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      Diagnosis and Characters of Non-Specific Low Back Pain in Japan: The Yamaguchi Low Back Pain Study

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          Abstract

          Study Design

          Cross sectional data from the Yamaguchi low back pain study conducted in Yamaguchi prefecture, Japan, was used for this analysis.

          Methods

          A total of 320 patients were recruited from walk-in orthopedic clinics in Yamaguchi Prefecture, Japan. Patients visited the clinics primarily for low back pain (LBP) and sought treatment between April and May 2015. A self-questionnaire was completed by patients, while radiographic testing and neurological and physical examination was performed by the orthopedist in each hospital. The cause and characters of LBP was determined following examination of the data, regional anesthesia and block injection.

          Results

          ‘Specific LBP’ was diagnosed in 250 (78%) patients and non-diagnosable, ‘non-specific LBP’ in 70 (22%) patients. The VAS scores of patients were: LBP, 5.8±0.18; leg pain, 2.9±0.18 and the intensity of leg numbness was 1.9±0.16. Item scores for SF-8 were: general health, 46.6±0.40; physical function, 43.5±0.51; physical limitations, 42.8±0.53; body pain, 42.1±0.52; vitality, 48.4±0.37; social function, 46.9±0.53; emotional problems, 48.9±0.43; mental health, 46.9±0.43.

          Conclusions

          The incidence of non-specific LBP in Japan was lower than previous reports from western countries, presumably because of variation in the diagnosis of LBP between different health care systems. In Japan, 78% of cases were classified as ‘specific LBP’ by orthopedists. Identification of the definitive cause of LBP should help to improve the quality of LBP treatment.

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          Most cited references16

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          Back pain and sciatica.

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            What is the source of chronic low back pain and does age play a role?

            The objective of this study was to estimate the prevalence, mean age, and association of prevalence and age of lumbar internal disc disruption (IDD), facet joint pain (FJP), sacroiliac joint pain (SIJP), spinal and pelvic insufficiency fractures, interspinous ligament injury/Baastrup's Disease, and soft tissue irritation by fusion hardware. The study's design was a retrospective chart review. The study was set in an academic spine center. A total of 378 cases from 358 patients were reviewed of which 170 cases from 156 patients who underwent diagnostic procedures were included. Discography, dual diagnostic facet joint blocks, intra-articular sacroiliac joint injections, anesthetic injections of painful interspinous ligaments/opposing spinous processes/posterior fusion hardware, or percutaneous augmentation were performed. Prevalence and age were analyzed for each diagnosis group. Patients with recalcitrant low back pain underwent diagnostic procedures based on their clinical presentation until the pain source was identified. The prevalence of internal disc disruption, facet joint pain and sacroiliac joint pain was 42%, 31%, and 18%, respectively. Patients with internal disc disruption were significantly younger than those with facet joint pain or sacroiliac joint pain. Increased age was associated with a decreased probability of internal disc disruption and increased probabilities of facet joint pain and sacroiliac joint pain as the source of low back pain until approximately age 70. Our data confirm the intervertebral disc as the most common etiology of chronic low back pain in adults. Based on our sample, the younger the patient, the more likely low back pain is discogenic in origin. Facetogenic or sacroiliac joint pain is more likely in older patients. Wiley Periodicals, Inc.
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              What can the history and physical examination tell us about low back pain?

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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                22 August 2016
                2016
                : 11
                : 8
                : e0160454
                Affiliations
                [001]Department of Orthopedics Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
                Tokai Daigaku, JAPAN
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Data curation: HS TK NN YY.

                • Formal analysis: HS.

                • Methodology: HS TT.

                • Supervision: TT.

                • Validation: HS TK.

                • Writing – original draft: HS TT.

                • Writing – review & editing: HS TK YY NN YI.

                Article
                PONE-D-16-04177
                10.1371/journal.pone.0160454
                4993356
                27548658
                1cf46afe-f0d1-4e8c-a1c3-8363fc468cc3
                © 2016 Suzuki et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 29 January 2016
                : 19 July 2016
                Page count
                Figures: 7, Tables: 4, Pages: 13
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Diagnostic Medicine
                Medicine and Health Sciences
                Diagnostic Medicine
                Signs and Symptoms
                Pain
                Lower Back Pain
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Signs and Symptoms
                Pain
                Lower Back Pain
                People and Places
                Geographical Locations
                Asia
                Japan
                Biology and Life Sciences
                Biomechanics
                Biological Locomotion
                Walking
                Biology and Life Sciences
                Physiology
                Biological Locomotion
                Walking
                Medicine and Health Sciences
                Physiology
                Biological Locomotion
                Walking
                Medicine and Health Sciences
                Anesthesiology
                Anesthesia
                Local and Regional Anesthesia
                Medicine and Health Sciences
                Pharmaceutics
                Drug Therapy
                Anesthesia
                Local and Regional Anesthesia
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Medicine and Health Sciences
                Pain Management
                Myalgia
                Medicine and Health Sciences
                Health Care
                Patients
                Custom metadata
                All relevant data are within the paper.

                Uncategorized
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