointi, fyysinen työkuormitus, sosioekonomiset tekijät, sekä psykososiaalisten ja elämäntapatekijöiden kasautuminen. Tutkimusaineisto koostui Pohjois-Suomen syntymäkohortti 1986:n osaotoksesta (Oulun selkätutkimus), johon kuului 1987 16–18-vuotiasta nuorta. Mahdollisia yhteyksiä arvioitiin erikseen sen mukaan, raportoivatko nuoret seurannan alussa alaselkäkipuoireita vai ei. Alaselkäkipu oli nuorilla yleistä, ja tytöillä yleisempää kuin pojilla. Keskimäärin joka toinen nuori raportoi oireita. Tutkittujen tekijöiden ja alaselkäkivun välisiä yhteyksiä todettiin selvemmin tytöillä. Ylipaino ennusti seurannassa ilmaantuvaa alaselkäkipua, mutta yhteys ei ollut vahva. Säännöllinen tupakointi oli yhteydessä alaselkäkipuun ja etenkin toistuviin oireisiin. Tutkituista työkuormitustekijöistä etenkin hankalat työasennot ja fyysisesti monella tapaa raskaaksi luokiteltava työ altistivat seurannassa uudelle alaselkäkivulle. Sosioekonomiset tekijät eivät olleet selkeästi yhteydessä alaselkäkipuun. Latenttien luokkien analyysi tunnisti seurannan alkuvaiheessa neljä erilaista ryhmää (klusteria) psykososiaalisten ja elämäntapatekijöiden perusteella molemmilla sukupuolilla. Sekä tytöillä että pojilla alaselkäkipua esiintyi erityisesti niissä ryhmissä, joissa esiintyi runsaasti käyttäytymishäiriöitä. Tunne-elämän ja käyttäytymisen ongelmat ennustivat alaselkäkivun vuoksi hoitoon hakeutumista tytöillä. Tulosten perusteella nuorten alaselkäkipuun liittyy sekä psykososiaalisia että elämäntapatekijöitä. Tuloksia voidaan hyödyntää alaselkäkivun ennaltaehkäisyn ja nuorten yksilöllisen hoidon suunnittelussa
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Stojkov, Jane. "Assessment of visceral pain associated with metritis in dairy cows." Thesis, University of British Columbia, 2014. http://hdl.handle.net/2429/51118.
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Metritis is a common disease in dairy cattle but little work has assessed pain associated with this disease. Tissue palpation is commonly used to assess pain in human and veterinary medicine. The objective of this study was to evaluate visceral pain responses during rectal and uterine palpation in healthy cows and in cows diagnosed with clinical signs of metritis. A total of 49 Holstein dairy cows (mean ± SD parity = 2.8 ± 1.8) were subjected to systematic health checks starting 3 d after parturition and continuing every 3 d for 21 d. Cows were scored for vaginal discharge (0 to 4); 13 cows showed a discharge score ≥ 2 during at least one health check and were classified as metritic and 29 cows were classified as ‘healthy’ all showing no sign of any other disease (including mastitis and lameness). Back arch and heart rate variability (HRV) before examination and during palpation were recorded using video and heart rate monitors. Back arch (cm²) on the day of diagnosis was greater in metritic versus healthy cows (1034.3 ± 72.7 cm² vs. 612.8 ± 48.7 cm²), and greater during uterine versus rectal palpation (869.2 ± 45.0 cm² vs. 777.9 ± 45.0 cm²). Heart rate frequency analysis showed that the low frequency portion (LF %) was higher in cows with metritis versus healthy cows (16.5 ± 1.2 vs. 12.9±1.0). The SD between normal to normal inter beat intervals and the root mean square of successive differences both decreased during uterine versus rectal palpation (1.9 ± 0.1 vs. 2.5 ± 0.1 and 1.3 ± 0.1 vs. 1.7 ± 0.1, respectively). Together, these results indicate that the inflammation associated with metritis is painful, and that the pain response can be detected during rectal and uterine palpation. Uterine palpation appears to be more aversive than rectal palpation, suggesting that the former should be avoided when possible.Land and Food Systems, Faculty of
Graduate
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Al, Zoubi Fadi. "Reliability of a measure of total lumbar spine range of motion in individuals with low back pain." Thesis, McGill University, 2013. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=114559.
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Lumbar spine range of motion (ROM) is conventionally measured using multiple, individual anatomical plane movements. This is unwieldy for clinical research, because it relies on the assumption that a large proportion of subjects will present with the same impairment. The objective of this thesis work, therefore, was to assess the reliability of a novel measure of total lumbar spine ROM, to be used in future studies. We hypothesized that the reliability of this measure would be ≥0.9, so as to meet previously suggested criteria for monitoring individual patient progress. Twenty subjects with chronic low back pain (LBP) were recruited for two testing sessions. At each session, subjects performed 3 series of 8 end-range, randomly ordered lumbar spine movements, at 45 degrees intervals around the full circle, with the help of visual feedback. Lumbar spine motion was acquired using two, 6-degrees-of-freedom electromagnetic motion capture sensors placed on the skin over the spinous processes of the twelfth thoracic (T12) and first sacral (S1) vertebrae. The measure of interest was based on the relative position of T12 in the transverse plane of S1. Two curve fitting approaches - least-squares ellipse and cubic spline - were used to fit a shape to the 8 end-positions of movement in each series. The area of this shape was used to provide a measure of the total ROM, and the centre point to provide a measure of movement distribution and symmetry. Generalizability theory was used to assess the reliability of the area of each shape, and of its centre point in the anterior-posterior and medio-lateral axes of the transverse plane of S1. The index of dependability for the total lumbar spine ROM (area) was excellent (0.94 - 0.95), and moderate-to-excellent (0.59 – 0.91) for its distribution (centre points), with slightly better values achieved with the spline-fitting approach. Analysis of extrapolated data also indicated that similar values would be achieved using 3 repetitions of the task in a single testing session. These results support the use of this novel measure of total lumbar spine ROM in future clinical studies.L'amplitude des mouvements de la colonne lombaire (ou ROM, pour range of motion en anglais) est traditionnellement mesurée à l'aide de multiples mouvements individuels exécutés sur les plans anatomiques. La technique utilisée pour obtenir cette mesure complique la recherche clinique, car elle repose sur l'hypothèse qu'une forte proportion de sujets présente la même déficience. L'objectif de cette thèse était donc d'évaluer la fiabilité d'une nouvelle mesure de mouvement global de la colonne lombaire, qui serait utilisée dans des études futures. Notre étude repose sur l'hypothèse que la fiabilité de cette mesure serait ≥ 0,9; de manière à répondre à des critères préalablement proposés pour suivre les progrès d'un patient unique.Vingt sujets souffrant d'une lombalgie chronique (ou LBP, pour low back pain en anglais) ont été recrutés pour deux séances. À chaque séance, les sujets, aidés d'une rétroaction visuelle, ont effectué 3 séries de 8 mouvements de fin d'étendue de colonne lombaire, à 45 degrés d'intervalle autour d'un cercle complet, et ce, dans un ordre aléatoire. Les mouvements de la colonne lombaire ont été obtenus au moyen de deux capteurs électromagnétiques à 6 degrés de liberté, placés sur la peau au-dessus des apophyses épineuses de la douzième vertèbre thoracique (T12) et de la première vertèbre sacrée (S1). La mesure qui nous intéresse a été calculée d'après la position relative de T12 dans le plan transversal de S1. Deux méthodes d'ajustement de courbe ont été utilisées pour lier les 8 points de fin de mouvement dans chaque série : l'ellipse par les moindres carrés et la fonction spline cubique. L'aire de la forme ainsi obtenue a servi à fournir une mesure de la ROM totale; et le point central, une mesure de la distribution et de la symétrie des mouvements. La théorie de la généralisabilité (en anglais Generalizability Theory) a été employée pour évaluer la fiabilité de l'aire de chaque forme et celle de son point central dans les axes antéro-postérieur et médio-latéral du plan transversal de S1. L'indice de fiabilité était excellent (0,94 – 0,95) pour la ROM globale de la colonne lombaire (l'aire) et allait de modéré à excellent (0,59 à 0,91) pour la distribution des mouvements (points centraux), avec des valeurs légèrement plus élevées pour la méthode d'ajustement par spline. L'analyse des données extrapolées a également indiqué que des valeurs similaires seraient obtenues en utilisant 3 répétitions de la tâche dans une séance unique. Ces résultats appuient l'utilisation de cette nouvelle mesure de la ROM de la colonne lombaire dans de futures études cliniques.
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Muslim, Khoirul. "Traditional Posterior Load Carriage: Ergonomic Assessment and Intervention Efficacy." Diss., Virginia Tech, 2013. http://hdl.handle.net/10919/23726.
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There is a high prevalence of musculoskeletal symptoms (MSS) among manual material handling (MMH) workers. However, limited investigations have been undertaken among one large group of workers using a particular MMH method called traditional posterior load carriage (PLC). Such load carriage is typically done without the use of an assistive device (e.g., backpack) in developing countries, and involves exposure to known risk factors for MSS such as heavy loads, non-neutral postures, and high levels of repetition. The current work was completed to investigate the characteristics of the PLC task and physical effects on workers, and to evaluate a practical intervention that may help improve the task. The first study investigated, through structured interviews with 108 workers, the types, prevalence, and impacts of MSS. PLC workers incur a relatively high MSS burden, primarily in the lower back, but also in the feet, knees, shoulders, and neck. These MSS were reported to interfere with daily activity, but only few workers sought medical treatment. Workers suggested several task improvements including the use of a belt, hook, or backpack/frame, and changes in the carriage method. The second and third study investigated, in a laboratory setting involving nine healthy males, the effects of load mass and size, and the use of a simple intervention, respectively, on factors related to low back pain risks during PLC. Increasing load mass caused increased torso flexion, lumbosacral flexion moment, abdominal muscle activity, and torso movement stability in the frontal plane. Increasing load size also caused higher torso flexion, peak torso angular velocity and acceleration, and abdominal muscle activity. Complex interactive effects of load mass and size were found on paraspinal muscle activity and slip risk. The intervention, involving a simple frame to support a load, and use with a higher load placement was found to be potentially beneficial as indicated by reduced lumbosacral moment and ratings of perceived discomfort in several anatomical regions compared to the traditional PLC. Outcomes of this research can facilitate future ergonomic guidelines and interventions to improve working conditions and occupational health and safety for PLC workers.Ph. D.
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Gallagher, Sean. "Effects of torso flexion on fatigue failure of the human lumbosacral spine." Connect to this title online, 2003. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1070310033.
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Thesis (Ph. D.)--Ohio State University, 2003.Title from first page of PDF file. Document formatted into pages; contains xvii, 238 p.; also includes graphics (some col.). Includes abstract and vita. Advisor: William S. Marras, Dept. of Industrial and Systems Engineering. Includes bibliographical references (p. 204-238).
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Breloff, Scott. "Quantifying Segmental Spinal Motion during Activities of Daily Living." Thesis, University of Oregon, 2013. http://hdl.handle.net/1794/13233.
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Back pain is a very common musculoskeletal impairment in most Americans. Average annual occurrence of back pain is reported around 30% of the population and is the most common cause of activity limitation in people younger than 45 years old. Eighty percent of the back pain presents in the lumbar spine. Although this ailment is very prevalent in the American population, there is a lack of empirical evidence supporting the common clinical diagnosis and intervention back pain strategies. The frequency of back pain and the lack of treatment methods were the motivation for this investigation. It is important to better understand spine dynamics during ambulatory tasks of daily activities to identify possible biomechanical mechanisms underlying back pain.
Current biomechanical quantification methods for spine dynamics are either too invasive or not detailed enough to fully comprehend detailed spinal movement. Therefore, a non-invasive but detailed procedure to calculate spine dynamics was developed and tested. In this study, multi-segmented spine dynamics (kinematics and kinetics) were calculated during four activities of daily living (level walking (W), obstacle crossing (OC), stair ascent (SA) and stair descent (SD)).
Our findings suggested an in-vivo multi-segmented spine surface marker set is able to detect different and repeatable motion patterns during walking among various spinal segments. The sacrum to lower lumbar (SLL) joint had the largest range of motion (ROM) when compared to the other more superior joints (lower lumbar to upper lumbar and upper lumbar to lower thoracic). Furthermore, SA task demonstrated more flexion ROM than both W and SD tasks. In addition to task influence, joints at different spine levels also demonstrated different ROMs, where SLL had a greater ROM than upper lumbar to lower thoracic (ULLT) in the transverse plane. Age was found to not significantly affect the segmental spinal ROM or peak angles. The vertical segmental joint reaction forces were different between tasks, where SD yielded larger vertical reaction forces than W.
Overall, findings from this dissertation work were able to show that a multi-segment spine marker system could be an effective tool in determining different spinal dynamics during various activities of daily living.
This dissertation includes unpublished co-authored material.
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Aguerrevere, Luis. "Multivariate Cluster Analysis of the MMPI-2 and MMPI-2-RF Scales in Spine Pain Patients with Financial Compensation: Characterization and Validation of Chronic Pain Subgroups." ScholarWorks@UNO, 2010. http://scholarworks.uno.edu/td/1267.
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Different psychosocial factors influence the experience and adaptation to pain. Previous cluster analytic studies using the Minnesota Multiphasic Personality Inventory-2nd edition described psychologically different subgroups of pain patients that had been shown valuable in determining outcome. However, these studies had limited applicability to medico-legal pain populations because they did not use newly developed scales or describe important medico-legal factors that have large effects on symptom endorsement. Using three methods of clustering, the current investigation explored the subgroups that resulted when using all the MMPI-2 and the newly developed MMPI-2-RF (Restructured Form) scales on a large and well-described population of medico-legal spine pain patients. Result demonstrated that the best solution for the current sample was the two-cluster solution when a traditional method was used. However, the best solution was the three-cluster solution when all MMPI-2 scales and a method that used all MMPI-2-RF scales were used. Thus, the three-cluster solution was considered the most adequate solution to differentiate patients in medico-legal settings. Moreover, results demonstrated that subgroup membership was not conditioned to spine related organic factors. Instead, malingering, education, ethnic background and legal status differentiated pain subgroups. Lastly, results demonstrated a dose-response relationship between perceived outcome and subgroup profile elevation. The current results are relevant for understanding the circumstances that can influence spine pain recovery and for informing decisions regarding possible interventions.
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Jia, Bochen. "Influence of Prolonged Sitting and Psychosocial Stress on Lumbar Spine Kinematics, Kinetics, Discomfort, and Muscle Fatigue." Diss., Virginia Tech, 2013. http://hdl.handle.net/10919/50546.
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Low back pain (LBP) is a common occupational problem and continues to be the leading cause of occupational disability. Among diverse known risk factors, sitting is commonly considered as an important exposure related to LBP. Both modern living and contemporary work involve increased sedentary lifestyles, including more frequent and prolonged sitting. At present, however, the causal role of sitting on LBP development is controversial due to the contribution of several moderating factors (e.g., task demands, duration of exposures, and presence of muscle fatigue). A few studies have assessed low back loads in seated postures, but none has investigated the effects of prolonged sitting or time-dependent variations on spinal structure and spinal loading. Adverse effects of muscle fatigue on low back pain are well documented, yet the specific relationship between muscle fatigue and sitting-related low back pain are not fully established. In addition to these fundamental limitations in our understanding of the physical consequences of sitting, there is also little evidence regarding the effects of task requirements on muscle fatigue and spine loading. Therefore, the main objectives of this work were, in the context of sitting, to: 1) develop and evaluate a method to assess paraspinal muscle fatigue using electrical stimulation; 2) develop and evaluate a method (model) to quantify biomechanical loads on the lumbar spine in a seated posture; and 3) quantify the effects of prolonged seated tasks on low back loads, body discomfort, and localized muscle fatigue (LMF). The primary hypothesis was that exposure to sitting-related LBP risks is influenced by task requirements and sitting duration.
A muscle stimulation protocol was developed to measure stimulation responses in the lumbar extensors. A stimulation protocol, which included one conditioning train along with three 16-second stimulation train at 2 Hz, was recommended as appropriate to measure those muscles potentially fatigued during prolonged seated tasks. A three-dimensional, sitting-specific, fatigue-sensitive, time-dependent, electromyography (EMG)-based biomechanical model of the trunk was developed to investigate the effects of seated tasks and time-dependent variations on lumbosacral loading during sitting. Reasonable levels of correspondence were found between measured and predicted lumbosacral moments under a range of seated tasks. Lastly, the effects of prolonged sitting and psychosocial work stress on low back were quantitatively identified. Only prolonged sitting significantly increased trunk flexion angles and led to muscle fatigue. Relatively weak correlations were found between subjective and objective measures, though the two fatigue measurement methods (based on EMG and stimulated responses) showed a good level of correspondence.
Overall, this work provides a quantitative assessment of biomechanical exposures associated with seated tasks. The methods developed in this work make a contribution in terms of measurement/modeling approaches that can be used to assess LBP-relevant risks during prolonged sitting. The results of this work provide a better understanding of the effects of prolonged sitting on the risk of developing sitting-related LBP. Finally, results regarding the influences of prolonged sitting and psychosocial demands can be used to guide future job design.
Ph. D.
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Murphy, Samuel David. "The occurrence of back pain and associated risk factors in schoolchildren." Thesis, University of Surrey, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.273246.
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Floyd, Kory. "Affection Deprivation Is Associated With Physical Pain and Poor Sleep Quality." ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2016. http://hdl.handle.net/10150/621473.
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Social bonds are necessary for human survival and affectionate communication is paramount for their formation and maintenance. Consequently, affection deprivation -the condition of receiving less affectionate communication than desired-is associated with social pain, and contemporary research indicates that social pain has substantial neurological overlap with physical pain. Thus, it was proposed that affection deprivation would be associated with the sensation of physical pain as well as with poor-quality sleep. Three studies involving a total of 1,368 adults from nearly all U.S. states and several foreign countries revealed significant associations between affection deprivation, physical pain, and multiple facets of disturbed sleep.
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Marsden, Mandy. "The epidemiology and risk associated with lower back pain in cyclists." Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/12114.
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Includes abstract.Includes bibliographical references (leaves 89-98).
Aims of this thesis: the research reported in this thesis consists of a literature review and two research parts. In the first research part, a descriptive cross-sectional survey was conducted, to investigate 1) the epidemiology and 2) the nature of LBP in cyclists, and 3) possible risk factors associated with LBP in cyclists. In the second research part, a case control study was conducted, to investigate the association between LBP in cyclists and 1) flexibility and 2) anthropometric measurements, and 3) bicycle set-up parameters.
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Mahan, Farrah R. B. A. "Pain and Fatigue Associated with Generalized Joint Hypermobility in Gaucher Disease." University of Cincinnati / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1525168102345918.
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Moulder, Nicole. "The relative effectiveness of proprioceptive exercises as an adjunct to cervical spine manipulation in the treatment of chronic cervical spine pain and disability associated with whiplash injury." Thesis, 2003. http://hdl.handle.net/10321/290.
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Thesis (M.Tech.: Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2003. 104 leavesWhiplash injuries are thought to occur in as many as one-fifth of all MVA’s in the United States and Canada. South Africa may have a higher incidence of whiplash injuries due to the exceptionally high road accident rate when compared with international norms (Burger 1996:478). The incidence rate is higher among female subjects and people aged 20-24 years (Teasell and Shapiro 1998: 72, Spitzer et al. 1995). Whiplash injuries or whiplash-associated disorders (WAD) often result in chronic pain with a poor response to conventional therapeutics. Manipulation, exercise and anti-inflammatories have been identified as the options with scientifically established validity in the management of WAD (Spitzer et al. 1995) Patients with WAD have a distortion of the posture control system as a result of disorganised neck proprioceptive activity. It would therefore appear that proprioceptive rehabilitative exercises would benefit WAD sufferers (Revel et al. 1994, Gimse et al. 1996). Spinal manipulation has also been shown to have a significant effect on proprioceptive-dependent abilities in subjects with chronic neck pain (Rogers 1997). This suggests that a combination of manipulation and proprioceptive rehabilitation may offer an improved treatment protocol for WAD (Fitz-Ritson 1995). The purpose of this investigation is to evaluate the relative effectiveness of proprioceptive exercises and cervical spine manipulation compared to manipulation alone, in terms of subjective and objective measures, in the treatment of whiplash-associated disorders.
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Lombard, Barend Jacobus. "An investigation into the patient management protocols of selected cervical spine conditions by chiropractors in KwaZulu-Natal." Thesis, 2016. http://hdl.handle.net/10321/1509.
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Submitted to the Faculty of Health Sciences at the Durban University of Technology in partial compliance with the requirements for a Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2016.Background: Neck pain is an extremely common condition and the treatment of neck pain forms an integral part of chiropractic practice. The optimal treatment of neck pain is provided when practitioners incorporate available evidence, experience, and knowledge regarding the clinical presentation of the patient into their treatment regimes. Current evidence suggests that a combination of manual therapy, specifically manipulation and/or mobilization, and rehabilitation may offer the optimum treatment for mechanical neck pain. However, numerous factors other than available evidence, experience and clinical presentation may influence treatment choices made by practitioners. Through the assessment of practice patterns, one may asses if the optimal treatment for a neck pain is being provided by practitioners and assess if factors specific to a practitioner may influence the treatment of neck pain. Objectives: The aim of this study is to determine the chiropractic treatment and management of mechanical neck pain, to compare this to evidence based recommendations for the conservative treatment of mechanical neck pain and to assess if factors other than the available evidence may influence the treatment of mechanical neck pain. Method: A quantitative, cross-sectional descriptive survey compiled using available literature and validated by means of a focus group and pilot testing, was administered to chiropractors practicing in KwaZulu-Natal. Upon completion of the questionnaire, the data was coded into an Excel spread sheet and imported into IBM SPSS version 20 for statistical analysis. This research protocol was approved by the Durban University of Technology Institutional Research Ethics Committee (REC 82/13) and the study took place from March to July 2014. Results: Ninety-six practitioners responded to the study which is a response rate of greater than 70%. Practitioners favoured the use of spinal manipulation, auxiliary therapeutic techniques (specifically those which were manual in nature), rehabilitation, and numerous forms of education. Specific variations in treatment pattern existed when comparing various patient presentations indicating that practitioner based factors impacted on treatment choices made by practitioners. The most significant findings included the increased utilisation of auxiliary therapeutic techniques by female practitioners, the increased utilisation of traction by practitioners identifying with the straight philosophy of chiropractic. Other significant findings included the increased utilisation of cervical collars by practitioners of increased age and experience and the increased utilisation of auxiliary therapeutic techniques by practitioners who did not attend health related conferences at least once every second year or did not attend short courses or subscribe to journals or magazines since qualification. Conclusions: This study indicates that treatment for mechanical neck pain offered by chiropractors in KwaZulu-Natal is in line with current evidence based recommendations for the treatment of mechanical neck pain, with practitioners commonly using modalities which were recommended, whilst rarely using modalities which were not recommended. The use of rehabilitation was, however, slightly lower than expected. Patient presentation and practitioner based factors were found to influence the treatment of mechanical neck pain; however, as a whole these variations were small with the majority of practitioners favouring the use of modalities which were recommended within the literature. Future studies should address the gap in the literature regarding the conservative treatment of cervical radiculopathy.
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"A study to compare cervical spine and temporomandibular adjustments to cervical spine adjustments in the treatment of temporomandibular disorders." Thesis, 2009. http://hdl.handle.net/10210/2653.
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Anderson, Brittany Chandré. "Cervical spine manipulation versus proprioceptive neuromuscular facilitation of the cervical spine in the treatment of mechanical neck pain." Thesis, 2014. http://hdl.handle.net/10210/12360.
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M.Tech. (Chiropractic)Aim of this study was to compare which treatment either Proprioceptive Neuromuscular Facilitation or chiropractic manipulation, whether by itself or in combination, was more effective and beneficial in the treatment of mechanical neck pain. The effectiveness was measured by the use of a Visual Analogue Scale, Vernon- Mior Neck Pain and Disability Index questionnaire and the measurement of cervical spine range of motion using an analogous cervical spine range of motion inclinometer (CROM). The questionnaire and the measurements were taken prior to the treatments at the first, fourth and seventh consultations.Thirty participants who met the inclusion criteria were randomly placed into three groups of equal size (10 participants each). Group one received a Proprioceptive Neuromuscular Facilitation (PNF) stretching protocol to the cervical spine. Group two received a chiropractic manipulation to the cervical spine. Group three received a combination treatment, first receiving chiropractic manipulation and then a PNF stretching protocol to the cervical spine. Participants were treated six times out of a total of seven sessions, over a maximum of a three week period.Subjective data was collected at the beginning of the first, fourth and seventh consultations. This was done by means of a Visual Analogue Scale and a Vernon-Mior Neck Pain and Disability Index Questionnaire, in order to assess pain and disability levels. Objective data was collected by means of measuring cervical spine range of motion using a cervical range of motion (CROM) inclinometer. Analysis of collected data was performed by a statistician from STATKON, a department of the University of Johannesburg.Clinically significant improvements in group 1, group 2 and group 3 were noted over the duration of the study with reference to pain and disability. Statistically significant changes were seen in all three groups with reference to pain and disability. Group 3 was shown to improve the most with regard to pain and disability. Group 1 had statistically significant improvement with regard to cervical range of motion in the ranges of left and right rotation. Group 2 experienced a decrease range of cervical motion with regard to extension. As the study consisted of a small group of participants further, more extensive studies are needed...
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Pousa, Inês Afonso. "Neuropathic Pain associated with Cancer Treatment." Dissertação, 2021. https://hdl.handle.net/10216/134628.
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Pousa, Inês Afonso. "Neuropathic Pain associated with Cancer Treatment." Master's thesis, 2021. https://hdl.handle.net/10216/134628.
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Carub, Joanne. "The effect of mobilisation on pressure pain thresholds in the thoracic spine." 2003. http://eprints.vu.edu.au/907/1/Carub_et.al_2003.pdf.
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Mobilisation is a commonly used technique by osteopaths however there is little evidence to support its efficacy in the treatment of the thoracic spine. This study examined the effect of a single mobilisation (seated extension articulation) intervention in an asymptomatic population. Volunteers were randomly allocated into either a treatment group or a control group (sham laser acupuncture) and pre-intervention pain pressure threshold (PPT) measurements were taken using a pressure electronic algometer on a single thoracic segment. The treatment group received a single application of mobilisation (thirty seconds) and post intervention PPT measurements recorded. Mobilisation applied to the thoracic spine produced a statistically significant increase in PPT while the control group demonstrated no change in PPT. This study supports previous studies that have reported hypoalgesic affects following mobilisation on the cervical and lumbar spine. This minor thesis was written by a post-graduate student as part of the requirements of the Master of Health Science (Osteopathy) program.
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Medle, Melanie. "The effect of mobilisation on pressure pain thresholds in the lumbar spine." 2005. http://eprints.vu.edu.au/850/1/Medley_et.al_2005.pdf.
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Mobilisation is a common technique used by manual therapists in the treatment of spinal pain, but there has been little investigation into its effect on pain in the lumbar region. The aim of this study is to determine the immediate effects of mobilisation on pressure pain thresholds (PPT) in the lumbar spine in an asymptomatic population. Analysis of pre and post intervention PPT values showed that there was only minimal increase in PPT in the mobilisation group and a decrease in the sham group. Paired t-tests indicated that there was no significant change following mobilisation and the effect size was small. When the different scores of the 2 groups were analyzed with an independent t-test, a significant difference between groups was found. Extension mobilisation of the lumbar spine did not produce any significant improvement in PPT in an asymptomatic population. Further research on the effectiveness of mobilisation, as well as other manual interventions, for low back pain is recommended. This minor thesis was written by a post-graduate student as part of the requirements of the Master of Health Science (Osteopathy) program.
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McIver, S. "The effect of manipulation on pressure pain thresholds in the thoracic spine." 2003. http://eprints.vu.edu.au/924/1/McIver_et.al_2003.pdf.
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A controlled, single blinded study investigated the effect of high velocity manipulation on pressure-pain threshold (PPT) in the thoracic spine in an asymptomatic population. Participants were randomly allocated into intervention groups, and received either a single extension thrust or thirty seconds of sham treatment consisting of 'laser accupuncture". PPT measurements were made using an electric pressure algometer immediately before and after intervention application. Pre- and post-manipulation PPT values were analyzed using a dependent t-test, and demonstrated a significant improvement in the manipulated group (P=0.04) but not in the control group (P=0.88). This study found that a single manipulation did increase thoracic PPT. Further research is warranted to investigate the effect of manipulation on thoracic pain. This minor thesis was written by a post-graduate student as part of the requirements of the Master of Health Science (Osteopathy) program.
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Forbes, Lauren Hayley. "Lumbar spine manipulation, compared to combined lumbar spine and ankle manipulation for the treatment of chronic mechanical low back pain." Thesis, 2009. http://hdl.handle.net/10321/461.
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Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at the Durban University of Technology, 2009.The low back and the lower limb are generally viewed as two isolated regions, however, there are many authors who believe that these two regions are functionally related. This is due to the two regions being connected to each other through the kinematic chain of the lower extremity. The lumbar spine is the link between the lower extremities and the trunk, and plays a significant role in the transfer of forces through the body via the kinematic chain. The physical link between the low back and the lower limb is supplied by the thoracolumbar fascia, which plays an important role in the transfer of forces between the spine, pelvis and legs. Although a relationship between the lower extremity and low back pain is often assumed, little research has been published to demonstrate the association. Most of the evidence so far has been anecdotal, without scientific research to support it. This study was designed to compare the relative effectiveness of lumbar spine manipulation, compared to combined lumbar spine and subtalar manipulation for the treatment of chronic mechanical low back pain, using subjective and objective measures, for the management of chronic mechanical low back pain. The study design was a quantitative clinical trial, using purposive sampling. It consisted of forty voluntary participants with chronic mechanical low back pain. There were two groups of twenty participants each, each of whom received six treatments within a three week period. Group A received manipulation of the lumbar spine only, whilst Group B received manipulation of both the lumbar spine and subtalar joint. The outcome measures included the response of the participants to the Numerical Pain Rating Scale-101 and the Quebec Low Back Pain and Disability Questionnaire. Objective data was obtained from three digital Algometer measures. Data was collected prior to the initial, third and sixth treatment. iv Statistically both groups showed improvements, subjectively and objectively, with regards to chronic mechanical low back pain. Inter-group testing for NRS over time showed no significant effect for both treatment groups. There was a significant treatment effect for Algometer Average TP1 while the treatment effect for Algometer Average TP2 was not significant. However, inter-group testing for the Quebec LBP over time showed no significant effect for both treatment groups. Inter-group analysis demonstrated no statistical significance between the two groups for subjective and objective measurements, thus suggesting that there is no additional benefit in treating the subtalar joint in the management of mechanical low back pain. Further studies will also benefit greatly from the use of larger sample sizes to improve statistical relevance of data.