Back pain in primary care : aspects on treatment and the possible influence of oral contraceptives
Author: Wreje, Ullacarin
Date: 1999-01-29
Location: Föreläsningssalen R 64, Huddinge Sjukhus
Time: 09.00
Department: Institutionen för klinisk vetenskap / Department of Clinical Sciences
Abstract
The general objectives of this thesis were to investigate back pain in a
primary-care setting, and especially to study the effect of manual
treatment on pelvic-joint dysfunction, the effect of sterile-water
injections on chronic, myofascial pain and the possible influence of oral
contraceptives (OC) on back pain in women in the fertile ages.
The effect of a single intervention with manipulation mobilisation was
compared with that of massage on pelvic-joint dysfunction with regard to
sick-leave, consumption of analgesic, pain and joint mobility. The
patients (n=39) formed two groups for treatment and sham treatment,
respectively. The outcome as regarded sick-leave and use of analgesics,
was significantly lower for the treatment group, while mobility, as
measured by Patrick's test and also pain assessments with VAS, did not
differ significantly.
Sterile water injections sub- and intracutaneously were compared with
saline injections given the same way in a randomised, controlled trial on
117 patients with chronic myofascial pain in six different medical
centres. A single intervention session was used. Both interventions had a
positive effect on pain and mobility, but sterile water was not found to
be better than saline with regard to pain relief. In a population study,
1,006 women in the ages 14-44 years, of whom 503 were OC users according
to a register of pharmaceuticals used and 503 had not been using OC for
the last 5 years, the registers of primary health diagnoses were
compared, and a difference in low-back- pain (LBP) diagnoses was found,
in that the OC users had a higher prevalence of LBP as a cause of primary
care contact than the non-users had. The difference was significant
(p<0.05) for 2 of the recorded 5 years.
To investigate the possible causes of this association, serum relaxin was
measured during the menstrual cycle in 12 healthy women and in 7 women
with chronic, posterior,pelvic pain (PPP). Relaxin was also recorded
during 1 month of OC use in the healthy women. Relaxin was detected
during the menstrual cycle in both groups of women and also during OC use
and tended to be higher during OC use. Collagen metabolism markers, the
aminoterminal of procollagen type I (PINP), the carboxyterminal
telopeptide of type I collagen (ICTP) and the aminoterminal of
procollagen type III (PIIINP), were also measured in two groups of non-
pregnant women, 20 healthy nulliparous, before and at 3months and 1 year
of OC-use and 12 with PPI? complaints, during the normal menstrual cycle
and also during one month of OC use. Collagen turnover was diminished
during OC use and a shift was also recorded in the anabolic/catabolic
hormone balance tending towards an increased catabolism, as estimated by
the levels of sexual- hormone-binding globulin (SHBG), insulin growth
factor I (IGF-I) and testosterone.
In conclusion, the outcome of the treatment trials points to a positive
effect of manual treatment on pelvic-joint dysfunction of acute and
sub-acute duration, while sterile-water injection treatment could not be
recommended for chronic myofascial pain. LBP in women was found to be
associated with OC use. Whether the association is causal or not cannot
be concluded from this study. However, also serum-relaxin levels and
collagen metabolism were influenced by the use of OC s.
Issue date: 1999-01-08
Publication year: 1999
ISBN: 91-628-3329-4
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