BMC Musculoskeletal Disorders

Details for subgrouping low back pain. (Brian Sweetman, 17 July 2013)

Kongsted et al (1) provide useful prognostic information for leg pain related to low back problems. Using the Quebec task force classification for such "sciatica", they classified the leg pain as reaching above or below knee level (along with the other criteria). This cut point is often used in this area of research to distinguish radicular pain from referred pain from the low... read full comment

Comment on: Kongsted et al. BMC Musculoskeletal Disorders, 14:171

Stratification of non-specific low back pain patients for therapeutic trials in general and illustrative suggestions for trials of manipulation in particular. (Brian Sweetman, 08 May 2013)

Orrock and Myers (1) have reviewed the present status of osteopathic intervention for so-called ¿non-specific¿ low back pain. They conclude that further clinical trials into this subject are required that have consistent and rigorous methods. However their introduction states that Non Specific Low Back Pain (CNSLBP) is a common, complex and disabling condition, but go on in the discussion to note that many studies had mixed back pain populations. There in lies one of the greatest problems of trial design. Should initial data collection allow for subgroup analysis? Which symptoms and signs are best for such... read full comment

Comment on: Orrock et al. BMC Musculoskeletal Disorders, 14:129

Different types of low back pain consequences confound the guidelines (Brian Sweetman, 08 May 2013)

Premature return to the work place may risk aggravation or reprecipitation of the underlying back pain problem. Surely it would be best to fix the back or work place first. But that is easier said than done and gauging recovery of the back is difficult. In their study Hendrick et al (1) question current wisdom. They reveal many incongruities between measures of impairment, disability and handicap, which help explain why guidelines on back care may well be... read full comment

Comment on: Hendrick et al. BMC Musculoskeletal Disorders, 14:126

Low back pain and sciatica; relationship of imaging findings to clinical symptoms. (Brian Sweetman, 08 May 2013)

Takatalo et al have recently reported MRI studies of disk degeneration in the young adult Oulo cohort. In the latest article (1) body mass index and smoking were linked to disk degeneration in males. In the slightly earlier article (2) the same MRI data was used to check which changes might be the causes of actual back pain symptoms and in particular the relationship between disk degeneration and Schmorls nodes. They include a helpful review of the modern literature in their following discussion. However they conclude that it is difficult to prove cause and effect and that it would need a prospective study with annual MRI studies for many years to get round this problem. To add to these deliberations it is perhaps interesting to draw attention to similar studies undertaken with plain x-... read full comment

Comment on: Takatalo et al. BMC Musculoskeletal Disorders, 14:87

Additional acknowledgement (Esther Maas, 03 April 2013)

The authors would like to add an acknowledgement to the article: funding for this open source publication was received from The Netherlands Organisation for Scientific Research (NWO). We thank NWO for this funding. read full comment

Comment on: Maas et al. BMC Musculoskeletal Disorders, 13:260

Different sorts of work activity cause different sorts of back pain. (Brian Sweetman, 11 March 2013)

Garg et aaal (1) have published the protocol for their study of back pain in industry. Because it is a prospective study it may be able to distinguish cause and effect. In particular it may be able to tell whether heavy work causes back pain or whether back pain prevents the worker from doing heavy work. But there is another type of problem with such studies. Could it be that there are several sorts of heavy work each of which can provoke a different sort of back pain? In order to answer this the researchers need to measure multiple ergonomic aspects of work, and they also need an adequate classification of subgroups of back... read full comment

Comment on: Garg et al. BMC Musculoskeletal Disorders, 14:84

Trial plans (Brian Sweetman, 24 January 2013)

The plans of Maas et al (1) to evaluate back pain treatments have two important features not usually included in such studies. One is to check for cost effectiveness. The second is to study subgroups. But individual treatments need to be inspected for each... read full comment

Comment on: Maas et al. BMC Musculoskeletal Disorders, 13:260

Pain drawings; similar observations but different interpretations. (Brian Sweetman, 24 January 2013)

Egloff and colleagues (1) provide one of the most detailed assessments of pain drawings in terms of the number of criteria they inspected. They compared a group of 62 patients selected as seemingly having somatoform-functional pain with a control group of 49 patients from the orthopaedic department with what the authors described as somatoform- nociceptive type pain. They identified 13 drawing criteria out of 24 that distinguish the ¿psychological¿ functional pain element. The number of criteria could be reduced to three, which identified the functional cases almost as effectively as did all thirteen criteria. These three best drawings criteria included the total number of marks, the length of the longest mark, and the presence of symmetric patterns.... read full comment

Comment on: Egloff et al. BMC Musculoskeletal Disorders, 13:257

Neck trauma or no trauma, that is the question. (Brian Sweetman, 24 January 2013)

Bruls et al (1) have recently published the protocol for their arm, neck and shoulder study. It is possible that the study has already started, but there are some aspects that might be worth incorporating if it is not too late or that might be added in one of the follow up stages. Indeed, some aspects might best be added at the end of the study so as not to influence the participants... read full comment

Comment on: Bruls et al. BMC Musculoskeletal Disorders, 14:8

Lumbar facet joint asymmetric ¿contralaterality¿ (Brian Sweetman, 04 December 2012)

Dear... read full comment

Comment on: Kuo et al. BMC Musculoskeletal Disorders, 11:151

Study Protocol ¿ Lumbar Epidural Steroid Injections for Spinal STENOSIS (LESS): A Double-Blind Randomized Controlled Trial of Epidural Steroid Injections for Lumbar Spinal Stenosis Among Older Adults (Laxmaiah Manchikanti, 19 July 2012)

We read with great interest the study protocol by Friedly et al for lumbar epidural injections for spinal stenosis [1]. The protocol is well designed and a useful contribution to the literature. Unfortunately, the authors have demonstrated a seemingly superficial approach with what is potentially a misinterpretation of the previously available research. With reference to the previous available research, the authors have quoted a preliminary article by Manchikanti et al [2] published in 2008; however, they have ignored multiple other publications in reference to the one-year follow-up of the complete manuscript of the 2008 publication [3] as well as lumbar interlaminar epidural injections for spinal stenosis by the same authors and other multiple manuscripts by various other authors. The... read full comment

Comment on: Friedly et al. BMC Musculoskeletal Disorders, 13:48

Wrong power calculation and analysis (David J Torgerson, 01 March 2012)

You are doing a cluster randomised controlled trial. However, your sample size is incorrect: you have not adjusted for clustering. Also your analysis strategy is incorrect: again you need to adjust for clustering. Even if you did the adjustment you only have 4 clusters, which is insufficient cluster replication. You need to increase the number of clusters to at least 8 and recalculate your sample size. read full comment

Comment on: Rathleff et al. BMC Musculoskeletal Disorders, 13:9

Comment (Robert Borden Hopkins, 29 February 2012)

After the work [1] was published we realized a minor error with regard to... read full comment

Comment on: Hopkins et al. BMC Musculoskeletal Disorders, 12:209

Error of pain measurement (Iben Axén, 06 July 2011)

In the methods section, the pain measurement is described as a Numeric Rating Scale, which is correct. However, in the result section as well as in Table 1, pain is described as a measurement with the Visual Analogue Scale, which is incorrect. This fact has no bearing on the figures (means and SD) presented, but they should, of course, read "NRS" even in the result and in the Table. We apologize for this error. read full comment

Comment on: Axén et al. BMC Musculoskeletal Disorders, 12:99

MRI imaging in acute whiplash has no value: is this a surprise? (Stephen Faulkner, 25 January 2011)

We were interested to review the results reported in the recent publication by Vetti et al. [1] While we agree with these authors’ conclusion that upper cervical MRI is a poor screening tool for all patients with an acute whiplash injury, the paper may leave the reader with the impression that diagnostic MRI of the craniovertebral ligaments is not a useful modality in certain subpopulations of chronic whiplash-injured patients. It is important to note that the study design employed by the authors only allowed for the evaluation of upper cervical MRI as a screening tool of acutely injured patients (n = 114); there were too few patients in the study with significant chronic pain (n = 23) to draw any meaningful conclusions regarding the ability of the test to discriminate between... read full comment

Comment on: Vetti et al. BMC Musculoskeletal Disorders, 11:260

Is fibromyalgia a progressive condition? (Kim Lawson, 05 August 2010)

The primary focus of the article of Silverman et al (BMC Musculoskeletal Disorders 2010, 11:66) towards the characterization of fibromyalgia (FM) severity is fundamental to a greater understanding of this condition. As correctly identified the limitations associated with potential biomarkers has not assisted in attempts of defining FM severity. It should also be noted a similar circumstance exists for the definition of the state of remission in FM, where often a lack of symptoms is viewed as a lack of the condition (ie an altered biology).
While the study and general interpretations of the outcomes are well constructed, there is however concern of the attempts to relate the measurement of FM severity with disease progression. This has led the authors to propose "..to slow progression... read full comment

Comment on: Silverman et al. BMC Musculoskeletal Disorders, 11:66

query (Paule Morbois, 15 July 2010)

I was only questioning the number in the sample of the study you presented here and the result you may have received provide little or no ground to as the validity based on the sample examined (2 patients only).
Do you intend in continuing such study as to increase the number presented and therefore improve the reliability of such results?

truthfully,
read full comment

Comment on: Lerario et al. BMC Musculoskeletal Disorders, 11:157

Not all physiotherapy is the same (Bill Vicenzino, 06 July 2010)

long-term delay in healing after corticosteroid injections [2]. Olausson and his colleagues are commended for undertaking such a trial.

On reading the physiotherapy intervention in this protocol I was concerned to read that our previous randomised clinical trial [3] was used as the basis of their physiotherapy treatment. My concern is that in our clinical trial the physiotherapy program consisted of mobilisation with movement treatment plus exercise [3-5], whereas their program consists of friction massage, Mill’s manipulation and soft tissue treatment with stretching of radial wrist extensors plus instructions for home exercises of eccentric exercise and stretching [1]. So my intention in posting this comment is to inform readers that it is not readily apparent how the... read full comment

Comment on: Olaussen et al. BMC Musculoskeletal Disorders, 10:152

The heredity of the hallux valgus (Carlos Piqué-Vidal, 06 July 2010)

I want to congratulate the authors for this interesting study.

I agree with the authors in the fact that, besides the hereditary factors, the exogenous factors as the footwear play an important role in the appearance and the evolution of the hallux valgus.

I think that it would have been interesting that they had stated the hereditary factor of the hallux valgus, they might have asked the parents for this information when they asked for the parental consent.

I want to index a recent article on the heredity of the hallux valgus (1). In this article the authors demonstrate that the hallux valgus has an inheritance autosomal dominant with uncomplete penetrance of 56 %.

The article explains that the affected women of hallux valgus have the mother... read full comment

Comment on: Klein et al. BMC Musculoskeletal Disorders, 10:159

Which Style of Tai Chi Are You Studying? (Jordan Keats, 07 August 2009)

Hello,
As you may know there are five major styles of taiji, in your abstract you simply say tai chi, what style of tai chi are you studying? As to the affect of various styles of taiji on the body I can not comment, but I have been practicing Chen Style tai chi for four years and it has completely alleviated my lower back pain caused by scoliosis. Who are the teachers/ masters participating in this study, and for how long does the study run?
Thanks,
Jordan read full comment

Comment on: Hall et al. BMC Musculoskeletal Disorders, 10:55

vitamin c can prevent crps post colles fracture (Jan fisher, 15 January 2009)

Just thought I'd mention this study which seems to fit well with this cohort study, "Can Vitamin C Prevent Complex Regional Pain Syndrome in Patients with Wrist Fractures?"A Randomized, Controlled, Multicenter Dose-Response StudyP.E. Zollinger, MD1, W.E. Tuinebreijer, MD, PhD, MSc, MA2, R.S. Breederveld, MD, PhD3 and R.W. Kreis, MD, PhD3.Identification of risks and early intervention is vital as you have indicated. http://www.ejbjs.org/cgi/content/abstract/89/7/1424Can Vitamin C Prevent Complex Regional Pain Syndrome in Patients with Wrist Fractures? A Randomized, Controlled, Multicenter Dose-Response Study -- Zollinger et al. 89 (7): 1424 -- Journal of Bone and Joint Surgery read full comment

Comment on: Brunner et al. BMC Musculoskeletal Disorders, 9:92

Ethical situation (Daniel Hernandez-Vaquero, 01 August 2008)

This study is retrospective and involves the use of clinical data collected from adults who underwent low-friction arthroplasties. The Reseearch Committee of the Hospital confirms that do not require any approval from the local ethics committee. read full comment

Comment on: Hernández-Vaquero et al. BMC Musculoskeletal Disorders, 9:69

Authors' response to comments (Neil O'Connell, 06 May 2008)

We have read with interest the comments made regarding our debate paper and thank the authors for their contribution to the discussion. Addressing the points raised we would argue that while interventional techniques such as facet joint injection and discography are commonly used in an attempt to make specific diagnoses in CNSLBP, the early promise of these techniques has not been supported by high-quality evidence. For a discussion of the limitations of interventional diagnostics in CNSLBP we would refer readers to the excellent review by Carragee and Hannibal (2004). It is possible that the low specificity and reliability of these approaches may rest with the techniques themselves. However an alternative explanation for this (and one which fits with our proposed model) is that CNSLBP is... read full comment

Comment on: Wand et al. BMC Musculoskeletal Disorders, 9:11

subgroups may exist! (Shahram Sadeghi, 21 April 2008)

Conventional interventions do not reveal the pain source in many cases. But with the use of joint blocks and discography; the facet joint, the sacroiliac joint and internal disc disruption can be identified as pain generators in almost 80% of patients; so we can see subgroups in low back pain! read full comment