Lower Back Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

LOWER BACK PAIN A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AM...

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LOWER BACK PAIN A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Lower Back Pain: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84016-4 1. Lower Back Pain-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on lower back pain. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON LOWER BACK PAIN ................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Lower Back Pain............................................................................ 4 E-Journals: PubMed Central ......................................................................................................... 6 The National Library of Medicine: PubMed .................................................................................. 7 CHAPTER 2. NUTRITION AND LOWER BACK PAIN ......................................................................... 23 Overview...................................................................................................................................... 23 Finding Nutrition Studies on Lower Back Pain .......................................................................... 23 Federal Resources on Nutrition ................................................................................................... 24 Additional Web Resources ........................................................................................................... 24 CHAPTER 3. ALTERNATIVE MEDICINE AND LOWER BACK PAIN ................................................... 27 Overview...................................................................................................................................... 27 The Combined Health Information Database............................................................................... 27 National Center for Complementary and Alternative Medicine.................................................. 28 Additional Web Resources ........................................................................................................... 34 General References ....................................................................................................................... 39 CHAPTER 4. CLINICAL TRIALS AND LOWER BACK PAIN ............................................................... 41 Overview...................................................................................................................................... 41 Recent Trials on Lower Back Pain ............................................................................................... 41 Keeping Current on Clinical Trials ............................................................................................. 48 CHAPTER 5. PATENTS ON LOWER BACK PAIN ............................................................................... 51 Overview...................................................................................................................................... 51 Patents on Lower Back Pain ........................................................................................................ 51 Patent Applications on Lower Back Pain..................................................................................... 66 Keeping Current .......................................................................................................................... 69 CHAPTER 6. BOOKS ON LOWER BACK PAIN ................................................................................... 71 Overview...................................................................................................................................... 71 Book Summaries: Online Booksellers........................................................................................... 71 The National Library of Medicine Book Index ............................................................................. 77 Chapters on Lower Back Pain ...................................................................................................... 78 CHAPTER 7. MULTIMEDIA ON LOWER BACK PAIN ........................................................................ 79 Overview...................................................................................................................................... 79 Video Recordings ......................................................................................................................... 79 Bibliography: Multimedia on Lower Back Pain ........................................................................... 80 CHAPTER 8. PERIODICALS AND NEWS ON LOWER BACK PAIN ..................................................... 83 Overview...................................................................................................................................... 83 News Services and Press Releases................................................................................................ 83 Newsletter Articles ...................................................................................................................... 85 Academic Periodicals covering Lower Back Pain......................................................................... 86 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 89 Overview...................................................................................................................................... 89 NIH Guidelines............................................................................................................................ 89 NIH Databases............................................................................................................................. 91 Other Commercial Databases....................................................................................................... 93 APPENDIX B. PATIENT RESOURCES ................................................................................................. 95 Overview...................................................................................................................................... 95 Patient Guideline Sources............................................................................................................ 95 Finding Associations.................................................................................................................... 99 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 101

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Overview.................................................................................................................................... 101 Preparation................................................................................................................................. 101 Finding a Local Medical Library................................................................................................ 101 Medical Libraries in the U.S. and Canada ................................................................................. 101 ONLINE GLOSSARIES................................................................................................................ 107 Online Dictionary Directories ................................................................................................... 108 LOWER BACK PAIN DICTIONARY ........................................................................................ 109 INDEX .............................................................................................................................................. 135

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with lower back pain is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about lower back pain, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to lower back pain, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on lower back pain. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to lower back pain, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on lower back pain. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON LOWER BACK PAIN Overview In this chapter, we will show you how to locate peer-reviewed references and studies on lower back pain.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and lower back pain, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “lower back pain” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Low Back Pain: 10 Questions Physicians Often Ask Source: Consultant. 801-803,808; April 1996. Summary: This journal article for health professionals answers 10 questions that physicians frequently ask about low back pain. Although tumors and infection are rare causes of lower back pain, the risk factors of these diagnoses should be considered before a physician rules them out. Radiographic or imaging studies are usually unnecessary during the initial evaluation, but plain films may be helpful if the patient reports no improvement after a few months of conservative treatment. Sciatica is the typical symptom of herniated disk. The hallmark of spinal stenosis, more common among elderly persons, is pain following prolonged standing or walking, but comfort while sitting. Epidural corticosteroid injections may provide temporary relief of pain that is caused by nerve compression by a herniated disk or spinal stenosis. The favorable

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natural history of herniated disk should be noted when surgery is being considered. The natural history of spinal stenosis is worse than that of sciatica, and surgery may be complicated by many co-morbid conditions. 22 references and 3 tables. (AA-M). •

Low Back Pain: Exercises To Prevent Recurrence Source: Consultant. 42(3): 357-358,361. March 2002. Summary: This journal article provides health professionals with information on a long term exercise program that they can prescribe for their patients who experience recurrent low back pain. Recurrences of such pain are common, so a long term exercise program that includes stretching, strengthening, and cardiovascular activities can minimize the frequency and pain of recurrences. Increasing flexibility plays an important role in recovery from low back pain and in prevention of future incidents. Exercises that stretch the muscles of the lower extremities and the hip are especially important. Exercises to strength the trunk, abdomen, and lower extremities also play an important role in both recuperation from and prevention of lower back injuries. Most exercises that build endurance and strength are based on either concentric contractions or eccentric contractions. Strengthening exercises need to incorporate multifidi, paravertebral, and abdominal muscles. If a patient with low back pain could participate in only one type of exercise, cardiovascular exercise would be the best choice. More muscles are used in cardiovascular activities than in any other type of exercise. In addition, 30 minutes of aerobic activity three to four times a week increases endorphin levels and improves blood flow and cardiopulmonary status. This, in turn, leads to an increased sense of well being, pain reduction, and improved ability of the muscles to relax. Walking is an excellent aerobic exercise for patients with low back pain, but many other exercises are also appropriate, including jogging on a treadmill, swimming, and biking. 5 figures and 6 references. (AA-M).

Federally Funded Research on Lower Back Pain The U.S. Government supports a variety of research studies relating to lower back pain. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to lower back pain. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore lower back pain. The following is typical of the type of information found when searching the CRISP database for lower back pain:

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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Project Title: CHRONIC LOW BACK PAIN AS A MODEL OF FIBROMYALGIA Principal Investigator & Institution: Clauw, Daniel J.; Associate Professor; Medicine; Georgetown University Washington, Dc 20057 Timing: Fiscal Year 2001; Project Start 15-JUN-1999; Project End 31-MAY-2003 Summary: Fibromyalgia (FM) is defined by a history of widespread pain, and the finding of tender points on examination. Arguably the two most discriminating features of FM are: 1) a generalized disturbance in pain perception, and 2) elevated levels of pronociceptive neuropeptides in the cerebrospinal fluid. The first feature, pain induced by a normally non-painful stimuli, is not surprising since this is a defining feature of FM. But it is not certain how tenderness relates to pain, since population based studies have demonstrated that not all persons who are tender have pain, and vice versa. And it has recently become clear that tender points are a poor measure of a person's inherent tenderness. The meaning of these elevated levels of CSF neuropeptides is likewise unclear. These findings may not be specific for FM, and may be the cause of pain and/or tenderness, or may be the result of pain, tenderness, or some other process. Chronic lower back pain (CLBP) is among the most common medical problems in industrial societies. Despite this, little is actually known about the precise cause for most cases of CLBP. Anatomic and psychosocial factors have been demonstrated to predict only a small portion of the variance in the degree of pain or disability in CLBP. In preliminary studies in CLBP, we have demonstrated that tenderness predicts a significant percentage of the variance in both functional status and pain, more than either the severity of path-anatomical abnormality (i.e., X-ray/MRI),or by psychosocial factors. In a small pilot study of a subset of these patients tenderness was correlated with CSF levels of pro-nociceptive neuropeptides. There are 3 specific aims in the proposed study: 1) To confirm in a cross-sectional study of 200 CLBP patients that pain sensitivity predicts more variance in clinical outcome (e.g. functional status, pain level, Roland index) than either anatomic or psychological factors. Furthermore, we will demonstrate that pain sensitivity is an independent trait, and not a surrogate for psychological factors such as depression, anxiety, or work-related stressors. 2) To demonstrate that an individual's global pain sensitivity is determined primarily by physiologic factors (e.g. neurotransmitters in cerebrospinal fluid) and modified by psychosocial factors (e.g. cognitive and behavior influences on pain perception). We will measure the CSF concentrations of pro-nociceptive peptides such as Substance P and Nerve Growth Factor, and hypothesize that the levels of these substances largely determine an individual's global pain sensitivity. This testing will be done in patients with CLBP and FM, as well as sedentary and non-healthcare-seeking controls. 3) To use alternative methods of pain assessment that are much less influenced by psychological factors (e.g., scaling methods, Multiple Random Staircase), using both pressure and thermal stimuli, to examine the true meaning of tender points, and the relationship between these results, and the results of the above noted physiologic and psychologic parameters in individuals with FM and CLBP. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MECHANISMS OF SPECIFIC TRUNK EXERCISES IN LOW BACK PAIN Principal Investigator & Institution: Henry, Sharon M.; Physical Therapy; University of Vermont & St Agric College 340 Waterman Building Burlington, Vt 05405 Timing: Fiscal Year 2003; Project Start 24-MAR-2003; Project End 29-FEB-2008

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Summary: (provided by applicant): Poor neuromuscular control, such as delayed muscle recruitment or alterations in levels of muscle activation, can lead to abnormal loads on joints and ligaments of the spine, leading to spinal instability and lower back pain (LBP). Active contraction of trunk muscles helps to control inter-segmental movement and stability in the lumbar spine by adding stiffness to the trunk. Muscle dysfunction associated with LBP has been thought to involve deep, local trunk muscles the transversus abdominis (TA) and multifidus muscles. These muscles are hypothesized to provide stability to the lumbar spine. Treatments which focus on retraining TA and multifidus by using low level isometric contractions of these specific deep trunk muscles during particular tasks and functional activities have been effective at reducing LBP and improving function for selected subgroups of LBP subjects. The precise muscle dysfunction associated with LBP has not been satisfactorily characterized, in part because muscles such as TA and multifidus are difficult to characterize directly given their anatomical location. However, analytical modeling can assist in characterizing these deeper muscles. A more complete characterization of the function of these muscles can lead to more precise treatments of LBP. The three major aims of this project are: 1) to characterize the pre-treatment motor control alterations (alterations in muscle latencies or in modulation of muscle activity level) in subjects with spondylolisthesis and mechanical LBP compared to healthy control subjects, and to determine whether specific deep trunk-muscle exercises (low level isometric contractions of TA and multifidus) improve these alterations compared to a general exercise protocol. We hypothesize that prior to treatment, muscle latencies will be earlier in LBP groups compared to the control group and that the latencies will improve (increase) in LBP subjects receiving specific trunk exercise protocol but not in subjects receiving a general exercise protocol at all time points post-treatment; 2) to employ biomechanical modeling to study mechanisms underlying these specific deep trunk muscle exercises. We hypothesize that increased activation of TA and multifidus muscles increases stability of the trunk by reducing intervetebral motion; and 3) to determine the effects of specific trunk exercises compared to more general strengthening and endurance exercises on pain and function during activities of daily living in the LBP subjects. We hypothesize that subjects in a specific exercise protocol will have decreased pain and increased functional ability compared to subjects in a general exercise protocol, at all time points post-treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “lower back pain” (or synonyms) into the search box. This search gives you access

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Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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to full-text articles. The following is a sample of items found for lower back pain in the PubMed Central database: •

Acute low back pain. by Car J, Sheikh A.; 2003 Sep 6; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=192848

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Acute low back pain: systematic review of its prognosis. by Pengel LH, Herbert RD, Maher CG, Refshauge KM.; 2003 Aug 9; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=169642

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Chronic low back pain. by Samanta J, Kendall J, Samanta A.; 2003 Mar 8; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=150466

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Community survey of factors associated with consultation for low back pain. by Waxman R, Tennant A, Helliwell P.; 1998 Dec 5; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28737

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Effect of UK national guidelines on services to treat patients with acute low back pain: follow up questionnaire survey. by Barnett AG, Underwood MR, Vickers MR.; 1999 Apr 3; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27816

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Multidisciplinary rehabilitation for chronic low back pain: systematic review. by Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C.; 2001 Jun 23; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=33389

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Outcome of low back pain in general practice: a prospective study. by Croft PR, Macfarlane GJ, Papageorgiou AC, Thomas E, Silman AJ.; 1998 May 2; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28536

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Predicting who develops chronic low back pain in primary care: a prospective study. by Thomas E, Silman AJ, Croft PR, Papageorgiou AC, Jayson MI, Macfarlane GJ.; 1999 Jun 19; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28145

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Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial. by Kendrick D, Fielding K, Bentley E, Kerslake R, Miller P, Pringle M.; 2001 Feb 17; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=26570

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Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences. by Moffett JK, Torgerson D, Bell-Syer S, Jackson D, Llewlyn-Phillips H, Farrin A, Barber J.; 1999 Jul 31; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28176

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web 6

PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with lower back pain, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “lower back pain” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for lower back pain (hyperlinks lead to article summaries): •

A 67-year-old man with increasing severe lower back pain since the night before. Author(s): Henderson MM. Source: Journal of Emergency Nursing: Jen : Official Publication of the Emergency Department Nurses Association. 2003 February; 29(1): 9-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12556822&dopt=Abstract

•

A 72-year-old woman with severe lower back pain and malaise. Author(s): Childs SA. Source: Journal of Emergency Nursing: Jen : Official Publication of the Emergency Department Nurses Association. 1992 December; 18(6): 547-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1469824&dopt=Abstract

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A biomechanical comparison of lifting techniques between subjects with and without chronic low back pain during freestyle lifting and lowering tasks. Author(s): Lariviere C, Gagnon D, Loisel P. Source: Clinical Biomechanics (Bristol, Avon). 2002 February; 17(2): 89-98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11832258&dopt=Abstract

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A lumbar body support (KBS 2000) alters lumbar muscle recruitment patterns in patients with acute-upon-chronic lower back pain. Author(s): Derman KL, Derman EW, Noakes TD. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1995 April; 85(4): 278-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7778005&dopt=Abstract

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A new design of vehicle seat intended to alleviate lower back pain. Author(s): Johnson DA, Samin JC, Neve M. Source: Journal of Biomechanical Engineering. 1989 August; 111(3): 261-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2528660&dopt=Abstract

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A new sign of inappropriate lower back pain. Author(s): Blom A, Taylor A, Whitehouse S, Orr B, Smith E. Source: Annals of the Royal College of Surgeons of England. 2002 September; 84(5): 3423. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12398129&dopt=Abstract

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A pilot study of the prevalence of lumbar disc degeneration in elite athletes with lower back pain at the Sydney 2000 Olympic Games. Author(s): Ong A, Anderson J, Roche J. Source: British Journal of Sports Medicine. 2003 June; 37(3): 263-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12782554&dopt=Abstract

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A randomized controlled trial of two strategies to implement active sick leave for patients with low back pain. Author(s): Scheel IB, Hagen KB, Herrin J, Oxman AD. Source: Spine. 2002 March 15; 27(6): 561-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11884902&dopt=Abstract

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A study of work stress, patient handling activities and the risk of low back pain among nurses in Hong Kong. Author(s): Yip Y. Source: Journal of Advanced Nursing. 2001 December; 36(6): 794-804. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11903709&dopt=Abstract

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A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Author(s): Pincus T, Burton AK, Vogel S, Field AP. Source: Spine. 2002 March 1; 27(5): E109-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11880847&dopt=Abstract

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Advances in the field of low back pain in primary care: a report from the fourth international forum. Author(s): Borkan J, Van Tulder M, Reis S, Schoene ML, Croft P, Hermoni D. Source: Spine. 2002 March 1; 27(5): E128-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11880849&dopt=Abstract

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An assessment of lower back pain in young adults: implications for college health education. Author(s): Reis J, Flegel M, Kennedy C. Source: Journal of American College Health : J of Ach. 1996 May; 44(6): 289-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8735167&dopt=Abstract

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Assessment of activities of daily living with an ambulatory monitoring system: a comparative study in patients with chronic low back pain and nonsymptomatic controls. Author(s): Spenkelink CD, Hutten MM, Hermens HJ, Greitemann BO. Source: Clinical Rehabilitation. 2002 February; 16(1): 16-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11841065&dopt=Abstract

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Bed rest for acute low back pain and sciatica. Author(s): Hagen KB, Hilde G, Jamtvedt G, Winnem M. Source: Nurs Times. 2001 August 2-8; 97(31): 40. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11957537&dopt=Abstract

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Can guidelines impact the ordering of magnetic resonance imaging studies by primary care providers for low back pain? Author(s): Rao JK, Kroenke K, Mihaliak KA, Eckert GJ, Weinberger M. Source: Am J Manag Care. 2002 January; 8(1): 27-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11814170&dopt=Abstract

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Cerebrospinal fluid protein findings in various lower back pain syndromes. Author(s): Ahonen A, Myllyla VV, Hokkanen E. Source: Acta Neurologica Scandinavica. 1979 August; 60(2): 93-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=158934&dopt=Abstract

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Chronic low back pain disability a modern-day epidemic (doctoral research proposal). Author(s): Hirokawa RG. Source: Hawaii Med J. 2001 November; 60(11): 284-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11797491&dopt=Abstract

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Chronic lower back pain due to sarcoma. Author(s): Hueber W, Dominkus M, Vesely M, Mendel M, Kotz R, Czembirek H, Smolen JS. Source: Clin Exp Rheumatol. 1998 May-June; 16(3): 309-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9631756&dopt=Abstract

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Cognitive-behavioral therapy and psychosocial factors in low back pain: directions for the future. Author(s): Pincus T, Vlaeyen JW, Kendall NA, Von Korff MR, Kalauokalani DA, Reis S. Source: Spine. 2002 March 1; 27(5): E133-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11880850&dopt=Abstract

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Combination hydrocodone and ibuprofen versus combination oxycodone and acetaminophen in the treatment of moderate or severe acute low back pain. Author(s): Palangio M, Morris E, Doyle RT Jr, Dornseif BE, Valente TJ. Source: Clinical Therapeutics. 2002 January; 24(1): 87-99. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11833838&dopt=Abstract

Studies

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Correlation of electromyography with computed tomography in evaluation of lower back pain. Author(s): Khatri BO, Baruah J, McQuillen MP. Source: Archives of Neurology. 1984 June; 41(6): 594-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6232914&dopt=Abstract

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Correlation of spinal mobility with the severity of chronic lower back pain. Author(s): Kang SW, Lee WN, Moon JH, Chun SI. Source: Yonsei Medical Journal. 1995 March; 36(1): 37-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7740834&dopt=Abstract

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Dental office ergonomics targets lower back pain. Author(s): Caplan SA. Source: Dent Today. 1989 May; 8(4): 45, 53. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2532022&dopt=Abstract

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Differences in electromyographic activity in the multifidus muscle and the iliocostalis lumborum between healthy subjects and patients with sub-acute and chronic low back pain. Author(s): Danneels LA, Coorevits PL, Cools AM, Vanderstraeten GG, Cambier DC, Witvrouw EE, De CH. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2002 February; 11(1): 13-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11931058&dopt=Abstract

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Dissolving a lifetime of lower back pain with chemonucleolysis. Author(s): Tompkins JS, Brown MD. Source: Nursing. 1985 July; 15(7): 47-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3159978&dopt=Abstract

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Do cerebral potentials to magnetic stimulation of paraspinal muscles reflect changes in palpable muscle spasm, low back pain, and activity scores? Author(s): Simons DG. Source: Journal of Manipulative and Physiological Therapeutics. 2002 January; 25(1): 778. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11898022&dopt=Abstract

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Effectiveness of a selected bedding system on quality of sleep, low back pain, shoulder pain, and spine stiffness. Author(s): Jacobson BH, Gemmell HA, Hayes BM, Altena TS. Source: Journal of Manipulative and Physiological Therapeutics. 2002 February; 25(2): 88-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11896375&dopt=Abstract

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Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in nonspondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint. Author(s): Luukkainen RK, Wennerstrand PV, Kautiainen HH, Sanila MT, Asikainen EL. Source: Clin Exp Rheumatol. 2002 January-February; 20(1): 52-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11892709&dopt=Abstract

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Efficacy of the transcutaneous electrical nerve stimulation for the treatment of chronic low back pain: a meta-analysis. Author(s): Brosseau L, Milne S, Robinson V, Marchand S, Shea B, Wells G, Tugwell P. Source: Spine. 2002 March 15; 27(6): 596-603. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11884907&dopt=Abstract

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Ethics in action. What would you do? A doctor admits a female patient with acute lower back pain and orders only normal saline injections. Author(s): Haddad A. Source: Rn. 1993 March; 56(3): 21, 23-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8451588&dopt=Abstract

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Evaluation of a training program for the prevention of lower back pain among hospital employees. Author(s): Fanello S, Jousset N, Roquelaure Y, Chotard-Frampas V, Delbos V. Source: Nursing & Health Sciences. 2002 March-June; 4(1-2): 51-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12084021&dopt=Abstract

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Evaluation of EMG signals from rehabilitated patients with lower back pain using wavelets. Author(s): Panagiotacopulos ND, Lee JS, Pope MH, Friesen K. Source: Journal of Electromyography and Kinesiology : Official Journal of the International Society of Electrophysiological Kinesiology. 1998 August; 8(4): 269-78. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9779400&dopt=Abstract

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Evaluation of lower back pain with bone scintigraphy and SPECT. Author(s): De Maeseneer M, Lenchik L, Everaert H, Marcelis S, Bossuyt A, Osteaux M, Beeckman P. Source: Radiographics : a Review Publication of the Radiological Society of North America, Inc. 1999 July-August; 19(4): 901-12; Discussion 912-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10464798&dopt=Abstract

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Evaluation of orthopedic testing of the low back for nonspecific lower back pain. Author(s): Walsh MJ. Source: Journal of Manipulative and Physiological Therapeutics. 1998 May; 21(4): 232-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9608377&dopt=Abstract

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How traditional Chinese medicine acupuncturists would diagnose and treat chronic low back pain: results of a survey of licensed acupuncturists in Washington State. Author(s): Sherman KJ, Hogeboom CJ, Cherkin DC. Source: Complementary Therapies in Medicine. 2001 September; 9(3): 146-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11926428&dopt=Abstract

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HPLC receptorassay of opioid peptides in the cerebrospinal fluid of lower back pain patients. Author(s): Desiderio DM, Onishi H, Fridland G, Wood G, Pagidipati D. Source: Biomedical Chromatography : Bmc. 1987; 2(2): 47-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2852511&dopt=Abstract

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IDET: a new approach to treating lower back pain. Author(s): Kennedy M. Source: Wmj. 1999 September-October; 98(6): 18-20. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10605350&dopt=Abstract

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Industrial medicine and acute musculoskeletal rehabilitation. 1. Diagnosing and managing the injured worker with low back pain. Author(s): Prather H, Foye PM, Cianca JC. Source: Archives of Physical Medicine and Rehabilitation. 2002 March; 83(3 Suppl 1): S36, S33-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11973688&dopt=Abstract

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Influence of imaging on clinical decision making in the treatment of lower back pain. Author(s): Gillan MG, Gilbert FJ, Andrew JE, Grant AM, Wardlaw D, Valentine NW, Gregori AC; Scottish Back Trial Group. Source: Radiology. 2001 August; 220(2): 393-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11477242&dopt=Abstract

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Influence of saddle type upon the incidence of lower back pain in equestrian riders. Author(s): Quinn S, Bird S. Source: British Journal of Sports Medicine. 1996 June; 30(2): 140-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8799599&dopt=Abstract

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Interexaminer reliability of low back pain assessment using the McKenzie method. Author(s): Kilpikoski S, Airaksinen O, Kankaanpaa M, Leminen P, Videman T, Alen M. Source: Spine. 2002 April 15; 27(8): E207-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11935120&dopt=Abstract

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Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. Author(s): Burke JG, Watson RW, McCormack D, Dowling FE, Walsh MG, Fitzpatrick JM. Source: The Journal of Bone and Joint Surgery. British Volume. 2002 March; 84(2): 196201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11924650&dopt=Abstract

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Intradiscal electrothermal therapy for the treatment of chronic discogenic low back pain. Author(s): Saal JA, Saal JS. Source: Clinics in Sports Medicine. 2002 January; 21(1): 167-87. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11877870&dopt=Abstract

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Italian version of the Roland Disability Questionnaire, specific for low back pain: cross-cultural adaptation and validation. Author(s): Padua R, Padua L, Ceccarelli E, Romanini E, Zanoli G, Bondi R, Campi A. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2002 April; 11(2): 126-9. Epub 2001 July 17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11956918&dopt=Abstract

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Lateral mass fusion for lower back pain. Author(s): Hughes SP, Dohler JR, Tan KM, Watson HJ, Scott JH. Source: Archives of Orthopaedic and Trauma Surgery. 1987; 106(6): 381-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2963600&dopt=Abstract

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Low back pain during streptokinase infusion. Author(s): Pinheiro RF, Pedrolo AS, Nigri M, Carvalho AC. Source: Arquivos Brasileiros De Cardiologia. 2002 February; 78(2): 230-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11887199&dopt=Abstract

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Low back pain. Author(s): Nikkanen HE, Brown DF, Nadel ES. Source: The Journal of Emergency Medicine. 2002 April; 22(3): 279-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11932092&dopt=Abstract

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Low back pain. Author(s): Van Tulder M, Koes BW. Source: American Family Physician. 2002 March 1; 65(5): 925-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11898967&dopt=Abstract

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Lower back pain and sciatica: 25 years of tropical fruit treatment (chemonucleolysis) Author(s): Graham CE. Source: The Medical Journal of Australia. 1995 September 18; 163(6): 335. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7565250&dopt=Abstract

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Lower back pain and sciatica: how best to manage them. Author(s): Bush K. Source: Br J Hosp Med. 1994 March 2-15; 51(5): 216-22. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7848409&dopt=Abstract

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Lower back pain is reduced and range of motion increased after massage therapy. Author(s): Hernandez-Reif M, Field T, Krasnegor J, Theakston H. Source: The International Journal of Neuroscience. 2001; 106(3-4): 131-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11264915&dopt=Abstract

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Lower back pain management in injured workers. Author(s): Kolb AJ. Source: Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 1999 December; 41(12): 1021; Author Reply 1021-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10636709&dopt=Abstract

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Lower back pain management in injured workers. Author(s): Gabel RM. Source: Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 1999 December; 41(12): 1021; Author Reply 1021-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10609219&dopt=Abstract

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Lower back pain, decreased libido, occasional dysuria and urgency when sitting in the “jet”. Author(s): Simpson CG. Source: Aviation, Space, and Environmental Medicine. 1991 February; 62(2): 184-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2001221&dopt=Abstract

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Lower back pain. Laminectomies, spinal fusions, demographics, and socioeconomics. Author(s): Bentkover JD, Sheshinski RH, Hedley-Whyte J, Warfield CA, Mosteller F. Source: International Journal of Technology Assessment in Health Care. 1992 Spring; 8(2): 309-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1385799&dopt=Abstract

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Lumbar muscle fatigue and chronic lower back pain. Author(s): Roy SH, De Luca CJ, Casavant DA. Source: Spine. 1989 September; 14(9): 992-1001. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2528828&dopt=Abstract

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Man with progressive lower back pain. Author(s): Arvin MC, Gehring RL, Crecelius JL, Curfman MF. Source: Indiana Med. 1991 August; 84(8): 554-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1833444&dopt=Abstract

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Management of the athlete with low back pain. Author(s): George SZ, Delitto A. Source: Clinics in Sports Medicine. 2002 January; 21(1): 105-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11877865&dopt=Abstract

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Manipulative therapy in lower back pain with leg pain and neurological deficit. Author(s): Bergmann TF, Jongeward BV. Source: Journal of Manipulative and Physiological Therapeutics. 1998 May; 21(4): 288-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9608384&dopt=Abstract

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Massage is better than acupuncture (and in the short term better than self care) in reducing pain and disability in patients with chronic lower back pain. Author(s): Hurley D. Source: The Australian Journal of Physiotherapy. 2001; 47(4): 299. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11774827&dopt=Abstract

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Morphometry of the lower lumbar vertebrae in patients with and without low back pain. Author(s): Santiago FR, Milena GL, Herrera RO, Romero PA, Plazas PG. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2001 June; 10(3): 228-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11469734&dopt=Abstract

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Motion palpation findings and self-reported low back pain in a population-based study sample. Author(s): Leboeuf-Yde C, van Dijk J, Franz C, Hustad SA, Olsen D, Pihl T, Robech R, Skov Vendrup S, Bendix T, Kyvik KO. Source: Journal of Manipulative and Physiological Therapeutics. 2002 February; 25(2): 80-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11896374&dopt=Abstract

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Multidisciplinary bio-psycho-social rehabilitation for chronic low back pain. Author(s): Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C. Source: Cochrane Database Syst Rev. 2002; (1): Cd000963. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11869581&dopt=Abstract

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Nursing assessment of lower back pain. Author(s): Shaw MC. Source: Rehabilitation Nursing : the Official Journal of the Association of Rehabilitation Nurses. 1994 March-April; 19(2): 122. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8128108&dopt=Abstract

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Nursing assessment of lower back pain. Author(s): Raab L. Source: Rehabilitation Nursing : the Official Journal of the Association of Rehabilitation Nurses. 1994 March-April; 19(2): 120, 122. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8128107&dopt=Abstract

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On the usefulness of somatosensory evoked responses for the evaluation of lower back pain. Author(s): Perlik S, Fisher MA, Patel DV, Slack C. Source: Archives of Neurology. 1986 September; 43(9): 907-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2943255&dopt=Abstract

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Opioid receptoractivity in CSF from an atypical lower back pain patient. Author(s): Desiderio DM, Liu DX, Wood G. Source: Life Sciences. 1988; 43(7): 577-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2840541&dopt=Abstract

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Pelvis-thorax coordination in the transverse plane during walking in persons with nonspecific low back pain. Author(s): Lamoth CJ, Meijer OG, Wuisman PI, van Dieen JH, Levin MF, Beek PJ. Source: Spine. 2002 February 15; 27(4): E92-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11840116&dopt=Abstract

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Percutaneous procedures for the diagnosis and treatment of lower back pain: diskography, facet-joint injection, and epidural injection. Author(s): el-Khoury GY, Renfrew DL. Source: Ajr. American Journal of Roentgenology. 1991 October; 157(4): 685-91. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1832511&dopt=Abstract

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Persistent low back pain and sciatica in the United States: treatment outcomes. Author(s): BenDebba M, Torgerson WS, Boyd RJ, Dawson EG, Hardy RW, Robertson JT, Sypert GW, Watts C, Long DM. Source: Journal of Spinal Disorders & Techniques. 2002 February; 15(1): 2-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11891445&dopt=Abstract

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Physiotherapy management of low back pain: a survey of current practice in northern Ireland. Author(s): Gracey JH, McDonough SM, Baxter GD. Source: Spine. 2002 February 15; 27(4): 406-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11840108&dopt=Abstract

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Planning grant awarded to study CAM in treatment of migraines and lower back pain. Author(s): Horrigan B, Block B. Source: Alternative Therapies in Health and Medicine. 2003 May-June; 9(3): 22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776472&dopt=Abstract

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Predicting return to work for lower back pain patients receiving worker's compensation. Author(s): Lancourt J, Kettelhut M. Source: Spine. 1992 June; 17(6): 629-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1385657&dopt=Abstract

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Psychological correlates of pain behavior in patients with chronic low back pain. Author(s): Dickens C, Jayson M, Creed F. Source: Psychosomatics. 2002 January-February; 43(1): 42-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11927757&dopt=Abstract

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Radiofrequency facet joint denervation in the treatment of low back pain: a placebocontrolled clinical trial to assess efficacy. Author(s): Dreyfuss P, Baker R, Leclaire R, Fortin L, Lambert R, Bergeron Y, Rossignol M. Source: Spine. 2002 March 1; 27(5): 556-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11880846&dopt=Abstract

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Return-to-work interventions for low back pain: a descriptive review of contents and concepts of working mechanisms. Author(s): Staal JB, Hlobil H, van Tulder MW, Koke AJ, Smid T, van Mechelen W. Source: Sports Medicine (Auckland, N.Z.). 2002; 32(4): 251-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11929354&dopt=Abstract

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Sacral stress fractures: an unusual cause of low back pain in an athlete. Author(s): Shah MK, Stewart GW. Source: Spine. 2002 February 15; 27(4): E104-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11840118&dopt=Abstract

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Sacroiliac joint arthrodesis for chronic lower back pain. Author(s): Waisbrod H, Krainick JU, Gerbershagen HU. Source: Archives of Orthopaedic and Trauma Surgery. 1987; 106(4): 238-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2956935&dopt=Abstract

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Second Prize: The effectiveness of physical modalities among patients with low back pain randomized to chiropractic care: findings from the UCLA low back pain study. Author(s): Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Belin TR, Yu F, Adams AH, Kominsky GF. Source: Journal of Manipulative and Physiological Therapeutics. 2002 January; 25(1): 1020. Erratum In: J Manipulative Physiol Ther 2002 March-April; 25(3): 183. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11898014&dopt=Abstract

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Simple custom-made disposable surface electrode system for non-invasive “electroacupuncture” or TNS and its clinical applications including treatment of cephalic hypertension and hypotension syndromes as well as temporo-mandibular joint problems, tinnitus, shoulder and lower back pain, etc. Author(s): Omura Y. Source: Acupuncture & Electro-Therapeutics Research. 1981; 6(2-3): 109-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6120617&dopt=Abstract

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Somatisation predicts the outcome of treatment in patients with low back pain. Author(s): Nickel R, Egle UT, Rompe J, Eysel P, Hoffmann SO. Source: The Journal of Bone and Joint Surgery. British Volume. 2002 March; 84(2): 18995. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11922359&dopt=Abstract

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Specific spinal exercise substantially reduces the risk of low back pain recurrence. Author(s): Buchbinder R, Hoving J. Source: The Australian Journal of Physiotherapy. 2002; 48(1): 55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11973769&dopt=Abstract

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Streptococcus viridans osteomyelitis with endocarditis presenting as acute onset lower back pain. Author(s): Buchman AL. Source: The Journal of Emergency Medicine. 1990 May-June; 8(3): 291-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2142706&dopt=Abstract

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The diagnostic utility of McKenzie clinical assessment for lower back pain. Author(s): Delaney PM, Hubka MJ. Source: Journal of Manipulative and Physiological Therapeutics. 1999 NovemberDecember; 22(9): 628-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10626707&dopt=Abstract

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The effect of coping strategies on the relief of pain following surgical intervention for lower back pain. Author(s): Gross AR. Source: Psychosomatic Medicine. 1986 March-April; 48(3-4): 229-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3704086&dopt=Abstract

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The effects of shiatsu on lower back pain. Author(s): Brady LH, Henry K, Luth JF 2nd, Casper-Bruett KK. Source: Journal of Holistic Nursing : Official Journal of the American Holistic Nurses' Association. 2001 March; 19(1): 57-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11847714&dopt=Abstract

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The efficacy of an aerobic exercise and health education program for treatment of chronic low back pain. Author(s): Tritilanunt T, Wajanavisit W. Source: J Med Assoc Thai. 2001 October; 84 Suppl 2: S528-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11853276&dopt=Abstract

Studies

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The GP's role in the management of chronic lower back pain. Author(s): Marshall M, Sweeney K. Source: Family Practice. 1998 August; 15(4): 375. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9792355&dopt=Abstract

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The reduction of chronic, nonspecific low back pain through the control of early morning lumbar flexion: 3-year follow-up. Author(s): Snook SH, Webster BS, McGorry RW. Source: Journal of Occupational Rehabilitation. 2002 March; 12(1): 13-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11837055&dopt=Abstract

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The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Author(s): Richardson CA, Snijders CJ, Hides JA, Damen L, Pas MS, Storm J. Source: Spine. 2002 February 15; 27(4): 399-405. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11840107&dopt=Abstract

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The relationship between lower extremity injury, low back pain, and hip muscle strength in male and female collegiate athletes. Author(s): Nadler SF, Malanga GA, DePrince M, Stitik TP, Feinberg JH. Source: Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine. 2000 April; 10(2): 89-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10798789&dopt=Abstract

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The role of the motor system in spinal pain: implications for rehabilitation of the athlete following lower back pain. Author(s): Hodges PW. Source: J Sci Med Sport. 2000 September; 3(3): 243-53. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11101263&dopt=Abstract

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Tramadol/acetaminophen combination tablets for the treatment of chronic lower back pain: a multicenter, randomized, double-blind, placebo-controlled outpatient study. Author(s): Ruoff GE, Rosenthal N, Jordan D, Karim R, Kamin M; Protocol CAPSS-112 Study Group. Source: Clinical Therapeutics. 2003 April; 25(4): 1123-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12809961&dopt=Abstract

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Treatment of chronic lower back pain with lumbar extension and whole-body vibration exercise: a randomized controlled trial. Author(s): Rittweger J, Just K, Kautzsch K, Reeg P, Felsenberg D. Source: Spine. 2002 September 1; 27(17): 1829-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12221343&dopt=Abstract

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Treatment of low back pain: myths and facts. Author(s): van Tulder MW. Source: Schmerz (Berlin, Germany). 2001 December; 15(6): 499-503. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11793157&dopt=Abstract

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Treatment of lower back pain with “pressing and pulling” at Kunlun (UB 60) method. Author(s): Yu SZ. Source: J Tradit Chin Med. 1988 December; 8(4): 267-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2977629&dopt=Abstract

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Variation in diagnosis and treatment of chronic low back pain by traditional Chinese medicine acupuncturists. Author(s): Hogeboom CJ, Sherman KJ, Cherkin DC. Source: Complementary Therapies in Medicine. 2001 September; 9(3): 154-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11926429&dopt=Abstract

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Wegener's granulomatosis presenting as lower back pain with prostatitis and ureteral obstruction. Author(s): Middleton G, Karp D, Lee E, Cush J. Source: The Journal of Rheumatology. 1994 March; 21(3): 566-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8006905&dopt=Abstract

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Whose autonomy? Which choice? A study of GPs' attitudes towards patient autonomy in the management of low back pain. Author(s): Rogers WA. Source: Family Practice. 2002 April; 19(2): 140-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11906978&dopt=Abstract

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Work-related outcomes in occupational low back pain: a multidimensional analysis. Author(s): Pransky G, Benjamin K, Hill-Fotouhi C, Fletcher KE, Himmelstein J, Katz JN. Source: Spine. 2002 April 15; 27(8): 864-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11935111&dopt=Abstract

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CHAPTER 2. NUTRITION AND LOWER BACK PAIN Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and lower back pain.

Finding Nutrition Studies on Lower Back Pain The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “lower back pain” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

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Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “lower back pain” (or a synonym): •

Manual therapy with steroid injections--a new approach to treatment of low back pain. A controlled multicenter trial with an evaluation by orthopedic surgeons. Author(s): Department of Family Medicine, Uppsala University, Sweden. Source: Blomberg, S Hallin, G Grann, K Berg, E Sennerby, U Spine. 1994 March 1; 19(5): 569-77 0362-2436

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Treatment of lower back pain with “pressing and pulling” at Kunlun (UB 60) method. Source: Yu, S Z J-Tradit-Chin-Med. 1988 December; 8(4): 267-8 0254-6272

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

Nutrition

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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The following is a specific Web list relating to lower back pain; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Vitamin B1 Source: Healthnotes, Inc.; www.healthnotes.com Vitamin B12 Source: Healthnotes, Inc.; www.healthnotes.com Vitamin B6 Source: Healthnotes, Inc.; www.healthnotes.com Vitamin C Source: Healthnotes, Inc.; www.healthnotes.com

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Food and Diet Low Back Pain Source: Healthnotes, Inc.; www.healthnotes.com Pain Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND LOWER BACK PAIN Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to lower back pain. At the conclusion of this chapter, we will provide additional sources.

The Combined Health Information Database The Combined Health Information Database (CHID) is a bibliographic database produced by health-related agencies of the U.S. federal government (mostly from the National Institutes of Health) that can offer concise information for a targeted search. The CHID database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “lower back pain” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: •

Massage Therapy for Low Back Pain: A Systematic Review Source: Journal of Pain and Symptom Management. 17(1): 65-69. January 1999. Summary: This journal article presents a systematic review of the literature on massage therapy for low back pain (LBP). The purpose was to examine the evidence for or against the efficacy of massage therapy for this indication. Only four randomized clinical trials were found in which massage was tested as a monotherapy for LBP. According to the author, all four trials had major methodological flaws. One of the studies suggests that massage is superior to no treatment. Two studies report that it is equally effective as spinal manipulation and transcutaneous electrical stimulation. One study suggests that massage is less effective than spinal manipulation. The author concludes that massage therapy may have some potential as a treatment for LBP, but too

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few trials of massage therapy exist for a reliable evaluation of its efficacy. The article has 1 table and 26 references. (AA-M).

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to lower back pain and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “lower back pain” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to lower back pain: •

A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Author(s): Flynn T, Fritz J, Whitman J, Wainner R, Magel J, Rendeiro D, Butler B, Garber M, Allison S. Source: Spine. 2002 December 15; 27(24): 2835-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12486357&dopt=Abstract

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A randomized double-blind pilot study comparing Doloteffin and Vioxx in the treatment of low back pain. Author(s): Chrubasik S, Model A, Black A, Pollak S. Source: Rheumatology (Oxford, England). 2003 January; 42(1): 141-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12509627&dopt=Abstract

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A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study. Author(s): Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Belin TR, Yu F, Adams AH; University of California-Los Angeles. Source: Spine. 2002 October 15; 27(20): 2193-204. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12394892&dopt=Abstract

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Acupuncture for low back pain in pregnancy. Author(s): Cummings M. Source: Acupuncture in Medicine : Journal of the British Medical Acupuncture Society. 2003 June; 21(1-2): 42-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12924847&dopt=Abstract

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Acupuncture: evidence for its use in chronic low back pain. Author(s): Henderson H.

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Source: British Journal of Nursing (Mark Allen Publishing). 2002 November 28December 11; 11(21): 1395-403. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12514474&dopt=Abstract •

Ayurveda in ankylosing spondylitis and low back pain. Author(s): Falkenbach A, Oberguggenberger R. Source: Annals of the Rheumatic Diseases. 2003 March; 62(3): 276-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12594124&dopt=Abstract

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Can patient reactions to the first chiropractic treatment predict early favorable treatment outcome in persistent low back pain? Author(s): Axen I, Rosenbaum A, Robech R, Wren T, Leboeuf-Yde C. Source: Journal of Manipulative and Physiological Therapeutics. 2002 September; 25(7): 450-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12214186&dopt=Abstract

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Chronic low back pain management in primary care. Author(s): Phillips K, Ch'ien AP, Norwood BR, Smith C. Source: The Nurse Practitioner. 2003 August; 28(8): 26-31. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12902938&dopt=Abstract

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Chronic low back pain: a study of the effects of manipulation under anesthesia. Author(s): Palmieri NF, Smoyak S. Source: Journal of Manipulative and Physiological Therapeutics. 2002 October; 25(8): E8E17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12381983&dopt=Abstract

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Clinical guidelines versus clinical practice in the management of low back pain. Author(s): Armstrong MP, McDonough S, Baxter GD. Source: Int J Clin Pract. 2003 January-February; 57(1): 9-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12587934&dopt=Abstract

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Combined physiotherapy and education is efficacious for chronic low back pain. Author(s): Moseley L. Source: The Australian Journal of Physiotherapy. 2002; 48(4): 297-302. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12443524&dopt=Abstract

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Comment on: Molsberger AF, Mau J, Pawelec DB, Winkler J. Does acupuncture improve the orthopedic management of chronic low back pain? Pain 2002; 99:579-87. Author(s): Leibing E, Pfingsten M, Leichsenring F.

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Source: Pain. 2003 July; 104(1-2): 425-6; Author Reply 426-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12855354&dopt=Abstract •

Comparing the satisfaction of low back pain patients randomized to receive medical or chiropractic care: results from the UCLA low-back pain study. Author(s): Hertzman-Miller RP, Morgenstern H, Hurwitz EL, Yu F, Adams AH, Harber P, Kominski GF. Source: American Journal of Public Health. 2002 October; 92(10): 1628-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12356612&dopt=Abstract

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Developing methods for acupuncture research: rationale for and design of a pilot study evaluating the efficacy of acupuncture for chronic low back pain. Author(s): Sherman KJ, Cherkin DC. Source: Alternative Therapies in Health and Medicine. 2003 September-October; 9(5): 5460. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14526711&dopt=Abstract

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Different views of health care professionals on the treatment of osteoarthritis including low back pain. Author(s): Chrubasik S, Conradt C, Black A. Source: Rheumatology (Oxford, England). 2003 August; 42(8): 1020-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12869679&dopt=Abstract

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Does acupuncture improve the orthopedic management of chronic low back pain--a randomized, blinded, controlled trial with 3 months follow up. Author(s): Molsberger AF, Mau J, Pawelec DB, Winkler J. Source: Pain. 2002 October; 99(3): 579-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12406534&dopt=Abstract

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Does spinal manipulative therapy help people with chronic low back pain? Author(s): Ferreira ML, Ferreira PH, Latimer J, Herbert R, Maher CG. Source: The Australian Journal of Physiotherapy. 2002; 48(4): 277-84. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12443522&dopt=Abstract

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Efficacy of percutaneous electrical nerve stimulation for the treatment of chronic low back pain in older adults. Author(s): Weiner DK, Rudy TE, Glick RM, Boston JR, Lieber SJ, Morrow LA, Taylor S. Source: Journal of the American Geriatrics Society. 2003 May; 51(5): 599-608. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12752833&dopt=Abstract

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Evaluation of a specific home exercise program for low back pain. Author(s): Descarreaux M, Normand MC, Laurencelle L, Dugas C.

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Source: Journal of Manipulative and Physiological Therapeutics. 2002 October; 25(8): 497-503. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12381971&dopt=Abstract •

Evaluation of chiropractic management of pediatric patients with low back pain: a prospective cohort study. Author(s): Hayden JA, Mior SA, Verhoef MJ. Source: Journal of Manipulative and Physiological Therapeutics. 2003 January; 26(1): 1-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12532132&dopt=Abstract

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Evaluation of orthopedic testing of the low back for nonspecific lower back pain. Author(s): Walsh MJ. Source: Journal of Manipulative and Physiological Therapeutics. 1998 May; 21(4): 232-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9608377&dopt=Abstract

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Interobserver reliability of the 24-hour schedule in patients with low back pain: a questionnaire measuring the daily use and loading of the spine. Author(s): Bakker EW, Koning HJ, Verhagen AP, Koes BW. Source: Journal of Manipulative and Physiological Therapeutics. 2003 May; 26(4): 226-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12750656&dopt=Abstract

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Is low back pain part of a general health pattern or is it a separate and distinctive entity? A critical literature review of comorbidity with low back pain. Author(s): Hestbaek L, Leboeuf-Yde C, Manniche C. Source: Journal of Manipulative and Physiological Therapeutics. 2003 May; 26(4): 243-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12750659&dopt=Abstract

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Low back pain in pregnancy. Author(s): Forrester M. Source: Acupuncture in Medicine : Journal of the British Medical Acupuncture Society. 2003 June; 21(1-2): 36-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12924846&dopt=Abstract

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Low back pain--a community-based study of care-seeking and therapeutic effectiveness. Author(s): Jacob T, Zeev A, Epstein L. Source: Disability and Rehabilitation. 2003 January 21; 25(2): 67-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12554381&dopt=Abstract

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Lower back pain is reduced and range of motion increased after massage therapy. Author(s): Hernandez-Reif M, Field T, Krasnegor J, Theakston H.

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Source: The International Journal of Neuroscience. 2001; 106(3-4): 131-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11264915&dopt=Abstract •

Manipulative therapy in lower back pain with leg pain and neurological deficit. Author(s): Bergmann TF, Jongeward BV. Source: Journal of Manipulative and Physiological Therapeutics. 1998 May; 21(4): 288-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9608384&dopt=Abstract

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Manual therapy and exercise therapy in patients with chronic low back pain: a randomized, controlled trial with 1-year follow-up. Author(s): Aure OF, Nilsen JH, Vasseljen O. Source: Spine. 2003 March 15; 28(6): 525-31; Discussion 531-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12642755&dopt=Abstract

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Massage is better than acupuncture (and in the short term better than self care) in reducing pain and disability in patients with chronic lower back pain. Author(s): Hurley D. Source: The Australian Journal of Physiotherapy. 2001; 47(4): 299. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11774827&dopt=Abstract

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One-shot percutaneous electrical nerve stimulation vs. transcutaneous electrical nerve stimulation for low back pain: comparison of therapeutic effects. Author(s): Hsieh RL, Lee WC. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2002 November; 81(11): 838-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12394995&dopt=Abstract

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Planning grant awarded to study CAM in treatment of migraines and lower back pain. /entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12779310

Author(s): Ann Intern Med. 2003 Jun 3;138(11):I33 Source: Alternative Therapies in Health and Medicine. 2003 May-June; 9(3): 22. <Title>Randomised controlled trial comparing the effectiveness of electroacupuncture and TENS for low back pain: a preliminary study for a pragmatic trial. Author(s): Tsukayama H, Yamashita H, Amagai H, Tanno Y. Source: Acupuncture in Medicine : Journal of the British Medical Acupuncture Society. 2002 December; 20(4): 175-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12512791&dopt=Abstract

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Spinal manipulation for chronic low back pain--where to from here? (Comment on Ferreira et al, Australian Journal of Physiotherapy 48: 277-284). Author(s): Edmondston S. Source: The Australian Journal of Physiotherapy. 2003; 49(1): 63-4; Author Reply 64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12600256&dopt=Abstract

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Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies. Author(s): Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Source: Annals of Internal Medicine. 2003 June 3; 138(11): 871-81. Review. Summary for Patients In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12779297&dopt=Abstract

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Systematic review of conservative interventions for subacute low back pain. Author(s): Pengel HM, Maher CG, Refshauge KM. Source: Clinical Rehabilitation. 2002 December; 16(8): 811-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12501942&dopt=Abstract

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The audible pop is not necessary for successful spinal high-velocity thrust manipulation in individuals with low back pain. Author(s): Flynn TW, Fritz JM, Wainner RS, Whitman JM. Source: Archives of Physical Medicine and Rehabilitation. 2003 July; 84(7): 1057-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12881834&dopt=Abstract

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The course of low back pain in a general population. Results from a 5-year prospective study. Author(s): Hestbaek L, Leboeuf-Yde C, Engberg M, Lauritzen T, Bruun NH, Manniche C. Source: Journal of Manipulative and Physiological Therapeutics. 2003 May; 26(4): 213-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12750654&dopt=Abstract

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The diagnostic utility of McKenzie clinical assessment for lower back pain. Author(s): Delaney PM, Hubka MJ. Source: Journal of Manipulative and Physiological Therapeutics. 1999 NovemberDecember; 22(9): 628-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10626707&dopt=Abstract

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The effectiveness of physical modalities among patients with low back pain randomized to chiropractic care: findings from the UCLA low back pain study. Author(s): Rupert R.

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Source: Journal of Manipulative and Physiological Therapeutics. 2002 October; 25(8): 538-9; Author Reply 539-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12381978&dopt=Abstract •

The effects of shiatsu on lower back pain. Author(s): Brady LH, Henry K, Luth JF 2nd, Casper-Bruett KK. Source: Journal of Holistic Nursing : Official Journal of the American Holistic Nurses' Association. 2001 March; 19(1): 57-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11847714&dopt=Abstract

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The prevalence of recalled low back pain during and after pregnancy: a South Australian population survey. Author(s): Stapleton DB, MacLennan AH, Kristiansson P. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2002 November; 42(5): 482-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12495090&dopt=Abstract

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The relation of race to outcomes and the use of health care services for acute low back pain. Author(s): Carey TS, Garrett JM. Source: Spine. 2003 February 15; 28(4): 390-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12590217&dopt=Abstract

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Treatment of chronic lower back pain with lumbar extension and whole-body vibration exercise: a randomized controlled trial. Author(s): Rittweger J, Just K, Kautzsch K, Reeg P, Felsenberg D. Source: Spine. 2002 September 1; 27(17): 1829-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12221343&dopt=Abstract

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Views on radiography use for patients with acute low back pain among chiropractors in an Ontario community. Author(s): Ammendolia C, Bombardier C, Hogg-Johnson S, Glazier R. Source: Journal of Manipulative and Physiological Therapeutics. 2002 October; 25(8): 511-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12381973&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to lower back pain; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Cervical Dysplasia Source: Integrative Medicine Communications; www.drkoop.com Endometriosis Source: Integrative Medicine Communications; www.drkoop.com Fibromyalgia Source: Healthnotes, Inc.; www.healthnotes.com Irritable Bowel Syndrome Source: Healthnotes, Inc.; www.healthnotes.com Low Back Pain Source: Integrative Medicine Communications; www.drkoop.com Lupus Source: Integrative Medicine Communications; www.drkoop.com Osteoarthritis Source: Healthnotes, Inc.; www.healthnotes.com Pelvic Inflammatory Disease Source: Integrative Medicine Communications; www.drkoop.com Premenstrual Syndrome Source: Integrative Medicine Communications; www.drkoop.com

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Systemic Lupus Erythematosus Source: Integrative Medicine Communications; www.drkoop.com Vaginal Inflammation Source: Integrative Medicine Communications; www.drkoop.com Vaginitis Source: Integrative Medicine Communications; www.drkoop.com •

Alternative Therapy Acupressure Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,662,00.html Chiropractic Source: Healthnotes, Inc.; www.healthnotes.com Chiropractic Source: Integrative Medicine Communications; www.drkoop.com Chiropractic Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,681,00.html Colon Therapy Source: Healthnotes, Inc.; www.healthnotes.com Massage Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,716,00.html Osteopathy Source: Integrative Medicine Communications; www.drkoop.com Osteopathy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,724,00.html Shiatsu Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,733,00.html Traditional Chinese Medicine Source: Integrative Medicine Communications; www.drkoop.com

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•

Homeopathy Actaea Racemosa Source: Healthnotes, Inc.; www.healthnotes.com Aesculus Hippocastanum Source: Healthnotes, Inc.; www.healthnotes.com Arnica Source: Healthnotes, Inc.; www.healthnotes.com Bryonia Source: Healthnotes, Inc.; www.healthnotes.com Calcarea Carbonica Source: Healthnotes, Inc.; www.healthnotes.com Calcarea Phosphorica Source: Healthnotes, Inc.; www.healthnotes.com Cimicifuga Source: Healthnotes, Inc.; www.healthnotes.com Dulcamara Source: Healthnotes, Inc.; www.healthnotes.com Ignatia Source: Healthnotes, Inc.; www.healthnotes.com Kali Carbonicum Source: Healthnotes, Inc.; www.healthnotes.com Natrum Muriaticum Source: Healthnotes, Inc.; www.healthnotes.com Nux Vomica Source: Healthnotes, Inc.; www.healthnotes.com Rhus Toxicodendron Source: Healthnotes, Inc.; www.healthnotes.com Ruta Graveolens Source: Healthnotes, Inc.; www.healthnotes.com Sulphur Source: Healthnotes, Inc.; www.healthnotes.com

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Herbs and Supplements Arctium Alternative names: Burdock, Gobo; Arctium lappa L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org

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Boswellia Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,759,00.html Bromelain Source: Healthnotes, Inc.; www.healthnotes.com Cayenne Alternative names: Capsicum annuum, Capsicum frutescens Source: Healthnotes, Inc.; www.healthnotes.com Cranberry Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10019,00.html Devil’s Claw Alternative names: Harpagophytum procumbens Source: Healthnotes, Inc.; www.healthnotes.com Devil's Claw Source: Prima Communications, Inc.www.personalhealthzone.com Digestive Enzymes Source: Healthnotes, Inc.; www.healthnotes.com Eucalyptus Alternative names: Eucalyptus globulus Source: Healthnotes, Inc.; www.healthnotes.com Ginger Alternative names: Zingiber officinale Source: Healthnotes, Inc.; www.healthnotes.com Hydrangea Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Juniper Berry Source: Prima Communications, Inc.www.personalhealthzone.com Pau d’Arco Alternative names: Tabebuia avellanedae, Tabebuia impestiginosa Source: Healthnotes, Inc.; www.healthnotes.com Peppermint Alternative names: Mentha piperita Source: Healthnotes, Inc.; www.healthnotes.com

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Phenylalanine Source: Healthnotes, Inc.; www.healthnotes.com Tanacetum V Alternative names: Tansy; Tanacetum vulgare (L.) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Turmeric Alternative names: Curcuma longa Source: Healthnotes, Inc.; www.healthnotes.com Willow Alternative names: Salix alba Source: Healthnotes, Inc.; www.healthnotes.com Willow Bark Alternative names: There are several species of willow includingSalix alba, Salix nigra, Salix fragilis, Salix purpurea, Salix babylonica, White Willow, European Willow, Black Willow, Pussy Willow, Crack Willow, Purple Willow, Weeping Willow, Liu-zhi Source: Integrative Medicine Communications; www.drkoop.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. CLINICAL TRIALS AND LOWER BACK PAIN Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning lower back pain.

Recent Trials on Lower Back Pain The following is a list of recent trials dedicated to lower back pain.8 Further information on a trial is available at the Web site indicated. •

Magnets in the Treatment of Sciatica Condition(s): Low Back Pain; Sciatica Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Dental and Craniofacial Research (NIDCR) Purpose - Excerpt: This 19-week study will evaluate magnets of very low power to treat sciatica (also referred to as lumbago, sciatica, or lumbar radicular pain). Some evidence suggests that magnets can alleviate pain associated with muscle, bone, and nerve problems. Individuals between 30 and 70 years of age who have had sciatica (sharp, shooting pains in the leg) daily for at least 3 months may be eligible for this study. The pain must be moderate to severe, occur on a daily basis, and be due to either disc problems or degeneration of the spine. Patients with pain in the buttock or posterior thigh without sciatica may also qualify if they have irritation of the lumbar (lower spine) nerve roots or if imaging studies such as magnetic resonance imaging (MRI) reveal a disc compressing the lumbar nerves on the same side as the pain. Candidates will be screened with a medical history, physical and neurological examinations, blood tests, pain evaluation, collection of demographic information, and possibly MRI. They will fill out questionnaires regarding pain, daily function, and psychological well being. The study has two phases, consisting of four 2-week periods in phase 1 and two 5-week periods in phase 2. - Phase 1: During two of the 2-week periods, subjects wear an elastic binder back support device with magnets sewn into them - one with the magnets aligned in the direction of the spine; the other with the magnets placed across the spine.

8

These are listed at www.ClinicalTrials.gov.

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During another period, subjects wear a dummy device that looks like a real magnet but has no actual magnetic force; in another, they wear no device at all. The magnets are worn at least 12 hours a day. - Phase 2: The subject wears the preferred magnet (real or sham) from phase 1 during one of these 5-week periods, and a dummy device during the other. Participants who did not find any of the magnets helpful in phase 1 may continue, nevertheless, with phase 2 and be assigned a magnet and sham device by the investigators. Participants may continue taking their regular pain medicines throughout the study's duration. They will keep a pain log during both phases, rating their pain on a scale of 0 to 10, and a record of side effects experienced with each period of the study. They will also keep a record of procedures, such as injections and manipulations, they undergo during the study to control pain flare-ups. Clinic visits will be scheduled as follows: - Visit 1: for screening and baseline studies before starting phase 1; participants may also come to the clinic after each 2-week period in phase 1 to exchange devices, or the devices may be mailed to the participant - Visit 2: at the end of phase 1 for an interview about the magnet treatments and to indicate the preferred treatment - Visit 3: at the end of the first phase 2 5-week period for a brief neurological examination, interview regarding treatment satisfaction and side effects, and completion of questionnaires - Visit 4: at the end of the second phase 2 5-week period for the same procedures as visit 2 During each visit, participants will have sensory testing, in which a pin is placed on the surface of the skin. This test does not cause any discomfort. At the end of the study, participants will be given the device that helped them, if any. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00044109 •

Spine Patient Outcomes Research Trial- Intervertebral Disc Herniation Condition(s): Herniated Disc; Low Back Pain Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); National Institute for Occupational Safety and Health (NIOSH/CDC); Office of Research on Women's Health (ORWH) Purpose - Excerpt: This study tests the effectiveness of different treatments for the three most commonly diagnosed lumbar (lower) spine conditions. The purpose of the study is to learn which of two commonly prescribed treatments (surgery and non-surgical therapy) works better for specific types of low back pain. In this part of the study, people with lumbar intervertebral disc herniation (damage to the tissue between the bones of the lower spine, or backbone) will receive either discectomy (surgical removal of herniated disc material) or non-surgical treatment. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000410

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•

Spine Patient Outcomes Research Degenerative Spondylolisthesis with Spinal Stenosis Condition(s): Spondylolisthesis; Spinal Stenosis; Low Back Pain Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); National Institute for Occupational Safety and Health (NIOSH/CDC); Office of Research on Women's Health (ORWH) Purpose - Excerpt: This study tests the effectiveness of different treatments for the three most commonly diagnosed conditions of the lower backbone (lumbar spine). The purpose is to learn which of two commonly prescribed treatments-surgery and nonsurgical therapy-works better for specific types of low back pain. Low back pain is one of the most widely experienced health problems in the United States and the world. It is the second most frequent condition, after the common cold, for which people see a doctor or lose days from work. In this part of the study, we will treat patients with spinal stenosis (a narrowing of spaces in the backbone that results in pressure on the spinal cord and/or nerve roots) caused by degenerative spondylolisthesis (a condition in which one vertebra, or spinal bone, slips forward on another) with either surgery or nonsurgical methods. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000409

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Spine Patient Outcomes Research Spinal Stenosis Condition(s): Spinal Stenosis; Low Back Pain Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); National Institute for Occupational Safety and Health (NIOSH/CDC); Office of Research on Women's Health (ORWH) Purpose - Excerpt: This study tests the effectiveness of different treatments for the three most commonly diagnosed conditions of the lower backbone (lumbar spine). The purpose is to learn which of two commonly prescribed treatments (surgery and nonsurgical therapy) works better for specific types of low back pain. Low back pain is one of the most widely experienced health problems in the United States and the world. It is the second most frequent condition, after the common cold, for which people see a doctor or lose days from work. In this part of the study, we will treat patients with spinal stenosis (a narrowing of spaces in the backbone that results in pressure on the spinal cord and/or nerve roots) with a type of surgery known as posterior decompressive laminectomy or with nonsurgical methods. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000411

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Usual Care Vs Choice of Alternative Rx: Low Back Pain Condition(s): Acute low back pain Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: This study compares two approaches to the management of acute low back pain: usual care (standard benefit) vs. the choice of: usual care, chiropractic, acupuncture or massage therapy (expanded benefit). 480 subjects with uncomplicated, acute low back pain will be recruited from a health maintenance organization, and randomized to either usual care (n=160) or choice of expanded benefits (n=320). Patients' preferences for individual therapies and expectations of improvement will be measured at baseline and throughout the study. Subjects randomized to the expanded benefits arm who choose chiropractic, acupuncture or massage will receive up to 10 treatments over a five-week period. Additional treatments will be available after the fifth week but will require a copayment. Treatments will be provided by licensed providers who have met strict credentialing criteria. Chiropractic, acupuncture or massage treatments will begin within 48 hours. Chiropractic, acupuncture and massage therapy scope of practice guidelines for the treatment of acute low back pain have been developed as have detailed data tracking procedures to be used at each patient visit. Symptom relief, functional status, restricted activity days, use of health care, and patient and provider satisfaction will be assessed at 2, 5,12, 26 and 52 weeks after initiation of treatment. Primary outcomes will include: 1) change in symptoms; 2) change in functional status; 3) patient satisfaction; and 4) total utilization of services associated with care for low back pain. Medical records and the HMO's cost management information system will identify use of services. It is hypothesized that patients offered their choice of expanded benefits will experience a more rapid improvement in symptoms, a faster return to baseline functional status, a decrease in utilization of conventional medical services, and will be more satisfied with their care. The study is a direct examination of the effectiveness of an insurance eligibility intervention, not a test of the efficacy of specific, non-allopathic treatment regimens. The results of this study will provide valuable information to clinicians, patients and third party payers on the relative benefits and costs of an "expanded benefits" treatment option which incorporates chiropractic, acupuncture and massage services for low back pain. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00010985

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The Use of Real Time Ultrasound Feedback in Teaching Abdominal Hollowing Exercises Condition(s): Low Back Pain Study Status: This study is no longer recruiting patients. Sponsor(s): National Center for Research Resources (NCRR) Purpose - Excerpt: Recently, physical therapists have begun treating people who have mechanical low back pain, hypothesized to be caused by segmental instability in the lumbar spine, with a very specific exercise program consisting of trunk stabilization exercises. The theory behind the use of trunk stabilization exercises to treat lower back pain is that active contraction of the trunk local segmental muscles helps to control

Clinical Trials 45

inter-segmental movement in the spine. The initial trunk stabilization exercise that physical therapists teach patients is an abdominal drawing in maneuver often called an abdominal hollowing exercise (AHE). A challenge for physical therapists is to establish the most effective means of teaching people to contract the relevant muscles needed to perform the AHE. The purpose of this study is to examine if supplementing the typical clinical instruction for teaching the AHE with visual ultrasound feedback to the patient is effective at reducing the length of time it takes an individual to learn to perform an AHE. Three groups of research volunteers will be taught how to do the AHE while receiving different kinds of feedback about their performance in order to determine which type of feedback is most effective in assisting people to learn the AHE. Group 1 will not receive any feedback about performance; Group 2 will receive feedback from palpation and verbal descriptive alone; and Group 3 will receive feedback from palpation, verbal descriptive feedback, and real time ultrasound. For the initial test when subjects are learning the AHE, the number of trials until the subject demonstrates his/her third correct AHE will be the outcome variable. For the retention test, the outcome variable will be the percentage of trials (out of ten) of correctly performed AHEs in the absence of visual, verbal or palpation feedback. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005771 •

A Prospective Cohort Study of MR Abnormalities and Back Pain Risk Condition(s): Low Back Pain Study Status: This study is completed. Sponsor(s): Department of Veterans Affairs; Department of Veterans Affairs Cooperative Studies Program Purpose - Excerpt: Low back pain is a frequent cause of disability and a common reason for outpatient care in veterans. Magnetic resonance imaging (MRI) of the lower back often reveals abnormalities,which may be used to justify expensive and invasive therapy, such as surgery. Yet the link between MRI abnormalities and the risk of developing clinically significant back pain is far from clear. This longitudinal study will determine the prevalence and incidence of MRI abnormalities among veterans and determine the extent to which specific MRI abnormalities predict future development of back pain. The result should help clinicians use MR imaging more efficiently, and they may ultimately help reduce the frequency of unnecessary back surgery. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00011739

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Efficacy of Acupuncture for Chronic Low Back Pain Condition(s): Low Back Pain Study Status: This study is not yet open for patient recruitment. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: This is a trial to clarify the extent to which acupuncture needling can diminish the effect of chronic back pain on patient functioning and symptoms.

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Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00065585 •

Evaluating Yoga for Chronic Low Back Pain Condition(s): Low Back Pain Study Status: This study is not yet open for patient recruitment. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: This study will compare the effectiveness of yoga classes, exercise classes, and a self-care book in the management of pain and function for people with low back pain. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00056212

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Low Back Pain Patient Education Evaluation Condition(s): Low Back Pain Study Status: This study is completed. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: Back pain is one of the most common of all symptoms. It is also a great cause of days lost from work and visits to health care providers. This study will develop and evaluate an approach to low back pain that allows subjects to talk with each other and with health professionals via an Internet discussion group. Results we will look at include health behaviors, such as exercise; health status, such as pain and disability; and health care use, such as number of visits to doctors and other health care providers. Anyone 18 years old or older who lives in the United States and has ongoing Internet access can take part in the study. All subjects must have back pain and meet the eligibility criteria listed below. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000408

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Massage, Meditation, and Tai Chi for Chronic Lower Back Pain Condition(s): Low Back Pain Study Status: This study is completed. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: This clinical trial is a preliminary study designed to prepare for a fullscale, randomized clinical trial of the effectiveness of tai chi, mediation, and therapeutic massage for chronic lower back pain in adults. Study Type: Interventional

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Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00070915 •

Physical CAM Therapies for Chronic Low Back Pain Condition(s): Chronic Low Back Pain Study Status: This study is completed. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: This is a pilot randomized trial intended to evaluate the effectiveness of acupuncture, chiropractic and massage for chronic back pain in older and younger adults. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00065975

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Psychosocial Treatment for Acute Low Back Pain Condition(s): Acute low back pain Study Status: This study is completed. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: Acute low back pain (severe pain that comes on suddenly and lasts a relatively short time) is very common in the United States, and accounts for substantial illness, functional limitations, pain, and health care costs. This study looks at whether a program designed to improve self-efficacy (a person's belief in his or her ability to reach a goal, such as managing one's own disease) and social support improves the health status of people with acute low back pain. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000418

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Using MRI Scans to Evaluate Spinal Manipulation Condition(s): Lower Back Pain Study Status: This study is completed. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: Lumbar spinal manipulation, or chiropractic adjusting, is thought to separate the surfaces of the spinal joints and thereby relieve lower back pain. This study will use MRI scans to evaluate the spinal joints before and after spinal manipulation. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00070902

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Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “lower back pain” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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•

For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 5. PATENTS ON LOWER BACK PAIN Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “lower back pain” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on lower back pain, we have not necessarily excluded nonmedical patents in this bibliography.

Patents on Lower Back Pain By performing a patent search focusing on lower back pain, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 9Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on lower back pain: •

Apparatus and method for providing pressure point therapy Inventor(s): Decanto; Anthony (57 Ariel Ct., Neshanic, NJ 08853) Assignee(s): none reported Patent Number: 5,470,304 Date filed: October 11, 1994 Abstract: A belt for providing individual pressure points in a user's lower back region in order to alleviate back pain. The belt is secured about the waist and includes a main panel positioned against the lower back region. The main panel includes several apertures corresponding to possible points of therapy. Threaded pins are inserted into the apertures corresponding to a point in the lower back where pain is being experienced. The pins are rotated through the main panel into the lower back thus providing pressure to the point of interest in the lower back. The pressure can be adjusted by rotation of the pin as desired. Excerpt(s): This invention relates to lower back treatment devices and more particularly, to a belt for providing pressure to specific points in a user's lower back region. Lower back pain is a common ailment that affects many people. There are many reasons for lower back pain, including over exertion of the back muscles, incorrectly lifting heavy objects, disc herniation or degenerative disc disease. In addition, lower back pain may be the result of dislocated vertebrae or dorso-lumbar scoliosis. Treatment of lower back pain has been accomplished in several ways in the past. One method applies traction to the lower back region of the spine in order to treat lower back pain. The lower back region typically includes the lumbar vertebrae of the spinal column and the area in the lower back that surrounds it. In this regard, reference is made to U.S. Pat. Nos. 2,835,247, 3,926,182 and 4,987,885 to Stabholz, and 3,889,664 to Heuser et al. Generally, these patents disclose lumbar traction devices having an upper belt, a lower belt and a tensioning mechanism disposed between the belts for forcing the belts apart. Such devices further include a lordosis pad positioned between the upper and lower belts. The lordosis pad is used to apply forward pressure against the lower back region and the spine while the spine is in tension. Web site: http://www.delphion.com/details?pn=US05470304__

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Apparatus for therapeutic treatment of low back pain Inventor(s): Becerra; Carlos (Atlanta, GA), Martin; Charity (Douglasville, GA), Medeiros; Joseph (Lantana, FL), Shealy; C. Norman (Fairgrove, MO) Assignee(s): Cluster Technology Corp. (Tampa, FL) Patent Number: 6,152,950 Date filed: March 31, 1998 Abstract: A therapeutic traction table for the treatment of low back pain includes a bed pivotable from a vertical to a horizontal position for facilitating the placement of a person in a horizontal position on the bed. An upper body harness and underarm supports anchor the upper body of the person to the bed. A lower body harness is attached to the lower body pelvic portion of the person, and includes an inflatable air

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bladder for positioning within the posterior cavity of the lumbar spine formed between the lower back of the person and the bed for relaxing low back muscles during a pulling force on the spine. A traction unit includes a strap connected to the lower body harness for providing a pulling force between the upper body and the lower body. The traction unit is vertically movable from a position generally along an axis of the spine to a vertically displaced position for pulling at a pre-selected and measurable angle to the axis of the spine and isolating the pulling force to a preselected portion of the spine during a programmable back treatment protocol. Excerpt(s): The present invention generally relates to the therapeutic treatment of the back and more particularly to treatment of low back pain. Pain in the lumbosacral spine is the most common of all pain complaint. It causes loss of work and is the single most common cause of disability in persons under 45 years of age. Such is described in various well-known references directed to acute low back problems and in particular articles addressing pain management. Traction-like methods are well known for pain relief. Although pelvic traction has been used to treat patients with low back pain for hundreds of years, most neurosurgeons and orthopedists have not been enthusiastic about it secondary to concerns over inconsistent results and cumbersome equipment. Simple traction has been known to be highly effective. However, few pain clinics ever include traction as part of their approach. Various authors have reported varying techniques which widen disc spaces, decompress the discs, unload the vertebrate, reduce disc protrusion, reduce muscle spasm, separate vertebrate, and lengthen and stabilize the spine. As addressed by C. Norman Shealy et al in the Fifth Edition of Pain Management, a Practical Guide for Clinicians, St. Lucie Press 1998, C. Norman Shealy et al addresses concepts in back pain management that include decompression, reduction and stabilization. Four broad categories of low back pain syndrome are identified as acute muscular low back paid which is usually self-limiting, acute low back pain involving sciatic radiation, chronic low back pain which has recurring symptoms modified by therapy, and neoplastic low back pain syndrome which is recurring, but eventually becoming progressive, constant, and intractable. Each type of low back pain syndrome has common features which vary with the intensity of the syndrome. Typically they will include regional pain, impairment and mechanical dysfunction exacerbated by activities of daily living, and mood and behavioral changes. It is agreed generally that all need to be addressed for overall successful outcome. Web site: http://www.delphion.com/details?pn=US06152950__ •

Diagnosis of neuromuscular dysfunction Inventor(s): Hodges; Paul William (Taringa, AU), Richardson; Carolyn Anne (St. Lucia, AU) Assignee(s): The University of Queensland (Queensland, AU) Patent Number: 5,916,172 Date filed: December 30, 1997 Abstract: A diagnostic apparatus for diagnosis of lower back pain (LBP) caused by neuromuscular dysfunction, said diagnostic apparatus comprising:a monitoring means for monitoring an anticipatory muscle signal resulting from one or more electrodes associated with an anticipatory muscle and a prime mover muscle signal resulting from one or more electrodes associated with at least one prime mover muscle associated with a limb; anda processing means for detecting a variation in the time of onset of the anticipatory muscle signal relative to the time of onset of the prime mover muscle signal

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for providing diagnosis of presence or absence of LBP.There is also provided a method for diagnosis of LBP caused by neuromuscular dysfunction said method including the steps of:(i) initiating a voluntary movement of a limb;(ii) electrically monitoring activation of at least one anticipatory muscle relative to activation of at least one prime mover muscle associated with the limb, and(iii) comparing time of onset of activation of the at least one anticipatory muscle relative to time of onset of activation of the at least one prime mover muscle to diagnose presence or absence of LBP. Excerpt(s): Low back pain (LBP) produces major societal, industrial, and personal problems, resulting in substantial annual health care costs, lost productivity, and disability (Flicker et al., 1993, Spine, 18, 582-586). Only a small percentage of low back complaints can be diagnosed definitively (Nachemson, 1975, NINCDS, Monograph No. 15, US Department of Health, Education and Welfare) because current techniques are effective only for diagnosis of LBP associated with damage or abnormality of the skeleton. However, a substantial percentage of these complaints can not be diagnosed because existing techniques are ineffective for diagnosis of LBP associated with muscular dysfunction. The importance of the muscular system in stabilising the lumbar spine is summarised in an article by Goel et al., (1993, Spine, 18, 1531-1541). The paraspinal muscles, in particular, have been shown to play a vital role in the stability and functional movement of the vertebral column but their role in spinal dysfunction is unclear. In this respect, reference may be made to studies in which it was determined that the lumbar multifidus (Kalimo et al., 1989, Ann. Med., 21, 353-359; Punjabi et al., 1989, Spine, 14, 194-200; Wilke et al., 1995, Spine, 20, 192-198) and the lumbar erector spinae (McGill, 1991, Spine, 16, 809-815; Soderberg and Barr, 1993, Spine, 8, 79-85; Sullivan, 1989, Phys. Ther., 69, 38-45) are important in stabilisation of the lumbar spine. Instability of the lumbar motion segment which often manifests in the neutral zone motion, is implicated as an important factor in the development of recurrent and chronic LBP (Punjabi, 1992, J. Spinal Disord., 5, 383-389; Panjabi, 1992, J. Spinal Disord., 5, 390397). In an article by Hides et al. (1994, Spine, 19, 165-172) reference is made to unilateral wasting of paraspinal muscles localised to one vertebral level in patients with acute/subacute LBP. Paraspinal muscle wasting also has been documented in postoperative patients (Laasonen, 1984, Neuroradiology, 26, 9-13; Mayer et al., 1989, Spine, 14, 33-36; Sihvonen et al., 1993, Spine, 18, 575-581) and in subjects with chronic LBP (Cooper et al., 1992, Br. J. Rheumatol., 31, 389-394; Tertti et al., 1991, Radiology, 180, 503507). Web site: http://www.delphion.com/details?pn=US05916172__ •

Ergonomically designed chair Inventor(s): Knapp; Herbert A. (272 Elm St., Norwich, VT 05055-9444) Assignee(s): none reported Patent Number: 6,244,659 Date filed: March 10, 2000 Abstract: A chair ergonomically designed to cause its occupant to assume a sitting posture that acts to distribute the load imposed by the sitter's upper body weight so as to relieve stress on the musculature of the lower back, thereby obviating lower back pain. The seat of the chair is slidable along a track that is upwardly inclined at a fixed angle relative to the structure on which the chair is supported. Hinged to the seat is a backrest that is supported at the rear of the chair. When an individual sits down to place his buttocks on the seat, he then slides the seat along the track until the backrest

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assumes an angle with respect to the seat at which it is comfortable to the sitter, and the seat is then latched to maintain this orientation. The resultant sitting posture of the individual is such that the load imposed by his upper body weight is to a substantial degree transferred away from the ischeal tuberosities and toward the lower back, where the weight is borne by the vertebral spinous processes, and to the thighs. Additionally, the iliopsosas and other musculature that normally maintains support when standing but is stressed when sitting in a conventional chair or bench is not stressed. Excerpt(s): This invention relates generally to chairs adapted to accommodate an individual in a manner avoiding adverse physical side effects; and more particularly to a chair ergonomically designed to cause its occupant to assume a sitting posture which obviates undue stress on the lower back and hence avoids lower back pain. Human factors engineering, also known as ergonomics, deals with interaction which take place between an individual and a device or machine he uses or operates. The objective of ergonomic design is to attain an optimum relationship between this individual and the machine or device. Thus in designing a kitchen utensil having a handle, an ergonomic design is one making it possible for an individual who is handicapped to be able to firmly grasp the handle despite the weakness of his grip. In the ergonomic design of a chair, the objective is not only to provide its occupant with a comfortable seat, for its main goal is to avoid impairment of the occupant's well being. Of primary concern in this regard is the avoidance of lower back pain, a condition which though widespread in a chair-sitting society, is difficult to treat effectively. Web site: http://www.delphion.com/details?pn=US06244659__ •

Exercise device to support user's body Inventor(s): Prsala; Jan (P.O. Box 91, Site 12, R.R. #3, Armdale, Nova Scotia, CA) Assignee(s): none reported Patent Number: 4,678,187 Date filed: February 4, 1985 Abstract: The invention relates to an exercise device capable of entirely supporting a person by the upper trunk through the use of the arm and back supports and by the feet through the use of the footrest. The upper trunk support (consisting of the arm and back supports) and the footrest are mounted on vertical posts on the solid rectangular frame, and one of the upper trunk support on the footrest is movable in relation to the other. The resilient material extends between the upper back support and the footrest and when stretched urges them together. When a person is properly positioned in the device, the person's body, at least from the lower back to the knees, is freely suspended, and by straightening the legs against the resistance of the resilient material, beneficial exercise for the development of the postural muscles may be achieved. By allowing the person's body, at least from the lower back to the knees, to be suspended freely during use of the device it is suitable for the prevention or treatment of lower back pain. Excerpt(s): The invention relates to an exercise device, in particular to an exercise device suitable for people suffering from lower back pain and similar problems. Various exercise devices have been proposed, however they generally require that the user be either standing, sitting or lying to perform the exercise. Such devices are not satisfactory for some people with lower back pain, since the very position in which the exercise is performed, such as sitting, may well aggravate the condition. Accordingly it is an object of the instant invention to overcome these deficiencies in previous devices by providing

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a device that allows the person's body to be suspended freely from the lower back to the knees during exercise. In recent years, more attention has been paid to the problem of lower back pain and the instant invention seeks to provide an exercise device suitable for a person with a lower back pain or other such condition. The instant invention offers a substantial improvement over the prior art as more fully described hereinafter. Web site: http://www.delphion.com/details?pn=US04678187__ •

Leg support pillow Inventor(s): Stokes; Lowell (440 Country La., Louisville, KY 40207) Assignee(s): none reported Patent Number: 5,878,453 Date filed: December 5, 1997 Abstract: A pillow for alleviating lower back pain includes an under-knee portion, which holds an individual's knee in flexion when he is lying on his back, and a betweenknee portion, which holds the individual's knees a spaced distance apart when he is lying on his side. The under-knee and between-knee portions are connected by a flexible web that permits automatic adjustment of the relative positions of the two pillow portions to accommodate different sizes of users. Excerpt(s): The present invention relates to pillows constructed to alleviate lower back pain. There have been many different pillows and cushions that have been designed to alleviate lower back pain. Many of these pillows serve to hold an individual's legs in a flexed position when the individual is lying on his back (supine position). Other pillows hold an individual's knees apart while he is lying on his side (lateral decubitus position). A conventional pillow may be used below the knees to maintain flexion or between the knees to maintain spacing, but the pillow must be re-positioned whenever an individual rolls from his back onto his side, or vice versa. Moreover, a conventional pillow is easily displaced as an individual moves and turns while he is sleeping. Thus, it would be desirable to have a dual-function pillow that provides the necessary support regardless of whether the individual is lying on his back or on his side and that does not have to be re-positioned when the individual moves. There have been a few attempts in the prior art to construct such a dual-function pillow. For example, U.S. Pat. No. 4,910,818, issued to Grabill et al., describes a dual-function pillow that includes three lobes, two of which form a base that is positioned below an individual's knees, and a third lobe which extends from the base between the individual's knees. This device provides support below the knees when an individual is in a supine position, and between the knees when the individual is lying on his side. The construction of this pillow, however, does not allow for adjustment of the position of the center lobe relative to the base lobes. The position of the center lobe is fixed relative to the base lobes. Thus, if the width of the pillow is not precisely tailored to the individual, the center lobe will not be at the correct height when the individual is lying on his side. The width of the pillow should be at least the width of a user's hips to prevent the user's legs from slipping off. However, if the pillow is made wide enough for a majority of users, a user with narrower hips has difficulty using the pillow while lying on his side because the center lobe of the pillow will cause his upper leg to be held up in the air. As for users with wider hips, the fixed center lobe prevents the pillow from resting on the bed while the user is lying on his side, resulting in the user supporting the full weight of the pillow. These difficulties prevent a single pillow from accommodating different sizes of people. This pillow must be custom fit to the user. In short, the prior art design, with the center lobe fixed relative

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to the base lobes, has several disadvantages that make the pillow impractical for common usage. The present invention is a dual-function pillow that includes an underknee portion that holds an individual's knees in a flexed position when he is lying on his back and a between-knee portion that holds an individual's knees a spaced distance apart when he is lying on his side. The two portions of the pillow are connected by a flexible web that allows for the shifting of the relative positions of the two portions. Because of this adjustability, the under-knee portion can be made amply wide so that the user's legs do not slip off the pillow without creating problems when the user rolls to his side. Web site: http://www.delphion.com/details?pn=US05878453__ •

Lower back heater mat with a leg support Inventor(s): Kiefer; John Steven (8410 Ferndale Cutoff, Little Rock, AR 72211) Assignee(s): none reported Patent Number: 5,718,722 Date filed: September 11, 1996 Abstract: A lower back heater mat with a leg support comprising a ladder shaped leg support and an electrical heater mat pivotally connected to the leg support. A person with lower back pain lying on the electrical heater mat is forced to elevate his or her legs on the leg support. The leg support and the electrical heater mat fold making allowing for easy transportation. Excerpt(s): The invention relates to a lower back heater mat with a leg support. More particularly, the invention relates to a cushioned mat with a lower back heater having a ladder shaped leg support which allows a person to elevate his or her legs while laying on the mat. Lower back pain is a common and an extremely painful ailment. Second only to work-related injuries, lower back pain has the highest incidence of disability and economic loss in the United States. Approximately 21 million Americans experience lower back pain. The total annual cost (health care plus indirect costs) attributable to low back pain is about $20 billion. However, the cost of human suffering is truly inestimable. Nearly everyone has experienced lower back pain at least once. Unfortunately, for many people lower back pain is chronic. Chiropractors and doctors provide generic advice to relieve the pain: elevating your legs to take the pressure of the vertebrae of your spine and apply heat to facilitate the healing process by increasing the blood circulation in the lower back area. Web site: http://www.delphion.com/details?pn=US05718722__

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Method and apparatus for measuring pelvic symmetry Inventor(s): Horvath; Laura (164 Osner Dr., Atlanta, GA 30342), Jirmenez; David (145 Copeland Rd. F-9, Atlanta, GA 30342) Assignee(s): none reported Patent Number: 5,966,827 Date filed: May 6, 1996 Abstract: A method and apparatus for measuring pelvic symmetry to aid in diagnosing and treating lower back pain. A first angle is measured between the horizon and a axis

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extending between a left ASIS and a left PSIS and simultaneously compared against a second angle corresponding to the angle between the horizon and an axis extending between a right ASIS and a right PSIS. The angle of a line extending through points bisecting each of the axis and the horizon is also measured. The angles are then compared against prior measurements or norms to assess posture and pelvic position in order to document progress of lower back pain treatment. Excerpt(s): This invention relates to a method and apparatus for aiding in the diagnosing and treating lower back pain by measuring the relationship between two sides of the bodies' pelvic bone, and more particularly to a method for measuring the symmetry of these two bones along the sacroiliac joint. Distortions of the spine are principally the result of faulty postural habits, trauma or injury of some sort, or congenital deformities. These distortions and particularly distortion of the pelvic structure can result in displacement of the innominate bones and sacrum from the norm, which is believed to be the source of some lower back pain. When diagnosing and treating lower back pain, it has been observed that there is a relationship between the asymmetry of the pelvic bone and symptoms of such pain. This asymmetry is possibly caused by incorrect shurling of the muscle groups in the lower back and mechanical problems in joints around the pelvic bone. Examples of mechanical problems include one muscle group being shorter or longer than the other resulting in the pelvis being askew. When the pelvis is askew, problems have been noticed in the lumbar vertebrae which disrupt mechanics of the skeleton. Web site: http://www.delphion.com/details?pn=US05966827__ •

Method for pain relief using low power laser light Inventor(s): Wong; Edmund (Honolulu, HI) Assignee(s): DioLase Corporation (Berkeley, CA) Patent Number: 5,640,978 Date filed: November 6, 1991 Abstract: The invention comprises a method for treatment of chronic and referred pain such as chronic headaches and migraine headaches, as well as pain of the upper back, neck and shoulders, and lower back pain using low power laser light. The source of such referred pain involves microscopic and macroscopic tears in the periosteal-osseous junctions of the upper vertebrae, the scapula, and the skull. These lesions stimulate the generation of histamines, kinins, bradykinins, prostaglandin, proteolytic enzymes, seratonin, and other substances which cause numerous localized autonomic reactions, such as muscle spasm, ischemia, local inflammation, edema, as well as generalized reactions such as increased blood pressure, photophobia, nausea, blurred vision, copious mucous flow of the nose and sinus, and the like. The muscle spasms are responsible for transmitting the pain sensation to other portions of the body, and the systemic reactions are often associated with migraine-type headaches. The sites of the periosteal-osseous lesions can be correlated directly with the distant locus of the referred pain sensation. The laser energy is directed to the sites of the lesions to cause an increase in lymphatic circulation at the site of the causative lesion in response to the laser energy. Laser energy delivered to the site results in increased blood circulation and cellular metabolism in the area, which promotes more rapid healing of the lesion. Excerpt(s): Although it is often said that the common cold is the most prevalent disease among humankind, it is also true that chronic pain is an affliction that is almost as

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prevalent. Chronic headaches, muscle pain, joint pain, and the like are experienced by most individuals, and many persons have such chronic pain on a daily or weekly basis. It is interesting to note that most forms of chronic pain often are not traceable to a specific causative factor. The term "referred pain" has been used to describe pain that is experienced at a locus removed from the cause or lacking an identified cause. From the perspective of a treating physician, this situation leads to skepticism concerning the patient's complaints, and a tendency to dismiss the complaints as psychosomatic, neurological, or imagined. From the perspective of the patient, there is real suffering experienced on a regular basis, and often there is no medical treatment to relieve the pain. Frequently, medical treatment consists of drugs such as analgesics or muscle relaxers. These substances are systemic, and can have adverse side effects such as kidney toxicity, liver inflammation, gastrointestinal symptoms, and the like. Alternative treatments consist of chiropractic manipulations, acupuncture, physical therapy, stress relief regimens, and the like. These approaches to treatment have had limited success for most chronic pain sufferers. Research conducted 40 to 50 years ago indicated that referred pain could be emulated in test subjects by injecting hypertonic saline solution into the interspinous ligaments and causing temporary inflammations of the periosteum at the points where muscle tissue extends from the upper spinal vertebrae to the skull and the scapula. Referred pain was produced at various sites remote from the injection points, and was virtually indistinguishable from the sensations described by chronic pain sufferers. Moreover, it was clear that induced inflammation of specific sites along the spinous processes resulted in pain sensation at corresponding specific sites throughout the body far removed from the cause, and that the pain sensation could also be induced in the form of headaches similar to migraine headaches. This research also established that the pain referral mechanism did not involve mere neural transmission. However, this promising early work apparently was not followed, and did not result in effective treatment modalities. Web site: http://www.delphion.com/details?pn=US05640978__ •

Orthotic apparatus useful for treating pain associated with spinal disorders Inventor(s): Beczak, Sr.; Terry A. (Wichita, KS), Szymke; Thomas E. (Savannah, GA) Assignee(s): Peach, U.S., Inc. (Wichita, KS) Patent Number: 5,634,891 Date filed: April 14, 1995 Abstract: A corset-type orthotic device is provided for treatment of lower back pain by causing uniform abdominal compression. The corset utilizes vertically spaced apart straps which overlap at the front of the corset to cause tightening of the corset about the torso of the wearer to increase the abdominal compression. The straps are connected at one end to lateral margins of a front panel of the corset and extend rearwardly through metal rings fixed to lateral margins of a rear panel of the corset. The straps then extend forwardly for joinder at the front panel. Upper and lower ones of the straps are also coupled and extend through another metal ring which allows the straps to vary in length to accommodate the variations in circumference of the lower ribs, waist and hips. Excerpt(s): The invention is directed to braces or orthotic devices used in the treatment of spinal disorders and, more particularly, to an abdominal corset-type orthotic which is used in the treatment of lumbar spine disorders. It has long been recognized that certain types of lower back pain in humans can be treated by wearing corset type devices. These devices are applied around the torso of the individual and are tightened to cause

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an increase in the intra-abdominal pressure in the wearer. The increased intraabdominal pressure in turn functions to reduce the compression force on the individual's spine by creating a semi-rigid hydra-pneumatic cylinder surrounding the spinal column. The load normally carried by the spine is distributed across this cylinder and the pressure on the lumbar inter-vertebral discs is correspondingly reduced. In many cases, the reduction in pressure also serves to provide dramatic relief in the pain associated with the spinal disorder. One problem associated with many corsets of the type described above is the difficulty in achieving the proper tensioning of the corset about the individual's torso. Typically, the corsets comprise front and back panels which are laced together along their lateral edges by at least one and often several laces. Tensioning of the corset is accomplished by pulling tightly and then securing the laces after the corset has been applied to the torso. It can be appreciated that the use of both hands is generally necessary to pull the ends of the laces to achieve the desired tensioning and then secure them together. The positioning of the laces at the sides of the individual also makes it difficult, particularly for the elderly and infirm, to reach the laces with both hands, let alone manipulate and pull the laces with the force necessary to achieve satisfactory abdominal compression. Web site: http://www.delphion.com/details?pn=US05634891__ •

Pelvic support method and means Inventor(s): Morrow; Winston G. (Lake Oswego, OR) Assignee(s): Spinal Dynamics, Inc. (Lake Oswego, OR) Patent Number: 4,489,982 Date filed: September 30, 1983 Abstract: A method and means for providing pelvic support to improve posture and relieve lower back pain is provided. The method comprises pressing a convex pillow against the region of the ilia, sacrum, and fifth lumbar vertebra to produce a substantial sacral base angle and to fully oppose any moment tending to cause rotational shifting of the pelvis. Another way to define the invention is a back pillow which may be used in a chair having a seat member, wherein the back pillow includes a convexly shaped support pillow for maintaining the pelvis of the user at a sufficient sacral base angle that substantially the entire weight of the upper portion of the user's body is supported by the seat member. The invention may alternatively be described as a chair comprising a substantially horizontal convex seat for supporting the ischial tuberosities of the occupant in the vicinity of the apex thereof, and a substantially vertical, generally convex support means for supporting the posterior portion of the occupant's pelvis at a sacral base angle of from between 25 and 45 degrees, and so that a gravitational line drawn downwardly from the center of L-3 intersects the anterior one-third of the sacral base. Excerpt(s): This invention relates to a method and means for providing pelvic support to improve posture and relieve lower back pain. Most so-called secretarial or working chairs include a substantially horizontal seat member and a substantially vertical back support member. This back support member is typically positioned substantially above the seat member, and is adapted to provide support to the small of the back or lumbar region of the occupant's spinal column. The typical lumbar support chair does not, however, support the pelvis of the occupant. Thus, as will be described in detail hereafter, the occupant's pelvis is permitted to shift posteriorly and inferiorly until the coccyx or tailbone contacts the seat of the chair. In order to counteract or prevent this

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shifting of the pelvis, the occupant must utilize muscles which are not intended for this purpose. The use of such muscles over an extended period results in fatigue and pain. It can also result in discomfort and damage to the lumbar vertebrae and the ligaments and tendons associated with such vertebrae, as will be described in detail below. (6) To provide a back pillow which may be used either with a conventional chair or as a supine support to produce a substantial sacral base angle in the pelvis of the user and to fully oppose any moment tending to cause rotational shifting of the pelvis. Web site: http://www.delphion.com/details?pn=US04489982__ •

Portable therapeutic device Inventor(s): Pascetta; Armand (Wilmington, DE), Yablon; Jeffrey S. (1030 Sproul Rd., Bryn Mawr, PA 19010) Assignee(s): Yablon; Jeffrey S. (Bryn Mawr, PA) Patent Number: 5,562,604 Date filed: March 6, 1995 Abstract: Portable therapeutic devices and methods for employing them are provided by this invention. The devices include a flexible containment bag including a fluid chamber containing a fluid medium and a self-contained pumping means disposed within the device for causing the fluid medium to circulate within the fluid chamber to provide a therapeutic effect upon contacting the device with a patient. In preferred embodiments of this invention, integral electromagnetic transducer assemblies are employed to create a pumping action within serpentine fluid channels, and solid state heat pumps are employed to control the temperature of the fluid during therapy. The devices of this invention are ideal for treating lower back pain and post-operative conditions associated with spinal surgery, as well as veterinarian treatments. Excerpt(s): This invention relates to therapeutic devices employing circulating media for treating patients with a whirlpool-like swirling motion, and more particularly, to portable therapeutic pads which circulate hot or cold fluids in close proximity to a patient for providing relief and therapy without significantly impeding the patient's daily routine. Recent reports indicate that as much as 80% of the adult population in the United States suffers from lower back pain to some degree or another. Typically, these symptoms are relieved with strong, pain-killing medications which must be used continuously and are often associated with adverse side effects. In an effort to minimize the use of medication and avoid these side effects, therapeutic pads have been developed for providing both hot and cold circulation therapy to a patient suffering from lower back pain. Such devices have also been valuable in reducing the postoperative pain and recovery time of patients following surgery. Although this invention is suitable for post-surgical treatments, such as those employed following laminectomy or discectomy procedures, the primary target is for the treatment of lower back pain of musculo-skeletal or mechanical origin. One prior art device that alleges usefulness in treating the lower back is provided by Adams, U.S. Pat. No. 4,112,943. Adams discloses a flexible bag equipped with a closed circulation system for providing a therapeutic flow of water at the site of lower back pain. The Adams' system contains a rather bulky pump and storage tank which must be carried along side the patient's bed while the patient is immobilized in a prone position. Web site: http://www.delphion.com/details?pn=US05562604__

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Posture stool Inventor(s): Laney; Wayne G. (Yakima, WA) Assignee(s): Gonzales; Abe (Yakima, WA) Patent Number: 5,415,460 Date filed: May 11, 1990 Abstract: A posture stool for the relief of transitory or chronic lower back pain, comprising a rectilinear base supporting a center step inclined at an angle to the horizontal, with a lower step on each side of the center step, the lower steps being of the same size as the center step and parallel with and equidistant from the center step and inclined at a lesser angle to the horizontal than the center step. Excerpt(s): During my chiropractic training, I studied the effect of biomechanics as it relates to the entire spine, and especially the lumbosacral region. While studying the basic concepts of how the stress of simple gravity can affect the entire spine and pelvic girdle, I learned that, by some alternating of the posture of the leg, stress on the spine could be eased. After I began my practice, I started dealing with the needs of patients experiencing real pain and suffering that did not always respond quickly to selective modes of conservative health care. I saw a need to help people who, while sitting or standing, were undergoing acute low back pain of differing origins, as well as those having longer term spinal stress. I soon realized that there is not a product on the market available to these patients, that would reduce the pain by helping to minimize the amount of stress on their spines. After thirteen years of trying to give my patients something they could do at home to alternate their sitting and standing posture stress, I concluded that there needed to be something developed that would give the average adult a way of eliminating sitting and standing stress accumulation. I suggested, at various times, that patients try using books, pieces of wood, or whatever was available, to put their feet upon to alternate spinal stresses. What this seemed to do for patients was, at times, impressive, but not always. What was needed was a more consistent height, angle and surface spatial relationship that would serve the purpose for adults having a wide range of physical stature. Web site: http://www.delphion.com/details?pn=US05415460__

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Sciatic exercise bench Inventor(s): Minor; Patsy A. (617 Evergreen St., Okawville, IL 62271) Assignee(s): none reported Patent Number: 5,938,576 Date filed: August 6, 1998 Abstract: A exercise bench particularly suitable for persons with lower back pain wherein the bench comprises a hard foam ridged mat hinged to an upper body support and head rest at one end thereof and having an adjustable angular support for supporting the upper body and head rest at a desired angle by the user. A pair of arched padded knee rails extends outwardly from the far side ends of the hard foam mat providing locations for depressing one's knees while performing legs raising exercises. A pair of padded hand rails extends up and over the padded knee rails and provides the locations for supporting oneself while performing exercises and exiting or entering the exercise bench. An adjustable height foot rest support extends between the pair of hand

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rails and at opposite ends of the hard foam mat from the upper body support and head rest. The height of the foot rest support is adjustable by the user to a desired height. Excerpt(s): The present invention relates to devices and methods for exercising and more particularly to devices and methods for a sciatic exercise bench which is for use by people with lower back pain comprising a hard foam center hinged to an upper body support and head rest at one end thereof having an adjustable angular support for supporting the upper body and head rest at a desired angle, a pair of padded knee rails extending outward from the far side ends of the hard foam mat, a pair of padded hand rails extending up and over the padded knee rail and an adjustable height foot rest pad support extending between the pair of hand rails at the opposite end of the hard foam mat. The height of the foot rest support is adjustable by the user to a desired height. Persons who suffer from lower back pain, sciatica, sometime find relief from performing several exercises that relieve the pain, however most of these exercises require the use of a table and chair in combination. The present invention provides a useful exercise bench which takes the place of the table and chair method and provides a better way to exercise a persons lower body. Prior to the present invention there has never been an exercise bench which is specifically directed toward persons with lower back pain and which comprises the elements described herein. Rifas, U.S. Pat. No. 5,647,829 which discloses an abdominal exercise apparatus and methods. Web site: http://www.delphion.com/details?pn=US05938576__ •

Spinal acupressure device Inventor(s): Choy; Daniel S. J. (892 River Bank Rd., Stamford, CT 06903) Assignee(s): none reported Patent Number: 5,290,307 Date filed: March 28, 1991 Abstract: An acupressure belt for the treatment of lower back pain is formed of a central fabric panel to which opposed elastic panels are affixed. The elastic panels terminate in a pair of end panels which may be joined together to retain the belt about the torso of the wearer. Located on the inner surface of the central panel is a plurality of acupressureapplying protrusions, each of which are individually positionable on the panel. The protrusions are positioned to apply pressure to the L.sub.1 -L.sub.4 acupressure points associated with the lower spine. A pair of overlapping elastic panels are further affixed to the opposed sides of the control panel about the torso with the protrusions in position, whereby acupressure is generated and applied for the relief of lower back pain. Excerpt(s): The present invention relates to a medical device and, in particular, to a device intended to alleviate lower back pain in a non-invasive manner. The oriental teachings of a plurality of target sites in the human body for the treatment of pain and certain ailments has been established in literature and practice for some three thousand years. These sites, some 400 in number, are located on 12 paired and 2 unpaired "meridians". The science of acupuncture, utilizing a series of thin needles inserted through the skin at such specific sites, provides a methodology for the treatment of ailments associated with the meridians. Current medical thinking suggests that the insertion of the acupuncture needles stimulates the production and release of endorphins, which serve to moderate or eliminate pain in surrounding areas. For obvious reasons, there is a reluctance on the part of certain individuals to participate in

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an acupuncture regimen. In addition, the physical insertion of the needles and their manipulation requires great skill and clearly is not a therapy which can be provided by the patient himself. Related acupressure therapy, which utilizes the known acupuncture points for the application of concentrated and direct pressure on the skin surface, rather than the penetration of the skin surface by an acupuncture needle, provides an alternative therapy which can accomplish the same results in a non-invasive manner and thus may be practiced by the patient without the continued presence and supervision of an acupuncture therapist. Web site: http://www.delphion.com/details?pn=US05290307__ •

Stretching method for preventing or relieving lower back pain Inventor(s): Ilan; Daniel (24 Hamatmid, Even Yehuda, IL) Assignee(s): none reported Patent Number: 5,772,612 Date filed: June 17, 1996 Abstract: A therapeutic method, for simultaneously stretching and lifting a user's lower back while the user is lying on his back on the ground, thereby relieving and preventing lower back pain. The device includes a frame which features a horizontally extending upper cross frame for accommodating the back of the user's knees. In use, the lower end of the frame contacts the ground and serves as a fulcrum. The device further includes a foot rest for accommodating the user's feet. The foot rest is mounted to the frame at a convenient point between the cross frame and the lower end. Excerpt(s): The present invention relates to a stretching device, particularly useful for the relieving or preventing of lower back pains. It is well known that lower back pains affect a very large portion of adults, especially middle aged adults and older. As a consequence, a great deal of suffering and disability is experienced by a large fraction of the population resulting, among other things, in a large number of lost work days and greatly diminished quality of life. A brief physiological analysis will help illustrate the cause of back pains and give an insight as to possible remedies. Web site: http://www.delphion.com/details?pn=US05772612__

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Therapeutic back belt and related method of manufacture Inventor(s): Hopwood; Sandra K. (Grand Rapids, MI), Pearson; David P. (Thousand Oaks, CA), Smith; Mark C. (Rockford, MI) Assignee(s): Access Business Group International LLC (Ada, MI) Patent Number: 6,623,419 Date filed: April 25, 2002 Abstract: A back belt including magnets, and a thermally active gel material to provide magnetic and thermal induced lower back pain relief. The magnets are arranged in multiple quadrapolar pods, which are secured to a contour-conforming, resilient support web. Preferably, an interior sheet sandwiches the pods and gel material between it and an exterior sheet in a cross-shaped array within the support web. In a more preferred embodiment, the belt includes a fastening strap that neatly secures excess belt by wrapping around the excess belt and drawing that excess against the

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remainder of the belt. In a preferred process of manufacturing the back belt, multiple quadrapolar magnet pods and the gel material are secured to a support web. Belt straps are secured to the support web. More preferably, a fastening strap is secured to at least one of the belt straps. Excerpt(s): The present invention relates to a therapeutic back belt, and more particularly to a back belt including magnets that address pain originating in the lower back. The application of magnetic fields to areas of the human body experiencing pain has become a widely accepted method of treating that pain. Such treatment is sometimes preferred over other conventional methods, such as surgery or administration of drugs, because, among other reasons, it is less invasive. It is believed that when a magnetic field is applied to an area of localized pain, it blocks chemical channels in nerve cells in the area of pain. As a result, the generation of pain impulses from the nerve cells, and subsequent transmission along the nerve cell fibers to the brain is reduced, thereby relieving the pain. Magnetic therapy has proven to be particularly helpful in reducing lower back pain, that is, pain originating in the sacral or lumbar regions of the back. One device used to provide magnetic therapy to the lower back is disclosed in U.S. Pat. No. 4,480,596 to Shumiyashu. In Shumiyashu, an array of magnets is positioned on a belt so that all the magnets exert either a positive or a negative magnetic field toward the lower back when the belt is worn around the waist of a user. The magnets are maintained in fixed positions relative to one another with a rigid plastic support sheet so that they do not attract one another and collapse the belt into a ball. Web site: http://www.delphion.com/details?pn=US06623419__ •

Therapeutic pillow for low back pain Inventor(s): Gostine; Mark L. (3110 Bonnell, S.E., Grand Rapids, MI 49506-3136) Assignee(s): none reported Patent Number: 5,544,377 Date filed: May 8, 1995 Abstract: A therapeutic pillow for relieving various types of low back pain. The pillow comprises two hemispherical end sections joined by an elongated midsection. The midsection is a substantially flat lumbar support portion with sloping surfaces extending to each end section, to provide a pillow that is substantially concave in shape. In use, when sleeping on one's side, the pillow is placed generally transverse to the length of the body under the side. The midsection provides support and alignment for the lumbar spine, thereby relieving pain associated with sagging of the spine. Further, by placing one hemisphere close to the back or hip, the pillow will wrap around the hip area and place pressure on the sacro-iliac joint, for pain relief in that particular area of the body. The pillow can also be placed transverse to the body under the stomach when one sleeps on his or her stomach, again to support and align the lumbar spine. The hemispherical end pads also serve to confine the sleeping person on the pillow and keep the person from rolling out of the pillow. Excerpt(s): The present invention relates to a therapeutic pillow, and particularly to a pillow which prevents and relieves pain associated with the sacro-iliac joint as well as the lumbar spine area. Numerous attempts have been made to provide a pad or cushion-like structure for engaging or supporting a person's lower back to alleviate pain. Such devices have traditionally been placed under a person's midsection when

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sleeping on one's stomach, or near the lower spine area when sleeping on one's back. For example, U.S. Pat. No. 4,989,591 to Anders Jr. discloses an orthopedic appliance and method for changing the angular relationship of an individual's longitudinal axis of the lower lumbar spine to the longitudinal axis of the femorae. The device has an upper surface having first and second portions which are angularly disposed to one another to support the hips in the described angular relationship when the person is lying prone over the device. While this device does serve to elevate the lower spine, the device can be the source of other pain or discomfort, due to the shape of the device, which is substantially arc-shaped in cross-section. This type of device tends to be uncomfortable or even painful due to the apparatus gathering or bunching up, and causing the application of localized pressure at the peak of the arc. Furthermore this device is not capable of applying gentle pressure to the back at the hip bone/pelvis region to alleviate pain associated with the sacro-iliac joint. Nor are any of the known devices designed to support and align the spine when a person is lying on his or her side, as opposed to the stomach or back. Various other devices have been proposed which serve as anti-roll devices during sleep, i.e., to confine or support an adult or infant while sleeping. These devices generally consist of spaced pads or cushions connected by a sheet or connecting member. The pads and connectors take various forms, including triangular, rounded, partially conical, cylindrical, wedge-like, and even slings. See, for example: U.S. Pat. No. 5,367,730 to Sher; U.S. Pat. No. 5,347,669 to Neviaser; U.S. Pat. No. 5,216,772 to Clute; U.S. Pat. No. 5,182,828 to Alivizatos; U.S. Pat. No. 4,923,187 to Mombrinie; U.S. Pat. No. 3,924,282 to Bond; and U.S. Pat. No. 2,952,856 to Ruff. These devices generally make no provision for support of the lower spine. Also, the spaced pads serve no therapeutic function--they merely restrain the person from rolling out of the device. Web site: http://www.delphion.com/details?pn=US05544377__

Patent Applications on Lower Back Pain As of December 2000, U.S. patent applications are open to public viewing.10 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to lower back pain: •

Ergonomic seating cushion Inventor(s): Loomos, Melanie; (Miami, FL) Correspondence: Michael C. Cesarano; Suntrust International Center, 28th Floor; 1 S.E. 3rd Avenue; Miami; FL; 33131-1714; US Patent Application Number: 20020124318 Date filed: March 9, 2001 Abstract: An ergonomic seating cushion has a central cavity whose interior boundaries form an oscillating waveform. This feature reduces the pressure gradient on skin pressing against the cushion, promoting blood flow to the region while maintaining a central area of little or no pressure upon the perineum area. The cushion may have a dimpled surface to further lower pressure gradients, and may be tilted forward to assist in increasing lordosis and reducing lower back pain, or rearward when used by

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This has been a common practice outside the United States prior to December 2000.

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pregnant women to assist in compensating for the weight of an unborn child during pregnancy. Excerpt(s): Modern society tends to promote sedentary lifestyles, in which office workers and others must perform their daily work while seated. Long periods of sitting are increasingly being identified as a major cause of lower back pain. Studies directed to that phenomenon have concluded that changes in the curvature of the spine that occur when a person sits down and remains seated for long lengths of time, are one cause of lower back pain. One such study is entitled Ergonomics in the Design of Office Furniture, by Kroemer, Ing, and Robinette, and published in Industrial Medicine, Vol. 38, No. 4 (Apr., 1969). Additional studies have been conducted to determine the extent of changes to spinal curvature that result from moving from a standing position to a seated position, and the effect upon the spine of seating posture and angle of recline when seated. Two typical studies are Posture of the Trunk When Sitting on Forward Reclining Seats, by Bendix and Biering-Sorensen, published in Scandinavian Journal of Rehabilitative Medicine, Vol 15 (1983); and The Influence of Different Sitting Positions on Cervical and Lumbar Posture, by Black, McClure and Polansky, published in SPINE, Vol. 21, No. 1 (1996). Lumbar lordosis is the term commonly used to refer to the forward curve of the lumbar spine. In one study (Lumbar Lordosis--Effects of Sitting and Standing, by Lord, Small, Dinsay and Watkins, published in SPINE, Vol. 22, No. 21 (1997)), lordosis was measured as an angle between various identifiable points within the spine, with "total lordosis" being measured from the cephalad endplate of L1 to the cephalad endplate of S1. Other measurements from L2 and S1, from L4 to S1, and from L5 to S 1 were also taken to determine the amount of curvature at each of the L1 locations, and the difference in curvature from standing to sitting. The results from that study are that lordosis increases by almost 50 percent when the patient moves from a sitting to a standing position, representing an angular change in total lordosis from 34.+.15 degrees when sitting to 49.+-.15 degrees when standing. Since lower back pain and increased intradiscal pressure are associated with sitting over long periods of time, there has been an interest in alleviating or mitigating the problem by increasing lordosis when a subject is seated. Various attempts to do this have been proposed, and have led to ergonomically designed chairs having backs that provide lower back support for the lumbar spine. Another proposal has been that seats should be sloped forward to increase the forward tilt of the pelvis when seated. The Kroemer study, however, indicates that, while tilting the seat may increase forward pelvic tilt, also increasing lordosis, it also causes the body to slide forward. Such forward thrust must then be counterbalanced by action of the leg muscles, which ultimately becomes uncomfortable and fatiguing. Other problems associated with sitting for long periods of time are documented in Sitting Posture and Prevention of Pressure Ulcers, by Defloor and Grypdonck, published in Applied Nursing Research, Vol. 12, No. 3 (Aug., 1999), Shear vs Pressure as Causative Factors in Skin Blood Flow Occlusion by Bennett, Kavner, Lee and Trainor, published in Arch Physical Medical Rehabilitation, Vol 60 (Jul., 1979), and Hemorrhoids by Nussain, published in Primary Care, Vol. 26, No. 1 (Mar., 1999), and include pressure ulcers, decreased blood flow, and aggravation of pre-existing hemorrhoids. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Exercise apparatus and method Inventor(s): Weitzman, Bernard; (New York, NY) Correspondence: Darby & Darby P.C.; Post Office Box 5257; New York; NY; 10150-5257; US Patent Application Number: 20030096685 Date filed: November 15, 2002 Abstract: This invention relates to health and fitness, and more particularly to exercise methods and devices. More particularly, the invention is directed to stretching exercises and physical therapy, for example an apparatus and exercises for lower back pain. The exercise apparatus comprises at least three cells abutting each other on a common base or frame. Each cell can be independently inflated and deflated to provide an adjustable support cushion having a range of shapes and firmness. An articulated frame is optionally provided for additional independent movement of the cells. Users lie down on the cushion and produce precise stretches and exercises by controlling the rate and degree of inflation or deflation of each cell or group of cells, and optionally, articulated movement of the frame. Stretching can occur passively, as when the body conforms to the shape of the cushion, or actively by exercising in concert with the conformation of the cushion. Excerpt(s): This application claims priority from Provisional Application No. 60/335,854 filed on Nov. 16, 2001. This invention relates to health and fitness, and more particularly to exercise methods and devices. More particularly, the invention is directed to stretching exercises and physical therapy, for example an apparatus and exercises for lower back pain. Lower back pain is widespread in our civilization. It has been estimated, for example by the US government, that its cost to the economy is second only to upper respiratory infection. Many forms of treatment are employed. These include verbal, psychotherapeutic or educational interventions, massage, exercise, physical therapy, and surgery. The usefulness of all of these approaches is real, but limited. Some people are helped by each of them; many are not. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Portable, inflatable lumbar cushion Inventor(s): Grosso, William M.; (New City, NY) Correspondence: Brian L. Wamsley, ESQ.; 119 Highview Avenue; Nanuet; NY; 10954; US Patent Application Number: 20020087105 Date filed: December 28, 2000 Abstract: A portable, inflatable lumbar belt cushion for providing support to the lower spine and surrounding paralumbar musculature of the wearer while seated. The present invention is for an inflatable belt cushion which adjustably reinforces the small of the back to support the lower spine in a proper lorsdosis, alleviating lower back pain caused by improper posture and fatigue. The belt encircles the wearer's waist and contains a compartment with an inflatable cushion centrally located in the back of the belt which is superimposeable in the small of the wearer's back. The inflatable cushion is of a hemi-elliptical design which is positioned horizontally in the small of the back such that the thicker center portion of the cushion supports the spine and the thinner end

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portions support the surrounding musculature. The cushion extends outwardly from the outer surface of the belt and thus does not create a compression between the belt and the spine. Support is provided only when the wearer is seated and the cushion creates pressure between the wearer and the back of a chair. The cushion is inflated by manual means such that the firmness and pressure of the cushion is totally adjustable. Excerpt(s): The present invention relates to a portable device capable of providing variable lower back support. More particularly, the invention relates to an inflatable, portable lumbar cushion which assists the spine being held in a proper forward curve position, or lordosis. The device comprises a portable, inflatable cushion, worn about the waist, having a particular configuration and dimensions to provide an individualized cushion when inflated. Inflating the lumbar cushion of this invention exerts pressure against a chair back when the wearer is seated, which in turn creates pressure against the lumbar vertebrae and the para-lumbar musculature to maintain the lower spine in a proper lordosis. Lower back pain is a serious problem in this country. It is estimated that eight out of ten Americans at one time or another will suffer from severe back pain. Most lower back pain from sitting is related to poor posture in which the person sits in a slumped or rounded posture. This poor posture occurs more readily when the seat or chair does not give proper support. The position that we hold our spine when we sit is crucial to preventing or exacerbating back problems. The proper position is for the spine to be held in a forward curve called a lordosis. When a proper lordosis is maintained, there is less pressure on the lower back. This can be illustrated with regard to the lumbosacral angle, or Ferguson's angle, formed at the base of the spine. See Yochum, T. R. and Rowe, L. J., Essentials of Skeletal Radiology, Vol. 1, Williams & Wilkins, p. 189 (1987). When the person is upright,the normal lumbosacral angle is 41.degree., with a standard deviation of.+-.7.degree. A decrease in the lumbosacral angle, such as when the lower back is becomes rounded when a person is seated in a slouched position, has been implicated as a mechanical factor in producing lower back pain by increasing disc pressure and placing undue stress on the lumbosacral posterior joints. Providing proper lower back support while seated would maintain the lumbosacral angle within its normal limits and thus alleviate lower back pain. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with lower back pain, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “lower back pain” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on lower back pain. You can also use this procedure to view pending patent applications concerning lower back pain. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON LOWER BACK PAIN Overview This chapter provides bibliographic book references relating to lower back pain. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on lower back pain include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “lower back pain” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “lower back pain” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “lower back pain” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

A 3D Multimedia Approach to the Diagnosis of Low Back Pain, Vol. 1: 18 & 40 Year Old Males, a Book CD Combo by Scott F. Nadler, et al; ISBN: 1872631630; http://www.amazon.com/exec/obidos/ASIN/1872631630/icongroupinterna

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A Color Atlas of Low Back Pain by Kenneth Mills, et al (1991); ISBN: 0803698585; http://www.amazon.com/exec/obidos/ASIN/0803698585/icongroupinterna

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Adults With Low Back Pain by Barbara Larson (2001); ISBN: 1569001499; http://www.amazon.com/exec/obidos/ASIN/1569001499/icongroupinterna

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Alternatives To Back Pain.Advice For People Suffering With Low Back Pain Who Hate Chiropractors by Malcolm, Dr. Conway, Dr. Malcolm Conway; ISBN: 0967264308; http://www.amazon.com/exec/obidos/ASIN/0967264308/icongroupinterna

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Anatomical Basis of Low Back Pain by L.G.F. Giles; ISBN: 0683035258; http://www.amazon.com/exec/obidos/ASIN/0683035258/icongroupinterna

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Appropriateness of Spinal Manipulation for Low Back Pain: Project Overview and Literature Review (1992); ISBN: 0833011502; http://www.amazon.com/exec/obidos/ASIN/0833011502/icongroupinterna

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Auto-traction : treatment of low back pain and sciatica : an electromyographic, radiographic and clinical study by Gertrud A. M. Lind; ISBN: 9172220236; http://www.amazon.com/exec/obidos/ASIN/9172220236/icongroupinterna

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Back in Action:: Do You Have Backache?-This Book Will Put It Right by Sarah Key; ISBN: 0712652388; http://www.amazon.com/exec/obidos/ASIN/0712652388/icongroupinterna

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Backache by Porter Shimer, Charles B. Inlander (1999); ISBN: 0312968213; http://www.amazon.com/exec/obidos/ASIN/0312968213/icongroupinterna

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Backache by Ian MacNab; ISBN: 0683053531; http://www.amazon.com/exec/obidos/ASIN/0683053531/icongroupinterna

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Backache and Disc Troubles (The New Self Help Series) by Arthur White; ISBN: 0722519354; http://www.amazon.com/exec/obidos/ASIN/0722519354/icongroupinterna

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Backache at Work by Laurens Rowe; ISBN: 9995319136; http://www.amazon.com/exec/obidos/ASIN/9995319136/icongroupinterna

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Backache Relief by Outlet; ISBN: 0517659999; http://www.amazon.com/exec/obidos/ASIN/0517659999/icongroupinterna

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Backache Survival: The Holistic Medical Treatment Program for Chronic Low Back Pain by Robert S. Ivker (2003); ISBN: 1585422363; http://www.amazon.com/exec/obidos/ASIN/1585422363/icongroupinterna

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Backache: Its Evolution and Conservative Treatment by D.P. Evans; ISBN: 0852004303; http://www.amazon.com/exec/obidos/ASIN/0852004303/icongroupinterna

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Backache: Putting It Behind You by Mark Foster, Dr. Mark Foster; ISBN: 1582441545; http://www.amazon.com/exec/obidos/ASIN/1582441545/icongroupinterna

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Backache: What Exercises Really Work by Dava Sobel, Arthur C. Klein; ISBN: 1854874918; http://www.amazon.com/exec/obidos/ASIN/1854874918/icongroupinterna

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Beat Backaches by James Wagenvoord; ISBN: 0688031676; http://www.amazon.com/exec/obidos/ASIN/0688031676/icongroupinterna

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Beyond Backache: A Personal Guide to Back and Neck Pain Relief by Michael M. Livingston (1988); ISBN: 0872122123; http://www.amazon.com/exec/obidos/ASIN/0872122123/icongroupinterna

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Bye Bye Backache by David C. Lindsey (1981); ISBN: 0939342014; http://www.amazon.com/exec/obidos/ASIN/0939342014/icongroupinterna

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Chronic Low Back Pain by Michael and Boas, Robert A. Stanton-Hicks (Editor); ISBN: 0890045984; http://www.amazon.com/exec/obidos/ASIN/0890045984/icongroupinterna

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Chronic Low Back Pain: Assessment and Treatment from a Behavioral Rehabilitation Perspective (Irv Series in Rehabilitation Research, Vol 1) by Johan W.S. Vlaeyen

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(1991); ISBN: 9026511736; http://www.amazon.com/exec/obidos/ASIN/9026511736/icongroupinterna •

Chronic Low Back Pain: Assessment and Treatment from a Behavioral Rehabilitation Perspective (Series in Rehabilitation Research, Vol 1) by Johannes Wolfgang Silvain Vlayen (1991); ISBN: 9026511728; http://www.amazon.com/exec/obidos/ASIN/9026511728/icongroupinterna

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Clinical Efficacy and Outcome in the Diagnosis and Treatment of Low Back Pain (Bristol-Meyers/Zimmer Orthopedic Symposium Series) by James N. Weinstein (Editor); ISBN: 0881678414; http://www.amazon.com/exec/obidos/ASIN/0881678414/icongroupinterna

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Clinical Guidelines for the Management of Acute Low Back Pain (1999); ISBN: 0850842298; http://www.amazon.com/exec/obidos/ASIN/0850842298/icongroupinterna

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Clinical Perspectives on Headache and Low Back Pain; ISBN: 3801703231; http://www.amazon.com/exec/obidos/ASIN/3801703231/icongroupinterna

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Clinical Perspectives on Headache and Low Back Pain by Claus Bischoff, et al; ISBN: 0889370257; http://www.amazon.com/exec/obidos/ASIN/0889370257/icongroupinterna

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Conquering Pain: How to Overcome the Discomfort of Arthritis, Backache, Heart Disease, Childbirth, Period Pain, Toothache, and Many Oth by Sampson Lipton; ISBN: 0668056908; http://www.amazon.com/exec/obidos/ASIN/0668056908/icongroupinterna

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Conservative Care of Low Back Pain by Arthur H. White, Robert Anderson (Editor); ISBN: 0683090070; http://www.amazon.com/exec/obidos/ASIN/0683090070/icongroupinterna

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Diagnosis and Treatment of Low Back Pain by Neil Kahanovitz (Editor); ISBN: 0881677752; http://www.amazon.com/exec/obidos/ASIN/0881677752/icongroupinterna

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Dr. Finneson on Low Back Pain by Bernard E. Finneson; ISBN: 0399115374; http://www.amazon.com/exec/obidos/ASIN/0399115374/icongroupinterna

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Evaluation and Treatment of Low Back Pain (Clinical Symposia, Vol 48, Pt 4) by Allan Jacobs (1997); ISBN: 9999981836; http://www.amazon.com/exec/obidos/ASIN/9999981836/icongroupinterna

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Evaluation of Practice Guideline Implementation in the Army Medical Department: The Low Back Pain Guideline Demonstration by Donna Farley (Editor) (2003); ISBN: 083303474X; http://www.amazon.com/exec/obidos/ASIN/083303474X/icongroupinterna

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Everything You Need to Know to Cure Your Own Backache by Beckett Howorth; ISBN: 0878051724; http://www.amazon.com/exec/obidos/ASIN/0878051724/icongroupinterna

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Exercise-Based Physiotherapy Management of Patients With Persistent, Non-Specific Low Back Pain: A Cognitive-Behavioural Approach to Assessment and Treatment in a Primary Care Setting (Comprehensive Summaries of Uppsala Dissertations, 881) by Eva Johansson (1999); ISBN: 9155445942; http://www.amazon.com/exec/obidos/ASIN/9155445942/icongroupinterna

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Freedom from Backaches by Lawrence W. Friedmann; ISBN: 067121571X; http://www.amazon.com/exec/obidos/ASIN/067121571X/icongroupinterna

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Goodbye Backache by David Imrie; ISBN: 0668058900; http://www.amazon.com/exec/obidos/ASIN/0668058900/icongroupinterna

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Good-Bye to Bad Backs: Simple Stretching and Strengthening Excerises for Alignment and Freedom from Lower Back Pain by Judith Scott, Richard M. Bachrach; ISBN: 0871271869; http://www.amazon.com/exec/obidos/ASIN/0871271869/icongroupinterna

•

Goodbye to Bad Backs: Stretching and Strengthening Exercises for Alignment and Freedom from Lower Back Pain by Judith Scott, et al; ISBN: 0871272547; http://www.amazon.com/exec/obidos/ASIN/0871272547/icongroupinterna

•

How to Conquer Backache (A Consultation with Dr Vernon Coleman) by Vernon Coleman; ISBN: 0600575217; http://www.amazon.com/exec/obidos/ASIN/0600575217/icongroupinterna

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Industrial Low Back Pain (Contemporary Litigation Series) by Sam W. Wiesel, et al (1985); ISBN: 087215856X; http://www.amazon.com/exec/obidos/ASIN/087215856X/icongroupinterna

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Interdisciplinary Rehabilitation of Low Back Pain by Tollison; ISBN: 0683083368; http://www.amazon.com/exec/obidos/ASIN/0683083368/icongroupinterna

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Joseph Corvo's Backache by Corvo; ISBN: 0091771366; http://www.amazon.com/exec/obidos/ASIN/0091771366/icongroupinterna

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Low Back Pain by Sam W. Wiesel, et al (1999); ISBN: 0327100133; http://www.amazon.com/exec/obidos/ASIN/0327100133/icongroupinterna

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Low Back Pain (1990); ISBN: 0683021516; http://www.amazon.com/exec/obidos/ASIN/0683021516/icongroupinterna

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Low Back Pain by Bernard E. Finneson; ISBN: 0397504934; http://www.amazon.com/exec/obidos/ASIN/0397504934/icongroupinterna

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Low Back Pain by William Hunter; ISBN: 9995080559; http://www.amazon.com/exec/obidos/ASIN/9995080559/icongroupinterna

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Low Back Pain : Care & Prevention With Traditional Chinese Medicine by Douglas Frank; ISBN: 093618566X; http://www.amazon.com/exec/obidos/ASIN/093618566X/icongroupinterna

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Low Back Pain Fast Facts Indispensable Guides to Clinical Practice by Robert L. Swezey, Andrei Calin (2003); ISBN: 1903734347; http://www.amazon.com/exec/obidos/ASIN/1903734347/icongroupinterna

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Low Back Pain Handbook by Brian P. D'Orazio (Editor); ISBN: 0750696184; http://www.amazon.com/exec/obidos/ASIN/0750696184/icongroupinterna

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Low Back Pain Syndrome (1995); ISBN: 0803616066; http://www.amazon.com/exec/obidos/ASIN/0803616066/icongroupinterna

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Low Back Pain: A Scientific and Clinical Overview by James N. Weinstein (Editor), et al; ISBN: 0892031603; http://www.amazon.com/exec/obidos/ASIN/0892031603/icongroupinterna

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Low Back Pain: An Evidence-Based, Biopsychosocial Model for Clinical Management by Jane Derebery (Editor), John R. Anderson (Editor) (2002); ISBN: 1883595347; http://www.amazon.com/exec/obidos/ASIN/1883595347/icongroupinterna

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Low Back Pain: An Historical and Contemporary Overview of the Occupational, Medical, and Psychosocial Issues of Chronic Back Pain by Peter Mandell, et al; ISBN: 155642082X; http://www.amazon.com/exec/obidos/ASIN/155642082X/icongroupinterna

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Low Back Pain: Assessment and Management by Dan M Spengler; ISBN: 0808914685; http://www.amazon.com/exec/obidos/ASIN/0808914685/icongroupinterna

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Low Back Pain: Clinical Diagnosis and Management by Leonard P. Seimon; ISBN: 093995740X; http://www.amazon.com/exec/obidos/ASIN/093995740X/icongroupinterna

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Low Back Pain: Diagnosis and Management by Andrew Frank (2001); ISBN: 1850091595; http://www.amazon.com/exec/obidos/ASIN/1850091595/icongroupinterna

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Low Back Pain: Health Care Needs Asessment: The Epidemiologically Based Needs Assessment Reviews, Second Series by Wessex Institute for Health Research and (1997); ISBN: 1857752015; http://www.amazon.com/exec/obidos/ASIN/1857752015/icongroupinterna

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Macnab's Backache by Ian MacNab, et al; ISBN: 0683057979; http://www.amazon.com/exec/obidos/ASIN/0683057979/icongroupinterna

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Management of Low Back Pain by Harold Carron (Editor); ISBN: 0723670013; http://www.amazon.com/exec/obidos/ASIN/0723670013/icongroupinterna

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Management of Low Back Pain in Primary Care by R. Bartley (Editor), Paul Coffey (Editor); ISBN: 0750647876; http://www.amazon.com/exec/obidos/ASIN/0750647876/icongroupinterna

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Managing Low Back Pain; ISBN: 0443085358; http://www.amazon.com/exec/obidos/ASIN/0443085358/icongroupinterna

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Medical Management of the Regional Musculoskeletal Diseases: Backache, Neck Pain, Disorders of the Upper and Lower Extremities by Nortin M. Hadler; ISBN: 0808916734; http://www.amazon.com/exec/obidos/ASIN/0808916734/icongroupinterna

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Models of Disability: Using Low Back Pain as an Example by Gordon Waddell; ISBN: 1853155314; http://www.amazon.com/exec/obidos/ASIN/1853155314/icongroupinterna

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Natural Medicine for Back Pain: The Best Alternative Methods for Banishing Backache from Acupressure & Chiropractic to Nutrition & Yoga (G.K. Hall Large Print Reference Collection) [LARGE PRINT] by Glenn S. Rothfeld, Suzanne Levert (Contributor); ISBN: 0783820267; http://www.amazon.com/exec/obidos/ASIN/0783820267/icongroupinterna

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Natural Medicine for Back Pain: The Best Alternative Methods for Banishing Backache: From Acupressure & Chiropractic to Nutrition & Yoga by Glenn S., Md Rothfeld, et al; ISBN: 0875962882; http://www.amazon.com/exec/obidos/ASIN/0875962882/icongroupinterna

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New Approach to Low Back Pain by Finneson; ISBN: 042503321X; http://www.amazon.com/exec/obidos/ASIN/042503321X/icongroupinterna

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New Approaches to Lower Back Pain by Nordin; ISBN: 0702023809; http://www.amazon.com/exec/obidos/ASIN/0702023809/icongroupinterna

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New Perspectives on Low Back Pain: Workshop, Airlie, Virginia, May 1988 by John W. Frymoyer (Editor), et al; ISBN: 0892030291; http://www.amazon.com/exec/obidos/ASIN/0892030291/icongroupinterna

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Occupational Health Guidelines for the Management of Low Back Pain at Work; ISBN: 1860161316; http://www.amazon.com/exec/obidos/ASIN/1860161316/icongroupinterna

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Occupational low back pain; ISBN: 0030632889; http://www.amazon.com/exec/obidos/ASIN/0030632889/icongroupinterna

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Occupational Low Back Pain by Malcolm H. Pope (Editor), et al; ISBN: 0275914461; http://www.amazon.com/exec/obidos/ASIN/0275914461/icongroupinterna

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Occupational Low Back Pain: Assessment, Treatment and Prevention by Malcolm H. Pope, et al; ISBN: 0801662524; http://www.amazon.com/exec/obidos/ASIN/0801662524/icongroupinterna

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Occupational therapy practice guidelines for adults with low back pain by Barbara A. Larson; ISBN: 1569001235; http://www.amazon.com/exec/obidos/ASIN/1569001235/icongroupinterna

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Pelvic Pain & Low Back Pain: A Handbook for Self Care & Treatment by Janet A. Hulme; ISBN: 1928812023; http://www.amazon.com/exec/obidos/ASIN/1928812023/icongroupinterna

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Preventing Low Back Pain by Paul D. Hooper; ISBN: 0683048732; http://www.amazon.com/exec/obidos/ASIN/0683048732/icongroupinterna

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Relief from Chronic Backache (1990); ISBN: 9993263907; http://www.amazon.com/exec/obidos/ASIN/9993263907/icongroupinterna

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Relief from Chronic Backache (Dell Medical Library) by Edmund Blair Bolles, Jackson Tan (Contributor); ISBN: 0440205719; http://www.amazon.com/exec/obidos/ASIN/0440205719/icongroupinterna

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Science & Medicine of Backache: Subject Analysis and Research Guide With Bibliography by Martha Garcy Gorman (1984); ISBN: 0881641146; http://www.amazon.com/exec/obidos/ASIN/0881641146/icongroupinterna

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Surgical Management of Low Back Pain (Neurosurgical Topics) by Daniel K. Resnick (Editor), Regis Haid (2001); ISBN: 1879284782; http://www.amazon.com/exec/obidos/ASIN/1879284782/icongroupinterna

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Symposium on Idiopathic Low Back Pain by Agustus White, Stephen Gordon; ISBN: 0801600596; http://www.amazon.com/exec/obidos/ASIN/0801600596/icongroupinterna

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The Back School and Other Conservative Approaches to Low Back Pain by Arthur H. White; ISBN: 0801654238; http://www.amazon.com/exec/obidos/ASIN/0801654238/icongroupinterna

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The John Hopkins White Papers: Low Back Pain and Osteoporosis (2001); ISBN: 9990833397; http://www.amazon.com/exec/obidos/ASIN/9990833397/icongroupinterna

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The Johns Hopkins White Papers: Low Back Pain and Osteoporosis by John P. Kostuik, Simeon Margolis; ISBN: 0929661273; http://www.amazon.com/exec/obidos/ASIN/0929661273/icongroupinterna

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The Nonsurgical Management of Acute Low Back Pain: Cutting Through the Ahcpr Guidelines by Erwin G., Md. Gonzalez (Editor), Richard S., Md. Materson (Editor); ISBN: 1888799137; http://www.amazon.com/exec/obidos/ASIN/1888799137/icongroupinterna

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The Practical Treatment of Backache and Sciatica by John Barrett, Douglas N. Golding (1985); ISBN: 0852007736; http://www.amazon.com/exec/obidos/ASIN/0852007736/icongroupinterna

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The Psychophysiology of Low Back Pain by Nicola Adams; ISBN: 044305259X; http://www.amazon.com/exec/obidos/ASIN/044305259X/icongroupinterna

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Therapeutic Exercise for Spinal Segmental Stabilization: In Lower Back Pain by Carolyn Richardson, et al; ISBN: 0443058024; http://www.amazon.com/exec/obidos/ASIN/0443058024/icongroupinterna

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Working With Backache by Suzanne H. Rogers; ISBN: 0931157013; http://www.amazon.com/exec/obidos/ASIN/0931157013/icongroupinterna

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Yoga for Backache by Michael Volin, Nancy Phelan; ISBN: 0099461900; http://www.amazon.com/exec/obidos/ASIN/0099461900/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “lower back pain” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 •

Backache from occiput to coccyx. Author: Burke, Gerald L.,; Year: 1969; Vancouver, B. C., 1964

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Backache in women. Author: Schleyer-Saunders, Emanuel.; Year: 1966; Bristol, Wright, 1966

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Backache relieved through concepts of posture. Author: Fahrni, W. Harry (Walter Harry),; Year: 1966; Springfield, Ill., Thomas [c1966]

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Backache, home treatment and prevention. Author: Homola, Samuel.; Year: 1969; West Nyack, N. Y., Parker [1968]

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Backache, stress and tension; their cause, prevention and treatment. Author: Kraus, Hans,; Year: 1965; New York, Simon and Schuster [c1965]

11

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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Low back pain and sciatica, by the. Sub-committee on Surgery of the Associate Committee on Medical Research. Author: National Research Council of Canada. Associate Committee on Medical Research.; Year: 1964; Ottawa, 1945

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Low back pain syndrome. Author: Cailliet, Rene.; Year: 1968; Philadelphia, Davis [c1968]

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Lumbar disc lesions; pathogenesis and treatment of low back pain and sciatica. Author: Armstrong, J. R. (James Rowan); Year: 1965; Edinburgh, Livingstone, 1965

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Neckache and backache. Proceedings of a workshop sponsored by the American Association of Neurological Surgeons in cooperation with the National Institutes of Health, Bethesda, Maryland, held at the McGregor Memorial Conference Center, Wayne State University, Detroit, Michigan. Edited by E. S. Gurdjian and L. M. Thomas. Author: Gurdjian, Elisha Stephens,; Year: 1968; Springfield, Ill., Thomas [c1970]

•

Yoga for backache [by] Michael Volin and Nancy Phelan. Author: Volin, Michael.; Year: 1965; [London] Pelham Books [1965]

Chapters on Lower Back Pain In order to find chapters that specifically relate to lower back pain, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and lower back pain using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “lower back pain” (or synonyms) into the “For these words:” box.

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CHAPTER 7. MULTIMEDIA ON LOWER BACK PAIN Overview In this chapter, we show you how to keep current on multimedia sources of information on lower back pain. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on lower back pain is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “lower back pain” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “lower back pain” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on lower back pain: •

Back Pain (Lower Back) at Time of Diagnosis Source: New York, NY: Patient Education Media, Inc./Time Life Medical. 1996. Contact: Patient Education Media, Inc./Time Life Medical. Time and Life Building, 1271 6th Street, New York, NY 10020. (212) 522-8089. (212) 522-8092 (fax). (800) 588-9959. PRICE: $19.95. Stock Number TLMV219. Summary: This 30-minute videocassette on lower back pain is divided into the following four parts: Part 1 uses computer animation to explain what is going on inside the body and how the lower back pain diagnosis is made; Part 2 discusses what happens after the diagnosis and introduces practical issues, such as types of health professionals who may become involved and what lifestyle changes may need to occur; Part 3 explores options for treatment and management of the condition; and Part 4 addresses issues and answers questions that frequently arise through the use of instudio question and answer sessions. The videotape is accompaniedby a patient

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workbook that provides program highlights, a glossary of terms, and a resource guide and a personal journal.

Bibliography: Multimedia on Lower Back Pain The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in lower back pain (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on lower back pain: •

Epidural injections for the diagnosis & treatment of low back pain [slide] Source: American Academy of Orthopaedic Surgeons; Year: 1979; Format: Slide; [Chicago]: The Academy, [1979]

•

Evaluation of low back pain [videorecording] Source: Carolyn Sturges; produced by Health Education Programs Incorporated; Year: 1980; Format: Videorecording; New York: Health Education Programs; [Edina, Minn.: for loan or sale by Video Training Resources], c1980

•

Evaluation of low back pain [videorecording] Source: Oklahoma University, Health Sciences Center, College of Health, Dept. of Physical Therapy; Year: 1978; Format: Videorecording; Oklahoma City: The Center: [for sale by its Media Productions], c1978

•

Evaluation of low back pain [videorecording] Source: Dept. of Continuing Education, Harvard Medical School and the Massachusetts General Hospital, Emergency Training Course; produced by Health Education Programs, inc; Year: 1979; Format: Videorecording; [New York]: Health Education Programs; [Edina, Minn: for loan or sale by Video Training Resources], c1979

•

Flexion exercises in management of low back pain [videorecording] Source: Emory University School of Medicine; Year: 1977; Format: Videorecording; Atlanta: Georgia Regional Medical Television Network: [for loan or sale by A. W. Calhoun Medical Library, 1977]

•

Low back pain [videorecording] Source: Emory University School of Medicine; Year: 1977; Format: Videorecording; Atlanta: Georgia Regional Medical Television Network: [for loan or sale by A. W. Calhoun Medical Library, 1977]

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Low back pain [videorecording] Source: a Hahnemann University and Videotech Associates Inc. production; Year: 1983; Format: Videorecording; [S.l.]: The Associates, c1983

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Low back pain, solving the clinical challenge [videorecording] Source: with Rodney Bluestone and Mary Rosenberg; Year: 1985; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1985

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Orthopaedic surgery: current concepts in the treatment of low back pain [sound recording] Source: American College of Surgeons; Year: 1977; Format: Sound recording; [Chicago]: The College, [1977]

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The Lower back pain syndrome [slide] Source: James Johnston; Year: 1974; Format: Slide; [New York]: Medcom, c1974

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The Ten commandments of the prevention of low back pain by exercise [videorecording] Source: presented by Emory University, School of Medicine and

Multimedia 81

Interstate Postgraduate Medical Association; Year: 1981; Format: Videorecording; Atlanta, Ga.: Emory Medical Television Network, 1981 •

To flex or not to flex [videorecording]: a discussion on management of low back pain Source: Emory University School of Medicine; Year: 1977; Format: Videorecording; Atlanta: Georgia Regional Medical Television Network: [for loan or sale by A. W. Calhoun Medical Library, 1977]

•

Understanding low back pain [videorecording] Source: Dept. of Medicine, Emory University, School of Medicine; Year: 1978; Format: Videorecording; Atlanta: Georgia Regional Medical Television Network: [for loan and sale by A. W. Calhoun Medical Library], 1978

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CHAPTER 8. PERIODICALS AND NEWS ON LOWER BACK PAIN Overview In this chapter, we suggest a number of news sources and present various periodicals that cover lower back pain.

News Services and Press Releases One of the simplest ways of tracking press releases on lower back pain is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “lower back pain” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to lower back pain. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “lower back pain” (or synonyms). The following was recently listed in this archive for lower back pain: •

Benefits of low back pain program persist Source: Reuters Health eLine Date: December 02, 2003

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Backache after childbirth not linked to epidural Source: Reuters Health eLine Date: August 16, 2002

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No link between epidural analgesia and long-term lower back pain Source: Reuters Medical News Date: August 15, 2002

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FDA approves Vertis' system for treatment of lower back pain Source: Reuters Industry Breifing Date: January 23, 2002

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Low back pain linked to stress in young adulthood Source: Reuters Health eLine Date: September 27, 2001

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X-rays deemed unnecessary for most low back pain Source: Reuters Health eLine Date: February 16, 2001

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Toxin injections may help lower back pain Source: Reuters Health eLine Date: May 05, 2000

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Lower back pain? 'Back mice' may be to blame Source: Reuters Health eLine Date: May 03, 2000

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Tramadol effective in treating chronic lower back pain Source: Reuters Medical News Date: April 24, 2000

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State of mind may influence lower back pain Source: Reuters Health eLine Date: April 19, 2000

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Low back pain common among farmers Source: Reuters Health eLine Date: April 28, 1999 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name.

Periodicals and News

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Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “lower back pain” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “lower back pain” (or synonyms). If you know the name of a company that is relevant to lower back pain, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “lower back pain” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “lower back pain” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on lower back pain: •

What Causes Back Pain? Source: Lifelong Health and Fitness. 3(2): 1,3. Summer 2001. Contact: Available from International Association of Physical Activity, Aging and Sports. The Center for the Study of Aging, Inc., 706 Madison Avenue, Albany, NY 12208-3604. (518) 465-6927. Fax (518) 462-1339. E-mail: [email protected]. Website: members.aol.com/IAPAAS. Summary: This newsletter article provides people who have back pain with information on this problem. The article begins by presenting some basic facts about the anatomy of the back and the spinal column. This is followed by a discussion of the causes of upper

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and lower back pain. Upper back pain is usually caused by a muscle spasm, arthritis, scoliosis, or stress fracture of the spine. Lower back pain can occur when the lumbar joint is stressed by lifting heavy objects or by a quick twisting movement or a fall. Other causes of lower back pain include a degenerative joint disease called ankylosis spondylitis, herniated or bulging disks, degenerative disk disease, muscle weakness or poor flexibility, and stress. 1 figure.

Academic Periodicals covering Lower Back Pain Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to lower back pain. In addition to these sources, you can search for articles covering lower back pain that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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APPENDICES

89

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute12: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

12

These publications are typically written by one or more of the various NIH Institutes.

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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.13 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:14 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

13

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 14 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway15 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.16 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “lower back pain” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 5340 184 970 51 9 6554

HSTAT17 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.18 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.19 Simply search by “lower back pain” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

15

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

16

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 17 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 18 19

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists20 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.21 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.22 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

20 Adapted 21

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 22 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on lower back pain can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to lower back pain. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to lower back pain. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “lower back pain”:

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•

Other guides Back Injuries http://www.nlm.nih.gov/medlineplus/backinjuries.html Monkeypox Virus Infections http://www.nlm.nih.gov/medlineplus/monkeypoxvirusinfections.html Sciatica http://www.nlm.nih.gov/medlineplus/sciatica.html Spinal Diseases http://www.nlm.nih.gov/medlineplus/spinaldiseases.html Spinal Stenosis http://www.nlm.nih.gov/medlineplus/spinalstenosis.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on lower back pain. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Low Back Pain: A Self-Care Guide Source: San Bruno, CA: StayWell Company. 1999. 16 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This booklet provides people who have back pain with information on the causes and treatment of low back pain. Causes include lifting improperly, making sudden moves, and falling. Common back problems include muscle strains or sprains, disk problems, or nerve problems. During the first few days, relief from back pain can be obtained by applying ice to the area of the back that hurts the most, taking over the counter medications, and applying heat to the sore area. In addition, moving around after a day or so of bed rest is important to resolving back pain. The pelvic tilt is one exercise that loosens tight muscles and helps relieve pain. Gentle stretching exercises help reduce tightness. Floor exercises such as the back extension, back rotation, and partial sit up can stretch and strengthen the lower back and stomach. Maintaining one's routine and making long-term lifestyle changes are also important to relieving back pain. The booklet presents tips on making daily actions such as dressing, brushing one's

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teeth or shaving, and standing a little easier. The booklet also explains the proper body mechanics involved in getting out of bed, getting out of a car, lifting, and sitting. In addition, the booklet presents the warning signs of the need for medical attention and outlines the elements of a personal action plan. •

Lower Back Pain in Athletes Source: American Orthopaedic Society for Sports Medicine. 2000. 2 p. Contact: Available from American Orthopedic Society for Sports Medicine. 6300 North River Road, Suite 500, Rosemont, IL 60018. (847) 292-4900. Fax: (847) 292-4908. Website: http://www.sportsmed.org. Summary: This fact sheet discusses causes and diagnosis of low back pain in athletes. Low back pain may be caused by stress fractures and herniated and bulging discs. Injured muscle can also cause pain. Back injuries may be caused by improper warmup and conditioning, twisting movements, and repetitive or excessive loads on the back. Xrays are used to identify fractures, arthritis, and slippage. MRI's assess degeneration, bulging, and herniated discs. Bone scans are used for assessing stress fractures. Lower back pain is most commonly caused by muscle injury, tears or sprain of the annulus that may be accompanied by sciatica, and bulging and herniated discs. Proper warm up and attention to body mechanics will help prevent lower back injuries.

•

Lumbar Disk Surgery: Treating Low Back Pain and Sciatica Source: San Bruno, CA: StayWell Company. 2000. 8 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This illustrated booklet provides people who have low back pain and sciatica with information on disk surgery. Although a conservative treatment plan may relieve pain in some people, others may need surgery. The booklet describes the anatomy and function of the lower back and explains how disk problems cause pain. This is followed by a discussion of the medical examination, focusing on the medical history, the physical examination, and diagnostic tests. The booklet then describes various types of disk surgery, including classic diskectomy, microdiskectomy, and percutaneous diskectomy. In addition, the booklet offers guidelines on recovering from back surgery, focusing on undergoing physical therapy, using proper body mechanics, exercising regularly, and obtaining followup care. 13 figures.

•

Low Back Pain Source: Rosemont, IL: American Academy of Orthopaedic Surgeons. 1996. 8 p. Contact: American Academy of Orthopaedic Surgeons, 6300 North River Road, Rosemont, IL 60018-4262. (847) 823-7186. (800) 346-AAOS. (800) 824-BONES. (800) 6266726. (847) 823-8125 (fax). Summary: This pamphlet for individuals with low back pain uses a question-andanswer format to provide an overview of low back pain. Questions concern what structures comprise the lower back; why low back pain is a common problem; how low back pain is diagnosed; and what factors cause low back pain, including sprains and strains, age, osteoporosis and fractures, and protruding disk. Additional questions deal

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with the best treatment for low back pain, reasons for surgical intervention, and the prevention of low back pain. The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “lower back pain” (or synonyms). The following was recently posted: Source: American College of Radiology - Medical Specialty Society; 1996 (revised 1999); 7 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2441&nbr=1667&a mp;string=lower+AND+back+AND+pain •

Adult low back pain Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1994 June (revised 2002 Sep); 61 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3498&nbr=2724&a mp;string=lower+AND+back+AND+pain

•

Guideline for hospitalization for low back pain Source: Washington State Department of Labor and Industries - State/Local Government Agency [U.S.]; 1999; 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1891&nbr=1117&a mp;string=lower+AND+back+AND+pain

•

Low back pain or sciatica in the primary care setting Source: Department of Defense - Federal Government Agency [U.S.]; 1999 May; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=2578&nbr=1804&a mp;string=lower+AND+back+AND+pain

•

Unremitting low back pain. In: North American Spine Society phase III clinical guidelines for multidisciplinary spine care specialists Source: North American Spine Society - Medical Specialty Society; 2000; 96 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2805&nbr=2031&a mp;string=lower+AND+back+AND+pain The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an

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ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to lower back pain. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to lower back pain. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with lower back pain. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about lower back pain. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines.

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The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “lower back pain” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “lower back pain”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “lower back pain” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “lower back pain” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.23

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

23

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)24: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

24

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

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On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on lower back pain: •

Basic Guidelines for Lower Back Pain Backaches and stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002130.htm

•

Signs & Symptoms for Lower Back Pain Back pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003108.htm Back pain, low Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003108.htm Loss of bladder or bowel control Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003142.htm Numbness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm

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Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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LOWER BACK PAIN DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Acupuncture Points: Designated locations along nerves or organ meridians for inserting acupuncture needles. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerobic Exercise: A type of physical activity that includes walking, jogging, running, and dancing. Aerobic training improves the efficiency of the aerobic energy-producing systems that can improve cardiorespiratory endurance. [NIH] Aggravation: An increasing in seriousness or severity; an act or circumstance that intensifies, or makes worse. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy,

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magnet therapy, spiritual healing, and meditation. [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Antiallergic: Counteracting allergy or allergic conditions. [EU] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Articular: Of or pertaining to a joint. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Autonomic: Self-controlling; functionally independent. [EU] Back Injuries: General or unspecified injuries to the posterior part of the trunk. It includes injuries to the muscles of the back. [NIH]

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Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Bed Rest: Confinement of an individual to bed for therapeutic or experimental reasons. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biomechanics: The study of the application of mechanical laws and the action of forces to living structures. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen

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are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Cauda Equina: The lower part of the spinal cord consisting of the lumbar, sacral, and coccygeal nerve roots. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cellular metabolism: The sum of all chemical changes that take place in a cell through which energy and basic components are provided for essential processes, including the synthesis of new molecules and the breakdown and removal of others. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chiropractic: A system of treating bodily disorders by manipulation of the spine and other parts, based on the belief that the cause is the abnormal functioning of a nerve. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Civilization: The distinctly human attributes and attainments of a particular society. [NIH]

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Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Cochlear: Of or pertaining to the cochlea. [EU] Cochlear Diseases: Diseases of the cochlea, the part of the inner ear that is concerned with hearing. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements,

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megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Concentric: Having a common center of curvature or symmetry. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constriction: The act of constricting. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a

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myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Credentialing: The recognition of professional or technical competence through registration, certification, licensure, admission to association membership, the award of a diploma or degree, etc. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Custom-made: Any active implantable medical device specifically made in accordance with a medical specialist's written prescription which gives, under his responsibility, specific design characteristics and is intended to be used only for an individually named patient. [NIH]

Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. [NIH] Decompression: Decompression external to the body, most often the slow lessening of external pressure on the whole body (especially in caisson workers, deep sea divers, and persons who ascend to great heights) to prevent decompression sickness. It includes also sudden accidental decompression, but not surgical (local) decompression or decompression applied through body openings. [NIH] Decompression Sickness: A condition occurring as a result of exposure to a rapid fall in ambient pressure. Gases, nitrogen in particular, come out of solution and form bubbles in body fluid and blood. These gas bubbles accumulate in joint spaces and the peripheral circulation impairing tissue oxygenation causing disorientation, severe pain, and potentially death. [NIH] Decubitus: An act of lying down; also the position assumed in lying down. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or

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involving degeneration; causing or tending to cause degeneration. [EU] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Diskectomy: Excision, in part or whole, of an intervertebral disk. The most common indication is disk displacement or herniation. In addition to standard surgical removal, it can be performed by percutaneous diskectomy or by laparoscopic diskectomy, the former being the more common. [NIH] Dislocation: The displacement of any part, more especially of a bone. Called also luxation. [EU]

Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duodenum: The first part of the small intestine. [NIH] Dynorphins: A class of opioid peptides including dynorphin A, dynorphin B, and smaller fragments of these peptides. Dynorphins prefer kappa-opioid receptors (receptors, opioid, kappa) and have been shown to play a role as central nervous system transmitters. [NIH] Dysuria: Painful or difficult urination. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Effector cell: A cell that performs a specific function in response to a stimulus; usually used to describe cells in the immune system. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Electroacupuncture: A form of acupuncture using low frequency electrically stimulated needles to produce analgesia and anesthesia and to treat disease. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the

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interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocardium: The innermost layer of the heart, comprised of endothelial cells. [NIH] Endorphin: Opioid peptides derived from beta-lipotropin. Endorphin is the most potent naturally occurring analgesic agent. It is present in pituitary, brain, and peripheral tissues. [NIH]

Enkephalins: One of the three major families of endogenous opioid peptides. The enkephalins are pentapeptides that are widespread in the central and peripheral nervous systems and in the adrenal medulla. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Ergonomics: Study of the relationships between man and machines; adjusting the design of machines to the need and capacities of man; study of the effect of machines on man's behavior. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Exercise Therapy: Motion of the body or its parts to relieve symptoms or to improve function, leading to physical fitness, but not physical education and training. [NIH] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

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Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Flexion: In gynaecology, a displacement of the uterus in which the organ is bent so far forward or backward that an acute angle forms between the fundus and the cervix. [EU] Fold: A plication or doubling of various parts of the body. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fundus: The larger part of a hollow organ that is farthest away from the organ's opening. The bladder, gallbladder, stomach, uterus, eye, and cavity of the middle ear all have a fundus. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrula: The embryo in the early stage following the blastula, characterized by morphogenetic cell movements, cell differentiation, and the formation of the three germ layers. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Glucocorticoids: A group of corticosteroids that affect carbohydrate metabolism (gluconeogenesis, liver glycogen deposition, elevation of blood sugar), inhibit corticotropin secretion, and possess pronounced anti-inflammatory activity. They also play a role in fat and protein metabolism, maintenance of arterial blood pressure, alteration of the connective tissue response to injury, reduction in the number of circulating lymphocytes, and functioning of the central nervous system. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Gonadal: Pertaining to a gonad. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Health Behavior: Behaviors expressed by individuals to protect, maintain or promote their health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural. [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community

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basis. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells, cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herniated: Protrusion of a degenerated or fragmented intervertebral disc into the intervertebral foramen compressing the nerve root. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hydra: A genus of freshwater cnidarians, of interest because of their complex organization and because their adult organization corresponds roughly to the gastrula of higher animals. [NIH]

Hydrocodone: Narcotic analgesic related to codeine, but more potent and more addicting by weight. It is used also as cough suppressant. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypotension: Abnormally low blood pressure. [NIH] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Incision: A cut made in the body during surgery. [NIH]

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Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intravenous: IV. Into a vein. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Ischial: A pointed projection on the posterior margin of the ischium. [NIH]

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Isometric Contraction: Muscular contractions characterized by increase in tension without change in length. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lesion: An area of abnormal tissue change. [NIH] Libido: The psychic drive or energy associated with sexual instinct in the broad sense (pleasure and love-object seeking). It may also connote the psychic energy associated with instincts in general that motivate behavior. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Linkages: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Lordosis: The anterior concavity in the curvature of the lumbar and cervical spine as viewed from the side. The term usually refers to abnormally increased curvature (hollow back, saddle back, swayback). It does not include lordosis as normal mating posture in certain animals ( = posture + sex behavior, animal). [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Lumbago: Pain in the lumbar region. [EU] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU]

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Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malaise: A vague feeling of bodily discomfort. [EU] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two

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hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monotherapy: A therapy which uses only one drug. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Muscle Fatigue: A state arrived at through prolonged and strong contraction of a muscle. Studies in athletes during prolonged submaximal exercise have shown that muscle fatigue increases in almost direct proportion to the rate of muscle glycogen depletion. Muscle fatigue in short-term maximal exercise is associated with oxygen lack and an increased level of blood and muscle lactic acid, and an accompanying increase in hydrogen-ion concentration in the exercised muscle. [NIH] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH]

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Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neuropeptides: Peptides released by neurons as intercellular messengers. Many neuropeptides are also hormones released by non-neuronal cells. [NIH] Neurotransmitters: Endogenous signaling molecules that alter the behavior of neurons or effector cells. Neurotransmitter is used here in its most general sense, including not only messengers that act directly to regulate ion channels, but also those that act through second messenger systems, and those that act at a distance from their site of release. Included are neuromodulators, neuroregulators, neuromediators, and neurohumors, whether or not acting at synapses. [NIH] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Opioid Peptides: The endogenous peptides with opiate-like activity. The three major classes currently recognized are the enkephalins, the dynorphins, and the endorphins. Each of these families derives from different precursors, proenkephalin, prodynorphin, and proopiomelanocortin, respectively. There are also at least three classes of opioid receptors, but the peptide families do not map to the receptors in a simple way. [NIH] Orthotic Devices: Apparatus used to support, align, prevent, or correct deformities or to improve the function of movable parts of the body. [NIH] Osteoarthritis: Degeneration of articular cartilage. Primary osteoarthritis is very common in older persons, especially affecting weight-bearing joints. Articular cartilage becomes soft, frayed and thinned. [NIH] Osteomyelitis: Inflammation of bone caused by a pyogenic organism. It may remain localized or may spread through the bone to involve the marrow, cortex, cancellous tissue, and periosteum. [EU] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Oxycodone: Semisynthetic derivative of codeine that acts as a narcotic analgesic more potent and addicting than codeine. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

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Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Pelvic: Pertaining to the pelvis. [EU] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perineum: The area between the anus and the sex organs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Photophobia: Abnormal sensitivity to light. This may occur as a manifestation of eye diseases; migraine; subarachnoid hemorrhage; meningitis; and other disorders. Photophobia may also occur in association with depression and other mental disorders. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Fitness: A state of well-being in which performance is optimal, often as a result of physical conditioning which may be prescribed for disease therapy. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]

Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Plasminogen: Precursor of fibrinolysin (plasmin). It is a single-chain beta-globulin of molecular weight 80-90,000 found mostly in association with fibrinogen in plasma; plasminogen activators change it to fibrinolysin. It is used in wound debriding and has been investigated as a thrombolytic agent. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postural: Pertaining to posture or position. [EU]

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Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prone: Having the front portion of the body downwards. [NIH] Prone Position: The posture of an individual lying face down. [NIH] Pro-Opiomelanocortin: A precursor protein, MW 30,000, synthesized mainly in the anterior pituitary gland but also found in the hypothalamus, brain, and several peripheral tissues. It incorporates the amino acid sequences of ACTH and beta-lipotropin. These two hormones, in turn, contain the biologically active peptides MSH, corticotropin-like intermediate lobe peptide, alpha-lipotropin, endorphins, and methionine enkephalin. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin

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synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatitis: Inflammation of the prostate. [EU] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pyogenic: Producing pus; pyopoietic (= liquid inflammation product made up of cells and a thin fluid called liquor puris). [EU] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons,

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alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radicular: Having the character of or relating to a radicle or root. [NIH] Radiculopathy: Disease involving a spinal nerve root (see spinal nerve roots) which may result from compression related to intervertebral disk displacement; spinal cord injuries; spinal diseases; and other conditions. Clinical manifestations include radicular pain, weakness, and sensory loss referable to structures innervated by the involved nerve root. [NIH]

Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recuperation: The recovery of health and strength. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Resolving: The ability of the eye or of a lens to make small objects that are close together, separately visible; thus revealing the structure of an object. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Sacroiliac Joint: The immovable joint formed by the lateral surfaces of the sacrum and ilium. [NIH]

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Saline: A solution of salt and water. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Sarcoma: A connective tissue neoplasm formed by proliferation of mesodermal cells; it is usually highly malignant. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Sciatica: A condition characterized by pain radiating from the back into the buttock and posterior/lateral aspects of the leg. Sciatica may be a manifestation of sciatic neuropathy; radiculopathy (involving the L4, L5, S1 or S2 spinal nerve roots; often associated with intervertebral disk displacement); or lesions of the cauda equina. [NIH] Scoliosis: A lateral curvature of the spine. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Second Messenger Systems: Systems in which an intracellular signal is generated in response to an intercellular primary messenger such as a hormone or neurotransmitter. They are intermediate signals in cellular processes such as metabolism, secretion, contraction, phototransduction, and cell growth. Examples of second messenger systems are the adenyl cyclase-cyclic AMP system, the phosphatidylinositol diphosphate-inositol triphosphate system, and the cyclic GMP system. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sedentary: 1. Sitting habitually; of inactive habits. 2. Pertaining to a sitting posture. [EU] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sensory loss: A disease of the nerves whereby the myelin or insulating sheath of myelin on the nerves does not stay intact and the messages from the brain to the muscles through the nerves are not carried properly. [NIH]

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Sex Behavior: Sexual activities of humans. [NIH] Sex Behavior, Animal: Sexual activities of animals. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Shoulder Pain: Unilateral or bilateral pain of the shoulder. It is often caused by physical activities such as work or sports participation, but may also be pathologic in origin. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Cord Injuries: Penetrating and non-penetrating injuries to the spinal cord resulting from traumatic external forces (e.g., wounds, gunshot; whiplash injuries; etc.). [NIH] Spinal Nerve Roots: The paired bundles of nerve fibers entering and leaving the spinal cord at each segment. The dorsal and ventral nerve roots join to form the mixed segmental spinal nerves. The dorsal roots are generally afferent, formed by the central projections of the spinal (dorsal root) ganglia sensory cells, and the ventral roots efferent, comprising the axons of spinal motor and autonomic preganglionic neurons. There are, however, some exceptions to this afferent/efferent rule. [NIH] Spinal Stenosis: Narrowing of the spinal canal. [NIH]

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Spinous: Like a spine or thorn in shape; having spines. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Spondylitis: Inflammation of the vertebrae. [EU] Spondylolisthesis: Forward displacement of one vertebra over another. [NIH] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Stabilization: The creation of a stable state. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Streptococci: A genus of spherical Gram-positive bacteria occurring in chains or pairs. They are widely distributed in nature, being important pathogens but often found as normal commensals in the mouth, skin, and intestine of humans and other animals. [NIH] Streptokinase: Streptococcal fibrinolysin . An enzyme produced by hemolytic streptococci. It hydrolyzes amide linkages and serves as an activator of plasminogen. It is used in thrombolytic therapy and is used also in mixtures with streptodornase (streptodornase and streptokinase). EC 3.4.-. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH]

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Supine: Having the front portion of the body upwards. [NIH] Supine Position: The posture of an individual lying face up. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Synapses: Specialized junctions at which a neuron communicates with a target cell. At classical synapses, a neuron's presynaptic terminal releases a chemical transmitter stored in synaptic vesicles which diffuses across a narrow synaptic cleft and activates receptors on the postsynaptic membrane of the target cell. The target may be a dendrite, cell body, or axon of another neuron, or a specialized region of a muscle or secretory cell. Neurons may also communicate through direct electrical connections which are sometimes called electrical synapses; these are not included here but rather in gap junctions. [NIH] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombolytic: 1. Dissolving or splitting up a thrombus. 2. A thrombolytic agent. [EU] Thrombolytic Therapy: Use of infusions of fibrinolytic agents to destroy or dissolve thrombi in blood vessels or bypass grafts. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH]

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Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Traction: The act of pulling. [NIH] Transcutaneous: Transdermal. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] VE: The total volume of gas either inspired or expired in one minute. [NIH] Venous: Of or pertaining to the veins. [EU] Ventricles: Fluid-filled cavities in the heart or brain. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Vestibulocochlear Nerve: The 8th cranial nerve. The vestibulocochlear nerve has a cochlear part (cochlear nerve) which is concerned with hearing and a vestibular part (vestibular nerve) which mediates the sense of balance and head position. The fibers of the cochlear nerve originate from neurons of the spiral ganglion and project to the cochlear nuclei (cochlear nucleus). The fibers of the vestibular nerve arise from neurons of Scarpa's ganglion and project to the vestibular nuclei. [NIH] Vestibulocochlear Nerve Diseases: Diseases of the vestibular and/or cochlear (acoustic) nerves, which join to form the vestibulocochlear nerve. Vestibular neuritis, cochlear neuritis, and acoustic neuromas are relatively common conditions that affect these nerves. Clinical manifestations vary with which nerve is primarily affected, and include hearing loss, vertigo, and tinnitus. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH]

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Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Weight-Bearing: The physical state of supporting an applied load. This often refers to the weight-bearing bones or joints that support the body's weight, especially those in the spine, hip, knee, and foot. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

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INDEX A Abdomen, 4, 109, 111, 120, 121, 131, 132 Abdominal, 4, 44, 45, 59, 63, 109, 124 Acetaminophen, 10, 21, 109 Activities of Daily Living, 6, 9, 53, 109 Acupuncture Points, 64, 109 Adaptation, 14, 109 Adjustment, 56, 109 Adrenal Cortex, 109, 115, 126 Adverse Effect, 109, 130 Aerobic, 4, 20, 109 Aerobic Exercise, 4, 20, 109 Aggravation, 67, 109 Algorithms, 109, 111 Alpha Particles, 109, 128 Alternative medicine, 85, 109 Anal, 110, 121 Analgesic, 109, 110, 113, 117, 119, 124 Anatomical, 5, 6, 72, 110, 119 Androgens, 109, 110, 115 Anesthesia, 29, 110, 116 Antiallergic, 110, 115 Antibody, 110, 113, 120 Antigen, 110, 113, 120 Anti-inflammatory, 109, 110, 115, 118, 119 Anti-Inflammatory Agents, 110, 115 Antineoplastic, 110, 115 Antipyretic, 109, 110 Anus, 110, 111, 125 Anxiety, 5, 110 Aqueous, 110, 111, 121 Arachidonic Acid, 110, 126 Arterial, 110, 118, 119, 127, 132 Arteries, 110, 111, 114, 122 Articular, 110, 124 Atypical, 17, 110 Autonomic, 58, 110, 130 B Back Injuries, 4, 96, 97, 110 Bacterial Physiology, 109, 111 Base, 56, 60, 61, 62, 68, 69, 111, 121 Bed Rest, 96, 111 Bilateral, 111, 130 Bile, 111, 118, 121, 131 Biomechanics, 8, 62, 111 Biopsy, 111, 125 Biotechnology, 6, 7, 77, 85, 91, 111 Bladder, 53, 107, 111, 118, 127, 133

Blood pressure, 58, 111, 118, 119 Blood vessel, 111, 112, 119, 120, 121, 130, 131, 132, 133 Bone Marrow, 111, 122 Bone scan, 97, 111, 129 Bowel, 35, 107, 110, 111, 116, 120, 131 Bowel Movement, 111, 116, 131 Branch, 105, 111, 125, 130, 132 Breakdown, 111, 112, 116, 118 C Carbohydrate, 111, 115, 118 Carcinogenic, 112, 120, 131 Cardiac, 112, 117, 123, 131 Cardiopulmonary, 4, 112 Cardiorespiratory, 109, 112 Cardiovascular, 4, 112 Case report, 112, 113 Case series, 112, 113 Cauda Equina, 112, 129 Caudal, 112, 125 Cell, 65, 68, 109, 111, 112, 113, 116, 118, 120, 123, 126, 128, 129, 132 Cellular metabolism, 58, 112 Cerebral, 11, 112 Cerebrospinal, 5, 10, 13, 112 Cerebrospinal fluid, 5, 10, 13, 112 Cerebrum, 112 Cervical, 11, 14, 17, 35, 67, 112, 121 Cervix, 112, 118 Character, 112, 115, 128 Chiropractic, 19, 28, 29, 30, 31, 33, 36, 44, 47, 59, 62, 75, 112 Cholesterol, 111, 112, 131 Civilization, 68, 112 Clinical study, 72, 113, 114 Clinical trial, 4, 41, 46, 48, 91, 113, 114, 127, 128 Cloning, 111, 113 Cochlear, 113, 132, 133 Cochlear Diseases, 113, 132 Codeine, 113, 119, 124 Cofactor, 113, 127 Collapse, 65, 111, 113 Comorbidity, 31, 113 Complement, 113, 114 Complementary and alternative medicine, 27, 28, 39, 113 Complementary medicine, 28, 114

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Computational Biology, 91, 114 Computed tomography, 11, 114, 129 Computerized axial tomography, 114, 129 Computerized tomography, 114 Concentric, 4, 114 Connective Tissue, 111, 114, 118, 122, 128, 129 Consciousness, 110, 114 Constriction, 114, 120 Consultation, 7, 74, 114 Contraindications, ii, 114 Control group, 6, 114 Controlled clinical trial, 19, 114 Coordination, 18, 114 Coronary, 114, 122 Coronary Thrombosis, 114, 122 Cortex, 115, 124 Corticosteroid, 3, 12, 115 Craniocerebral Trauma, 115, 132 Credentialing, 44, 115 Curative, 115, 132 Custom-made, 19, 115 Cyclic, 115, 126, 129 D Databases, Bibliographic, 91, 115 Decision Making, 13, 115 Decompression, 53, 115 Decompression Sickness, 115 Decubitus, 56, 115 Degenerative, 43, 52, 86, 115 Delivery of Health Care, 116, 118 Diagnostic procedure, 51, 85, 116 Diastolic, 116, 119 Digestion, 111, 116, 120, 121, 131 Digestive system, 48, 116 Direct, iii, 44, 64, 116, 123, 128, 132 Diskectomy, 97, 116 Dislocation, 116, 131 Distal, 116 Dorsal, 116, 125, 130 Drive, ii, vi, 23, 116, 121 Drug Interactions, 116 Duodenum, 111, 116, 131 Dynorphins, 116, 124 Dysuria, 16, 116 E Edema, 58, 116, 120 Effector, 113, 116, 124 Effector cell, 116, 124 Efficacy, 12, 19, 20, 27, 30, 44, 45, 47, 73, 116, 133 Electroacupuncture, 32, 116

Electrode, 19, 116 Electrolyte, 115, 117, 122 Electromyography, 11, 12, 117 Electrons, 111, 117, 120, 127 Endocarditis, 20, 117 Endocardium, 117 Endorphin, 4, 117 Enkephalins, 117, 124 Environmental Health, 90, 92, 117 Enzyme, 116, 117, 127, 131 Epidemic, 10, 117 Epidural, 3, 18, 80, 84, 117 Ergonomics, 11, 55, 67, 117 Esophagus, 116, 117, 131 Exercise Therapy, 32, 117 Extremity, 21, 117 F Family Planning, 91, 117 Fat, 110, 111, 115, 117, 118, 128, 130 Fatigue, 61, 68, 117, 123 Fatty acids, 118, 126 Feces, 118, 131 Flexion, 21, 56, 80, 118 Fold, 57, 118 Foramen, 118, 119 Forearm, 111, 118 Fundus, 118 G Gallbladder, 109, 116, 118 Gas, 115, 118, 119, 133 Gastrointestinal, 59, 118 Gastrula, 118, 119 Gene, 77, 111, 118 Glucocorticoids, 109, 115, 118 Glycogen, 118, 123 Gonadal, 118, 131 Governing Board, 118, 126 Growth, 5, 110, 118, 122, 123, 129 H Health Behavior, 46, 118 Health Care Costs, 47, 54, 118, 119 Health Education, 9, 20, 80, 118 Health Expenditures, 118, 119 Health Status, 46, 47, 118, 119 Hemolytic, 119, 131 Hemorrhage, 115, 119, 125, 131 Hemorrhoids, 67, 119 Heredity, 118, 119 Herniated, 3, 42, 86, 97, 119 Hormonal, 115, 119 Hormone, 115, 119, 126, 129 Hydra, 60, 119

Index 137

Hydrocodone, 10, 119 Hydrogen, 111, 119, 123, 124, 127 Hydrolysis, 119, 127 Hypertension, 19, 119, 120 Hypotension, 19, 119 I Ibuprofen, 10, 119 Id, 24, 34, 98, 99, 104, 106, 119 Immune response, 110, 115, 119 Impairment, 53, 55, 119, 122 Incision, 119, 120 Indicative, 71, 120, 125, 133 Infarction, 115, 120, 122 Infection, 3, 68, 120, 122, 124, 131 Inflammation, 36, 58, 59, 110, 120, 122, 124, 127, 128, 131 Infusion, 14, 120 Initiation, 44, 120 Insight, 64, 120 Intervertebral, 14, 42, 116, 119, 120, 121, 128, 129 Intervertebral Disk Displacement, 120, 121, 128, 129 Intestine, 111, 116, 119, 120, 121, 131 Intracellular, 120, 126, 129 Intracranial Hypertension, 120, 132 Intravenous, 120 Invasive, 19, 45, 63, 65, 120, 122 Involuntary, 120, 123, 130 Ion Channels, 120, 124 Ions, 111, 117, 119, 120 Ischemia, 58, 120 Ischial, 60, 120 Isometric Contraction, 6, 121 J Joint, 12, 14, 18, 19, 20, 59, 65, 86, 110, 115, 121, 128, 131 K Kb, 90, 121 L Large Intestine, 116, 120, 121, 128 Lens, 121, 128 Lesion, 58, 121 Libido, 16, 110, 121 Library Services, 104, 121 Ligament, 121, 127, 131 Linkages, 121, 131 Liver, 59, 109, 110, 111, 116, 118, 121, 129 Liver scan, 121, 129 Lobe, 56, 121, 126 Localized, 58, 65, 66, 120, 121, 124 Longitudinal study, 45, 121

Lordosis, 52, 66, 67, 69, 121 Lumbago, 41, 121 Lymph, 112, 122 Lymph node, 112, 122 Lymphatic, 58, 120, 122, 131, 132 M Magnetic Resonance Imaging, 10, 41, 122, 129 Malaise, 8, 122 Malignant, 110, 122, 123, 129 MEDLINE, 91, 122 Meningitis, 122, 125 Mental Disorders, 49, 122, 125 Meta-Analysis, 12, 33, 122 MI, 7, 64, 65, 108, 122 Microbe, 122, 133 Microbiology, 109, 110, 122 Mineralocorticoids, 109, 115, 122 Mobility, 11, 122 Modeling, 6, 122 Modification, 122, 127 Molecular, 91, 93, 111, 114, 122, 125 Molecule, 110, 111, 113, 116, 119, 122, 128 Monotherapy, 27, 123 Motion Sickness, 123 Muscle Fatigue, 16, 123 Musculature, 54, 68, 69, 123, 131 Myocardium, 122, 123 N Narcotic, 119, 123, 124 Nausea, 58, 123 NCI, 1, 48, 89, 123 Necrosis, 120, 122, 123 Need, 3, 4, 53, 62, 73, 78, 79, 85, 97, 100, 109, 117, 118, 123 Neoplasia, 123 Neoplasm, 123, 129 Neoplastic, 53, 123 Nerve, 3, 5, 12, 30, 32, 41, 43, 65, 96, 110, 112, 119, 123, 128, 130, 131, 133 Nervous System, 116, 117, 118, 123, 124 Neural, 59, 123 Neuromuscular, 6, 53, 123 Neuronal, 123, 124 Neurons, 123, 124, 130, 132, 133 Neuropathy, 124, 129 Neuropeptides, 5, 124 Neurotransmitters, 5, 124 Neutrons, 109, 124, 127 Nuclei, 109, 117, 122, 124, 127, 133 O Opioid Peptides, 13, 116, 117, 124

138 Lower Back Pain

Orthotic Devices, 59, 124 Osteoarthritis, 30, 35, 124 Osteomyelitis, 20, 124 Osteoporosis, 76, 77, 97, 124 Outpatient, 21, 45, 124 Oxycodone, 10, 124 P Palliative, 124, 132 Palpation, 17, 45, 124 Pancreas, 109, 116, 124 Pathogenesis, 78, 124 Pathologic, 111, 114, 125, 130 Patient Education, 46, 79, 96, 102, 104, 108, 125 Patient Satisfaction, 44, 125 Pelvic, 35, 52, 53, 57, 58, 60, 62, 67, 76, 96, 125, 127 Peptide, 124, 125, 126, 127 Perception, 5, 125 Percutaneous, 18, 30, 32, 97, 116, 125 Perineum, 66, 125 Pharmacologic, 110, 125, 133 Photophobia, 58, 125 Physical Examination, 97, 125 Physical Fitness, 117, 125 Physical Therapy, 5, 28, 59, 68, 80, 97, 125 Physiologic, 5, 125, 126, 128 Pilot study, 5, 9, 28, 30, 125 Pituitary Gland, 115, 125, 126 Plasminogen, 125, 131 Poisoning, 123, 125 Posterior, 41, 43, 53, 60, 69, 110, 111, 116, 120, 124, 125, 129 Postmenopausal, 124, 125 Postural, 55, 58, 125 Practicability, 126, 133 Practice Guidelines, 44, 76, 92, 98, 126 Prevalence, 9, 34, 45, 126 Progesterone, 126, 131 Progressive, 16, 53, 118, 123, 126 Projection, 120, 126 Prone, 61, 66, 126 Prone Position, 61, 126 Pro-Opiomelanocortin, 124, 126 Prospective study, 7, 33, 121, 126 Prostaglandin, 58, 126 Prostaglandins A, 126, 127 Prostate, 127 Prostatitis, 22, 127 Protein S, 77, 111, 127 Proteins, 110, 113, 123, 125, 127, 133 Proteolytic, 58, 113, 127

Protocol, 6, 21, 53, 127 Protons, 109, 119, 127 Psychic, 121, 127 Psychosomatic, 20, 59, 127 Public Policy, 91, 127 Publishing, 6, 29, 127 Pulmonary, 111, 127 Pulmonary Artery, 111, 127 Pyogenic, 124, 127 Q Quality of Life, 64, 127 R Race, 34, 127 Radiation, 53, 127, 128, 129, 134 Radicular, 41, 128 Radiculopathy, 128, 129 Radioactive, 111, 119, 121, 128, 129 Radiography, 7, 34, 128 Radiological, 13, 125, 128 Randomized, 9, 19, 21, 27, 28, 30, 32, 33, 34, 44, 46, 47, 116, 128 Randomized clinical trial, 27, 46, 128 Receptor, 109, 110, 128 Rectum, 110, 111, 116, 118, 121, 127, 128 Recuperation, 4, 128 Recurrence, 4, 20, 128 Refer, 1, 67, 113, 124, 128 Regimen, 64, 116, 128 Reliability, 14, 31, 128 Remission, 128 Resolving, 96, 128 Restoration, 125, 128 Rheumatism, 119, 128 Risk factor, 3, 126, 128 S Sacroiliac Joint, 12, 21, 58, 128 Saline, 12, 59, 129 Salivary, 116, 129 Salivary glands, 116, 129 Saponins, 129, 131 Sarcoma, 10, 129 Scans, 47, 129 Sciatica, 3, 10, 15, 18, 41, 63, 72, 77, 78, 96, 97, 98, 129 Scoliosis, 52, 86, 129 Screening, 42, 113, 129 Second Messenger Systems, 124, 129 Secretion, 115, 118, 122, 129 Sedentary, 5, 67, 129 Segmental, 6, 44, 77, 129, 130 Segmentation, 129 Self Care, 16, 32, 76, 109, 129

Index 139

Senile, 124, 129 Sensory loss, 128, 129 Sex Behavior, 121, 130 Sex Behavior, Animal, 121, 130 Shock, 130, 133 Shoulder Pain, 12, 130 Side effect, 42, 55, 59, 61, 109, 130, 132 Skeletal, 61, 69, 110, 130 Skeleton, 54, 58, 121, 126, 130 Skull, 58, 59, 115, 130 Smooth muscle, 130 Social Environment, 127, 130 Social Support, 47, 130 Soft tissue, 111, 130 Spasm, 11, 53, 58, 86, 130 Specialist, 99, 115, 130 Species, 39, 127, 130, 131, 134 Spinal cord, 43, 112, 117, 123, 124, 128, 130 Spinal Cord Injuries, 128, 130 Spinal Nerve Roots, 128, 129, 130 Spinal Stenosis, 3, 43, 96, 130 Spinous, 55, 59, 131 Spleen, 122, 131 Spondylitis, 29, 86, 131 Spondylolisthesis, 6, 43, 131 Sprains and Strains, 97, 121, 131 Stabilization, 44, 53, 77, 131 Staging, 129, 131 Steroid, 24, 129, 131 Stimulus, 116, 117, 120, 131, 132 Stomach, 65, 66, 96, 109, 116, 117, 118, 119, 123, 131 Stool, 62, 121, 131 Streptococci, 131 Streptokinase, 14, 131 Stress, 9, 19, 54, 55, 59, 62, 69, 77, 84, 86, 97, 107, 108, 123, 131 Stroke, 49, 90, 131 Subacute, 33, 54, 120, 131 Subarachnoid, 125, 131 Subclinical, 120, 131 Subcutaneous, 116, 131 Subspecies, 130, 131 Supine, 56, 61, 132 Supine Position, 56, 132 Suppression, 115, 132 Synapses, 124, 132 Systemic, 36, 58, 59, 111, 120, 132 Systolic, 119, 132

T Therapeutics, 10, 11, 12, 13, 16, 17, 19, 20, 21, 29, 31, 32, 33, 34, 132 Thermal, 5, 64, 124, 132 Thigh, 41, 132 Thoracic, 111, 132 Thorax, 18, 109, 121, 132 Threshold, 119, 132 Thrombolytic, 125, 131, 132 Thrombolytic Therapy, 131, 132 Thrombosis, 127, 131, 132 Thymus, 122, 132 Tinnitus, 19, 132, 133 Tissue, 42, 59, 110, 111, 114, 115, 116, 117, 118, 121, 122, 123, 124, 125, 130, 132 Tomography, 132 Tooth Preparation, 109, 132 Toxic, iv, 124, 132, 133 Toxicity, 59, 116, 133 Toxicology, 92, 133 Toxins, 110, 120, 133 Traction, 52, 53, 72, 133 Transcutaneous, 12, 27, 32, 133 Transfection, 111, 133 Trauma, 14, 19, 58, 123, 133 Treatment Outcome, 18, 29, 133 U Unconscious, 119, 133 Urine, 111, 133 Uterus, 112, 118, 126, 133 V Vaccine, 127, 133 Vascular, 120, 133 VE, 45, 133 Venous, 119, 127, 133 Ventricles, 112, 133 Vertebrae, 17, 52, 57, 58, 59, 61, 69, 120, 130, 131, 133 Vertebral, 54, 55, 60, 133 Vestibulocochlear Nerve, 132, 133 Vestibulocochlear Nerve Diseases, 132, 133 Veterinary Medicine, 91, 133 Virulence, 133, 134 W Weight-Bearing, 124, 134 X X-ray, 5, 84, 97, 114, 129, 134

140 Lower Back Pain

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