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 Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 27  |  Issue : 1  |  Page : 22-25

Chronic low back pain and treatment with microwave diathermy


1 Department of Physical Medicine and Rehabilitation, Sheri-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India
2 Department of Anesthesiology, Sheri-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India
3 Department of Internal Medicine, Sheri-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India

Date of Web Publication10-Jul-2013

Correspondence Address:
Sheikh Javeed Ahmad
Department of Physical Medicine and Rehabilitation, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir - 190 011
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-5333.114860

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  Abstract 

Clinical trial of 100 patients of chronic low back ache was conducted in the Department of Physical Medicine and Rehabilitation (PMR) at Sher-i-Kashmir Institute of Medical Sciences Soura a Tertiary care hospital for period of two year from January 2010 to January 2012 to find out effect of Microwave diathermy (MWD). All patients were treated with Microwave diathermy along with conventional treatment. The results were compared and student's 't' test was applied to see the level of significance. A significant improvement after treatment (P=0.000) was found. The present study suggests that short wave diathermy is effective for the treatment of patients with chronic low back pain.

Keywords: Chronic low back pain, microwave diathermy, conventional treatment


How to cite this article:
Ahmad SJ, Buchh VN, Koul AN, Rather AH. Chronic low back pain and treatment with microwave diathermy. Indian J Pain 2013;27:22-5

How to cite this URL:
Ahmad SJ, Buchh VN, Koul AN, Rather AH. Chronic low back pain and treatment with microwave diathermy. Indian J Pain [serial online] 2013 [cited 2019 Sep 22];27:22-5. Available from: http://www.indianjpain.org/text.asp?2013/27/1/22/114860


  Introduction Top


The incidence of chronic low back pain is increasing day by day leading to long term disability. [1] Low back pain is a symptom complex, [2] if it persists for at least 3 months it is known as chronic low back pain. [3] Almost 80% of all people experience back pain to some extent during their life time; a price paid for upright posture. [4],[5] Low back pain affects the area between the lower rib cage and gluteal folds and often radiates to thigh. [6] Back pain is one of the most prevalent medical diseases in industrialized countries [7] and common disability in patients under the age of 40 years. [8] Common abnormalities in lumbar spine are degenerative changes found in all older people. [9] Back pain in most cases is self-limiting with recovery in 70% within 1 month and 90% within 2 to 3 months while in about 4%, duration exceeds 6 months. [10] The men and women are equally affected most commonly between the age of 30 and 55 years. [11] The herniated disk is found in 5% of all cases of chronic low back pain. [12] The other causes of low back pain are infections, tumors, fractures osteoporosis, ankylosing spondylitis, and rheumatoid arthritis. The other associated risk factors include involvement in occupation requiring forward bending, lifting heavy weight, exposure to vibration caused by vehicles, or industrial machinery. [13],[14]

The treatment and management of Low back pain needs multidisciplinary approach. Current multidisciplinary bio psychological rehabilitation regards disabling chronic pain as a result of multiple interrelating physical, psychological and social or occupational factors. [15] Microwave diathermy produces heat with deeper tissue penetration [16] and is used as modality of treatment in patients with chronic low back pain. So the aim of this study was to find out the effects of microwave diathermy in the management of patients with chronic low back pain.


  Material and Methods Top


The study was conducted on 100 patients (36 males and 64 females) during the period 2010-2012 who attended department of Physical Medicine and Rehabilitation, Sher-i-Kashmir institute of medical sciences, Soura Srinagar, Kashmir, India, a multispecialty hospital. The patients were selected randomly according to the following clinical criteria.

Inclusion criteria : Patient of either sex with age above 35 years and below 55 years with chronic low back pain.

Exclusion criteria : The patients below the age of 35 and above 55 years, having low back pain for less than 3 months, with traumatic low back pain or acute and inflammatory low back pain, with any complication like cauda equina syndrome, caries spine, malignancy, etc.

Treatment Procedures

All patients were treated in the department with MWD in the low back region for 15 min, 6 times in a weak for four weeks. Non-steroidal anti-inflammatory drugs and therapeutic exercises with activities of daily living instructions were prescribed to all the patients.

Date Collection Procedure

After the treatment as per schedule, the patients were followed up weekly for 4 weeks and outcome were recorded for pain by Visual Analog Scale [17],[18],[19] from 0-10 (0 = no pain and 100 is worst possible pain).

Statistical analysis

All the outcome assessment data were analyzed by using computer and the SPSS package program (version-16.0) for student's paired 't' test to see the level of significance. The results were expressed as mean and standard deviation and P= 0.05 was considered as the level of significance.


  Results Top


A total of 100 patients of chronic low back pain were included in the study. These included 36 males and

64 female patients with male: female ratio 1:1.88 [Figure 1]. The mean age of the patients in study was 42.69 ± 4.28 years. Most of the patients in both males and females were found in the age group of 41-50 years [Figure 2] and [Figure 3]. The mean weight of patients was 64.22 ± 5.5 kg and mean height was 154.88 ± 8.5 cms. Mean duration of symptoms was 36.90 ± 7.82 months. Most of the patients (95%) gave history of gradual onset of pain. Maximum patients had pain of intermittent character (80%) while (20%) had pain of continuous character.
Figure 1: Distribution of sex in the study subject (n=100)

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Figure 2: Distribution of age in the study subject (n=100)

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Figure 3: Mean pain scores at different times

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Outcome of the treatment

There was significant improvement of VAS score with respect to time. It was observed that improvement of symptoms started at the end of 1 week that is pretreatment summation score V s W 1 score (at the end of one week summation score) 7.27 ± 0.71 vs. 6.30± 0.80, respectively (P = 0.00, Mean difference = 0.97, 95% CI= 0.90 to 1.05, Effect size = 2.51) and the improvement gradually increased day by day. And after the end of treatment there was significant improvement found in our study that the pretreatment vs. post treatment summation score was 7.27 ± 0.71 vs. 4.12 ± 0.50 (P = 0.00, Mean difference = 3.15, 95% CI = 3.04 to 3.26, Effect size = 5.78) [Table 1]. This proves that treatment with MWD is helpful for the improvement of the patient with chronic low back pain.
Table 1: The time point treatment responses of the patient (n= 100)

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  Discussion Top


In this study 100 patients of chronic low back pain participated, out of which 36 (36%) were male and 64 (64%) were female with male:female ration of 1:1.88. Although male and female are equally prone to develop chronic low back pain. [20] The female preponderance in our study may be due to more females attending our hospital. The mean age of patients was 42.69 ± 4.28 with maximum patients in the age group of 40-45 years. In a study, it was found maximum patients were in the age group of 30-39 years. [21] This almost coincides with our study. The current study showed significant improvement of symptoms by applying Microwave diathermy began to appear at the end of first week. The improvement continued throughout the whole period of 4 weeks. At the end of 4 th week highly significant improvement of symptoms was found. Zaman [22] reported that the patients who received microwave diathermy have complete relief of pain compared to placebo group (P = 0).

Gibson et al studied 109 patients and it was observed that improvement after treatment with short wave diathermy was observed in 59% patients. [23] Rahman found that 77.42% of patients were improved after the treatment with short wave diathermy (SWD). [21] Shakoor et al. found significant improvement after SWD in patients with neck pain. [24] Bansil et al found SWD was effective in the treatment of OA Knees joint. [25] Rahman et al. conducted a comparative study in patients of spondylosis; SWD was found to be an effective treatment. [26] Lunda and Bombarien [27] acknowledged the trend of using electrotherapeutic and thermal modalities in management of chronic low back pain with uncertain effectiveness. In meticulous review, Chard and Dieppe [28] indicated that the use of non pharmacological intervention like SWD in osteoarthritis is an essential treatment.

In conclusion, present study showed that SWD is an effective modality in the treatment of the patients with chronic low back pain as an adjuvant to NSAIDS. Large controlled group for specific evaluation of its effect is recommended.

 
  References Top

1.Casey PJ, Weinstein JN. Low back pain. In: Ruddy S, Jr. EDH, Sledge CB, editors, Kewlly's Textbook of Rheumatology. Vol. 36. Philadelphia-London: W.B. Saunders; 2001. p. 509-24.  Back to cited text no. 1
    
2.Frank A. Low back pain, education and debate. BMJ 1993;306:901-9.  Back to cited text no. 2
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3.Datta D, Mirza SK, White III AA. Low back pain. In: Kelley's textbook of rheumatology. Harris ED, Budd RC, Genoves MC, Firestein GS, Sargent JS, Sledge CB, editors. 7 th ed. Philadelphia: WB Saunders; 2005. p. 588-600.  Back to cited text no. 3
    
4.Hult L. Cervical, dorsal and lumber spine. Acta Orthop Scand Suppl 7;1954;17:1-102.  Back to cited text no. 4
    
5.Nachemson AI. The lumber spine, an orthopaedic challenge. Spine 1976;11:59-71.  Back to cited text no. 5
    
6.Frymoyer JW. Back pain and Sciatica. N Engl J Med 1998;318:291-300.  Back to cited text no. 6
    
7.Levine DB, Leipzig JM. The painful back. In: MCCarty DJ, Koopman WJ, editors. Arthritis and Allied conditions. Vol. 2. Philadelphia-London: Lea and Febiger; 1993. p. 1583-600.  Back to cited text no. 7
    
8.Engstrom JW. Back and neck pain. In: Braunwald E, Hauser SL, Fauci AS, Lango DL, Kasper DL, Jameson JL, editors. Harrison 'principles of internal Medicine. New York-London. Mc Graw-Hill 2001;16:79-90.  Back to cited text no. 8
    
9.Porter RW. Management of Back Pain. 2 nd ed, Vol. 2. Edinburgh-Tokyo: Churchill Livingstone; 1993. p. 13-27.  Back to cited text no. 9
    
10.Horal J. The clinical appearance of low back pain disorders in the city of Gothenburg, Sweden Comparison of incapacitated probands with matched controls. Acta Orthop Scand Suppl 1969;118:1-109.  Back to cited text no. 10
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11.Kelsy JL. An epidemiological study of acute herniated lumber intervertebral discs. Rheumatol Rehabil 1975;14:144-59.  Back to cited text no. 11
    
12.Hirsh C Etiology and pathogenesis of low back pain. Israel J Med Sci 1996;2:362-70.  Back to cited text no. 12
    
13.Frymoyer JW, Pope MH, Clements JH, Wilder DG, MacPherson B, Ashikaga T. Risk factors in low-back pain. An epidemiological survey. J Bone Joint Surg 1983;65:213-8.  Back to cited text no. 13
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14.Kelsey JL, Hardy RJ. Driving of motor vehicles as risk factor for facute herniated lumber intervertebral discs. Am J Epidemiol 1975;102:63-73.  Back to cited text no. 14
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15.Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C. Multidisciplinary rehabilitation for chronic low back pain: Systematic review. BMJ 2001;322:1511-6.  Back to cited text no. 15
    
16.Weber DC, Hoppe KM. Physical agent modalities. In: Physical medicine and rehabilitation. Braddom RL, editor. 3 rd ed. China: Saunders Elsevier; 2007. p. 459-77.  Back to cited text no. 16
    
17.Williams AC de C, Davis HT, Chadury Y. Simple pain rating scales hide complex idiosyncratic meanings. Pain 2000;85:457-63.  Back to cited text no. 17
    
18.Price DD, Bush FM, Long S, Harkins SW. A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales. Pain 1994;56:217-26.  Back to cited text no. 18
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19.Mannche C, Asmussen K, Lauritsen B, Vinterberg H, Kreiner S, Jordan A. Low back pain rating scale: Validation of tool for assessment of low back pain. Pain 1994;57:317-26.  Back to cited text no. 19
    
20.Shakoor MA, Huq MN, Khan AA, Moyeenuzzaman M. Effects of ultrasound therapy (UST) in osteoarthritis of the knee joint. C M-O-S(child) H J 2003;1:11-6.  Back to cited text no. 20
    
21.Rahman MM. Low Back pain - clinical analysis 342 cases. Bangladesh Med Coll J 1999;4:67-71.  Back to cited text no. 21
    
22.Zaman MM. A study on patients with low back pain attending Physical Medicine and Rehabilitation Department of IPGM and R. Dhaka, IPGM and R, 1992 Dissertation.  Back to cited text no. 22
    
23.Gibson T, Grahame R, Harkness J, Woo P, Balagrave P, Hills R. Controlled comparison of shortwave diathermy treatment with osteopathic treatment in nonspecific low back pain. Lancet 1985;1:1258-60.  Back to cited text no. 23
    
24.Shakoor MA, Islam MQ, Zaman MM, Mian MAH, Khan S. Effects of cervical traction and shortwave diathermy on the patients with neck pain. J Dhaka Med Coll 2001;10:91-5.  Back to cited text no. 24
    
25.Bansil CK, Joshin JB. Effectiveness of shortwave Diathermy and Ultrasound in the treatment of Osteoarthritis of the Knee joint. Med J Zambia 1975;9:138-9.  Back to cited text no. 25
    
26.Rahman S, Moyeenuzzaman M, Islam MQ. Controlled comparison of microwave diathermy treatment with exercise in lumber spondylosis. Bangladesh J Med 1997;8:22-4.  Back to cited text no. 26
    
27.Li LC, Bombardier C. Physical therapy management of low back pain an explaratory survey of therapist approaches Phys Ther 2001;81:1018-28.  Back to cited text no. 27
    
28.Chard J, Dieppe P. The case for nonpharmacologic therapy of osteoarthritis. In: Current Rheumatology, Cronstein BN, editor. Philadelphia: Current Science; 2001. p. 88-94.  Back to cited text no. 28
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]


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