Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Chronic low back pain and its association with lumbar vertebrae and intervertebral disc changes in adults. A case control study(Wiley, 2018) Karunanayake, A.L.; Pathmeswaran, A.; Wijayaratne, L.S.AIM: This study was done to determine the association between chronic low back pain and vertebral fractures, intervertebral disc space (IDS) narrowing, vertebral osteophytes and spondylolisthesis among adults. METHOD: This case control study was done in Sri Lanka. Cases were patients with low back pain and controls were without low back pain. Postero-anterior and lateral radiographs of lumbar sacral spine of both groups were studied. To detect vertebral fractures in fourth and fifth lumbar vertebrae, anterior and posterior heights of vertebrae were measured using a Vernier caliper and antero-posterior ratio (A/P) was calculated. Having an A/P ratio value of < 0.89 was considered as a vertebral fracture. Presence of disc space narrowing, vertebral osteophytes and spondylolisthesis was assessed by two radiologists working independently. Bivariate and logistic regression analysis was done to find associations. RESULTS: There were 140 cases and 140 controls. Mean (SD) age for cases was 51.6 (17) years. Mean (SD) age for controls was 50 (15) years. Females made up 62% of cases and controls. Fifth lumbar vertebral fracture (odds ratio [OR] = 10.2; P = 0.001), fourth lumbar vertebral fracture (OR = 2.5; P = 0.017) and IDS narrowing (OR = 4.15, P = 0.009) had a significant association with low back pain and vertebral osteophytes and spondylolisthesis did not have a significant association with low back pain. CONCLUSION: Only vertebral fractures and IDS narrowing had a significant association with chronic low back pain.Item Epidemiological differences between localized and nonlocalized low back pain(Lippincott Williams & Wilkins, 2017) Coggon, D.; Ntani, G.; Walker-Bone, K.; Palmer, K.T.; Felli, V.E.; Harari, R.; Barrero, L.H.; Felknor, S.A.; Gimeno, D.; Cattrell, A.; Vargas-Prada, S.; Bonzini, M.; Solidaki, E.; Merisalu, E.; Habib, R.R.; Sadeghian, F.; Kadir, M.M.; Warnakulasuriya, S.S.; Matsudaira, K.; Nyantumbu, B.; Sim, M.R.; Harcombe, H.; Cox, K.; Sarquis, L.M.; Marziale, M.H.; Harari, F.; Freire, R.; Harari, N.; Monroy, M.V.; Quintana, L.A.; Rojas, M.; Harris, E.C.; Serra, C.; Martinez, J.M.; Delclos, G.; Benavides, F.G.; Carugno, M.; Ferrario, M.M.; Pesatori, A.C.; Chatzi, L.; Bitsios, P.; Kogevinas, M.; Oha, K.; Freimann, T.; Sadeghian, A.; Peiris-John, R.J.; Sathiakumar, N.; Wickremasinghe, A.R.; Yoshimura, N.; Kelsall, H.L.; Hoe, V.C.; Urquhart, D.M.; Derrett, S.; McBride, D.; Herbison, P.; Gray, A.; Vega, E.J.STUDY DESIGN: Cross-sectional survey with longitudinal follow-up OBJECTIVES.: To test the hypothesis that pain which is localised to the low back differs epidemiologically from that which occurs simultaneously or close in time to pain at other anatomical sites SUMMARY OF BACKGROUND DATA.: Low back pain (LBP) often occurs in combination with other regional pain, with which it shares similar psychological and psychosocial risk factors. However, few previous epidemiological studies of LBP have distinguished pain that is confined to the low back from that which occurs as part of a wider distribution of pain. METHODS: We analysed data from CUPID, a cohort study that used baseline and follow-up questionnaires to collect information about musculoskeletal pain, associated disability and potential risk factors, in 47 occupational groups (office workers, nurses and others) from 18 countries. RESULTS: Among 12,197 subjects at baseline, 609 (4.9%) reported localised LBP in the past month, and 3,820 (31.3%) non-localised LBP. Non-localised LBP was more frequently associated with sciatica in the past month (48.1% vs. 30.0% of cases), occurred on more days in the past month and past year, was more often disabling for everyday activities (64.1% vs. 47.3% of cases), and had more frequently led to medical consultation and sickness absence from work. It was also more often persistent when participants were followed up after a mean of 14 months (65.6% vs. 54.1% of cases). In adjusted Poisson regression analyses, non-localised LBP was differentially associated with risk factors, particularly female sex, older age and somatising tendency. There were also marked differences in the relative prevalence of localised and non-localised LBP by occupational group. CONCLUSIONS: Future epidemiological studies should distinguish where possible between pain that is limited to the low back and LBP which occurs in association with pain at other anatomical locations.Item Association between pain and disability in patients with chronic mechanical low back pain(Sri Lanka Medical Association, 2015) Perera, G.L.R.S.; Wijayaratne, L.S.; Senarath, U.; Dissanayake, P.H.; Karunanayake, A.L.; Dissanayake, V.H.W.INTRODUCTION AND OBJECTIVES: Low back pain is the leading cause of years lived with disability in developed countries as well as in South Asian countries. The aim of this study is to evaluate the association between the intensity of pain and disability in patients with chronic mechanical low back pain (CMLBP) who attended the rheumatology clinic, National Hospital of Sri Lanka (NHSL). METHOD: This is a descriptive study on 675 patients with CMLBP who attended the rheumatology clinic, NHSL, from May 2012 to May 2014, recruited according to inclusion and exclusion criteria. Intensity of pain was measured using the 101-point numerical pain rating scale (NRS) and the disability was measured using the modified Oswestry Disability Index (MODI). A multiple linear regression model adjusted for age, gender, level of education, duration and frequency of pain and duration of treatment was used to assess the association between the intensity of pain and disability. RESULTS: Majority (482, 71.4%) were females. Mean age was 49.19 ± 11.75 years. Mean score for NRS was 46.79 ± 20.38 and for MODI was 31.77 ± 14.16, while 84.3% had daily pain. Intensity of pain was positively associated with the disability (p<0.01) and the standardized regression coefficient was +0.627 after adjusting for confounders. Frequency of pain, female gender and aging were positively associated with disability (p<0.05) while level of education, and durations of pain and treatment did not reach significant level. Conclusion: Intensity of pain explains 63% of the disability associated with CMLBP. Frequency of pain, female gender and age were also associated with disability.Item Risk factors for chronic low back pain in adults. A case control study done in Sri Lanka(OMICS International, 2014) Karunanayake, A.L.Introduction: Not many risk factor studies for low back pain have been done in Sri Lanka. Objectives To determine the association between low back pain and posture, exercise, family history, level of education, level of income, smoking, consumption of alcohol, body mass index (BMI) and consumption of animal proteins. Methodology: A case control study was done at two main teaching hospitals in Colombo North region Sri Lanka. This study was done on adult subjects. A pretested structured interviewer administered questionnaire was used to collect data. Their weights and heights were also measured. Results: The data were collected from 530 cases and 530 controls. Their age range was 18- 90 years. Mean age (SD) for cases was 49.4 (15) years. Mean age (SD) for controls was 47.1 (17) years. Females accounted for 67% of cases and 64% of controls. Bad posture (P < 0.001), low level of physical exercise (P < 0.001), positive family history (P < 0.001), high level of income (P < 0.001), high BMI and low BMI (P = 0.001), low level of education (P = 0.013) and regular consumption of alcohol (P = 0.039) had a significant association with low back pain. Smoking and consumption of animal proteins did not have a significant association with low back pain.Item Risk factors for chronic low back pain(OMICS International, 2014) Karunanayake, A.L.Chronic low back pain that last for more than 3 months affects an estimated 15-45% of the population and is the most common cause of disability in individuals between the ages of 45 and 65 years. It has a high morbidity with high social and economic effects. The studies done all over the world show that the prevalence of chronic low back pain is increasing. However the improvements in the understanding of the pathology and management of low back pain have not improved significantly over the years. Therefore having knowledge of risk factors for low back pain will help in the prevention of development of low back pain. Therefore a review of current literature regarding the risk factors for low back pain was carried out. According to majority of studies bad posture, lack of physical exercise, presence of low back pain related genes, low levels of education and poor nutrition had a significant association with low back pain. Few studies have found a significant association between low back pain and indulging in regular smoking, regular alcohol consumption, being overweight and underweight and low socio-economic background. However some studies have failed to find a significant association between these factors and low back painItem Radiological changes of spine in patients with chronic low back ache(Department of Family Medicine, Aga Khan University Pakistan, 2007) Karunanayake, A.L.; Pathmeswaran, A.; Wijayaratne, L.S.OBJECTIVE: To determine the association between causes such as disc space narrowing, vertebral osteophytes and spondylolisthesis with chronic low backache among Sri Lankan adults. METHODOLOGY: A case control study was done at the Teaching hospital Ragama and Rehabilitation hospital Ragama Sri Lanka. Postero- anterior and lateral radiographs of the lumbo- sacral spine of a hundred and thirty cases and a hundred and thirty three controls were studied. The cases and controls were matched for age and sex. All radiographs were read by two radiologists working independently for the presence of verebral osteophytes, spondylolisthesis and disc space narrowing. The results were analysed by applying chi squared test for bivariate associations and logistic regression for multivariate associations. RESULTS: The age range of the study subjects was 18-82 years. Mean (SD) age for cases was 49.3 years (15 years); Mean (SD) age for controls was 51.4 years (17 years). There were 81 (62.3%) females with low backache and 82 (61.7%) females without low backache. Disc space narrowing was present in 15% of cases and 2% of controls. A person with disc space narrowing had a 7 times greater chance of developing low backache compared to a person without disc space narrowing (OR = 6.8, P= 0.008). Vertebral osteophytes were present in 72% of cases and 64% of controls. Spondylolisthesis was present in 8% of cases and 7% of controls. Vertebral osteophytes and spondylolisthesis did not have a significant association with low backache. Conclusion: Among the radiological features of the lumbar spine, disc space narrowing was the only feature with a significant association with low backache.