ArticlePDF AvailableLiterature Review

Abstract

Low back pain is a massive problem in modern population, both in social and economic terms. It affects large numbers of women, especially those aged 45-60. Going through a perimenopausal period is associated with many symptoms, including low back pain. This paper is a review of published research on the association between the perimenopausal age and low back pain. PubMed databases were investigated. After the search was narrowed to “menopausal status, back pain”, 35 studies were found. Seven studies, which suited our area of research best, were thoroughly analyzed. All studies show increased pain when women enter this period of their life. There is no agreement among researchers regarding which stage of menopause is the most burdensome. Examples of possible treatments and physiotherapeutic methods targeting low back pain are also presented. Physiotherapeutic procedures used to treat low back pain include exercises in safe positions, balance exercises, manual therapy, massage and physical measures.
203
Review papeR
DOI: 10.5114/pm.2015.54347
Prz Menopauzalny 2015; 14(3): 203-207
Corresponding author:
Mateusz Kozinoga, MSc, Rehasport Clinic, 30 Górecka St., 60-201 Poznań,
e-mail: mkozinoga@hotmail.com
Submitted: 06.10.2014
Accepted: 02.07.2015
Abstract
Low back pain is amassive problem in modern population, both in social and economic terms. It affects
large numbers of women, especially those aged 45-60. Going through aperimenopausal period is associated
with many symptoms, including low back pain.
This paper is areview of published research on the association between the perimenopausal age and low
back pain. PubMed databases were investigated. After the search was narrowed to “menopausal status, back
pain”, 35 studies were found. Seven studies, which suited our area of research best, were thoroughly analyzed.
All studies show increased pain when women enter this period of their life. There is no agreement among re-
searchers regarding which stage of menopause is the most burdensome.
Examples of possible treatments and physiotherapeutic methods targeting low back pain are also pre-
sented. Physiotherapeutic procedures used to treat low back pain include exercises in safe positions, balance
exercises, manual therapy, massage and physical measures.
Key words: menopause, low back pain.
Introduction
As their life expectancy increases, contemporary
women live athird of their life in menopause [1]. Chron-
ic pain is more prevalent in women than in men, and
it increases with age [2-4]. According to Whelan et al.,
even 80% of women suffer from various symptoms (in-
cluding pain) in the perimenopausal period (which is
usually defined as the age range of 45-55) [5].
Going from a premenopausal period to a post-
menopausal one is aresult of slower production of fe-
male hormones by ovaries. This process is gradual and
spread over time, and anatural part of aging. Numer-
ous symptoms associated with the perimenopausal
period have been identified. Physical ones can include
spine and joint pain, hot flashes, night sweats, chronic
tiredness; psychological symptoms can include irrita-
tion and anxiety, mood swings, depression and sleep
disorders. The analyzed studies showed an associa-
tion between the menopausal period and depression,
hot flashes and sleep disorders but little attention
was paid to pain (in spine and peripheral joints) as an
equally prevalent symptom associated with this period
of life [6].
This review focuses on the association between the
perimenopausal and post-menopausal periods of life
and low back pain (LBP). Additionally, it describes phy-
siotherapeutic procedures used to treat low back pain.
Spine pain, especially in the lumbar region, is ase-
rious health issue in the modern world. At some point
in life, 36.4% to 58% of people in European countries
and the United States experience LBP [7, 8]. This poses
a great medical and socio-economic challenge to such
extent that some researchers call it alifestyle disease. It
is the main cause of absence in the workplace, and the
second cause of visiting primary health care profession-
als. Spine pain has negative psychological consequences
as it impairs daily functioning of the affected person. It
also poses aserious socio-economic problem – it is costly
due to disability-related absence in the workplace [9].
The purpose of the paper is to review available stud-
ies on perimenopausal women with LBP. This review
can shed more light on the issue of pain in women who
undergo menopause.
Back pain in women in the
perimenopausal period
PubMed databases were investigated. After the
search was narrowed to “menopausal status, back
pain”, 35 studies were found.
Low back pain in women before and after menopause
Mateusz Kozinoga1,2, Marian Majchrzycki3, Sylwia Piotrowska4
1Spine Disorder Unit, Department of Pediatric Orthopedics, Poznan University of Medical Sciences, Poznan, Poland
2Rehasport Clinic Poznan, Poland
3Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, Poznan, Poland
4Department of Physiology, Poznan University of Medical Sciences, Poznan, Poland
M R/P M 14(3) 2015
204
The selected studies were analyzed to verify wheth-
er they described the perimenopausal period of life,
correlated back pain and menopausal status, divided
the study group into sub-groups depending on the
menopausal status (not all studies did).
Twenty-eight papers were excluded due to lack of
information about back pain and menopausal status.
Seven studies, which suited our area of research best,
were thoroughly analyzed.
Most studies [1, 10-12] divided women into five
groups:
1. Premenopausal women who had had aregular pe-
riod in the past three months.
2. Early perimenopausal women who had an irregular
period in the past three months.
3. Late perimenopausal women who had menstruated
irregularly in the last 12 months but not in the last
3 months.
4. Postmenopausal women who had not menstruated
in the last 12 months.
Aseparate group of women who have hormone re-
placement therapy.
All analyzed studies showed that women who are
experiencing or experienced menopause suffered from
increased joint and spine pain.
According to Dugan et al. [10], 61% of women in the
study group of 2218 reported lumbar spine pain. Back
pain experienced at least once in two weeks prior to the
study was reported by 56% of 294 women in group 1
(premenopausal), 65% of 856 women in group 2 (early
perimenopausal), 59% of 137 women in group 3 (late
perimenopausal) and 61% of 152 women in group 4
(postmenopausal). Additionally, an association between
increased BMI and increased pain was observed, which
probably is aresult of increased mechanical loading of
the spine. Mitchell and Woods [12] divided their study
subjects into similar groups. In group 1 (late reproduc-
tive stage), of 196 women, 81.6% reported pain; in
group 2 (early transition stage), of 171 women, 77.8%
reported pain; in group 3 (late transition stage), of 106
women, 83% reported pain; in group 4 (early postmeno-
pause), of 67 women, 80.6% reported pain.
Along-term study by Szoeke et al. [11] established
that in the period of 8 years, the number of women
suffering from back pain grew from 44% to 59%. Most
women who took part in this study went from the
premenopausal to postmenopausal stage during the
study. The authors of the study also noticed adirect
association between increased BMI and increased
spine pain.
Astudy by Poomalar and Bupathy [1] on the Indian
female population divided 500 participants into 3 sub-
groups (perimenopausal, early postmenopausal and late
postmenopausal). Alow back pain incidence was as fol-
lows: 80% (n = 135), 76% (n = 133), and 79% (n = 232),
respectively.
AJapanese study by Manabe [13] of 2244 women
(group 1: 25-44 years, n = 719; group 2: 45-64 years,
n = 1,153; group 3: over 65 years, n = 372) showed
lumbar spine pain in 21%, 34% and 37% of study par-
ticipants, respectively. A study by Sievert [14] on the
Mexican female population is yet another paper show-
ing the risk of developing low back pain in women go-
ing through aperimenopausal period of life.
Athree-year study by Brennan Braden et al. [15]
examined 67,963 postmenopausal women aged 50-79
with chronic pain (low back pain, neck pain, headache,
joint pain or stiffness) and established that increased
BMI ( 30) was associated with the worsening of
pain. What is interesting is that when an opioid-using
group was compared to the group not using opioids, it
turned out that the former tended to have worse pain
scores (mean 41 vs. 72.6), worse physical functioning
(56.8 vs. 80.6), slightly higher BMI (29.5 vs. 27.3), were
more likely to be disabled (13.5% vs. 1.9%) and were
more likely to be diagnosed with depression (20.5%
vs. 11.1%).
There are disagreements in the literature about the
relationship between BMI and low back pain. Astudy of
Australian community-dwelling women from 2010 re-
ported adirect association between high BMI and both
high low back pain intensity and disability [16]. On the
other hand, a2010 study by Park et al. [17], in which
78 Korean women hospitalized due to spine pain were
observed, took alook at a relationship between BMI,
bone mineral density, age and the stage of postmeno-
pause. The results showed no association between BMI
and the incidence of back pain. This could be due to
asmall number of studied cases with BMI higher than
30 (3 women out of 78). The study also concluded that
compared to women with normal bone mineral density,
women with lower bone mineral density were signifi-
cantly older (p = 0.003) and had been postmenopausal
for alonger time (p = 0.031).
All these studies seem to unanimously suggest
an increased incidence of low back pain in perimeno-
pausal women comparing to other age groups. Table I
shows all of the discussed studies. None of them con-
tained any information about the treatment of pain
which would take into consideration perimenopause-
related factors (the risk of osteoporosis, hormonal im-
balance). These topics are legitimate topics for further
research.
On the other hand, Holte [18] concludes that the
menopausal period of life is not always associated with
negative symptoms. Norwegian women he studied re-
ported alower incidence of headaches during meno-
pause. Moreover, sleep disorders could be afactor in
spine pain. Resting can influence muscle tension and
tiredness, as aresult reducing the pain [19]. We have
not found any studies which would examine this issue
in depth.
M R/P M 14(3) 2015
205
Treating low back pain in perimenopausal
women
Physiotherapeutic procedures used to treat low
back pain include exercises, manual therapy, massage
and physical measures. Pharmacology is also used (e.g.
non-steroidal anti-inflammatory drugs) [20, 21].
According to Mishra et al. [22], the exercise program
for postmenopausal women should include endurance
(aerobic) exercises, strength exercises and balance ex-
ercises. Out of these, aerobics, weight bearing, and re-
sistance exercises are effective at increasing the bone
mineral density of the spine in postmenopausal women
[23]. This is an extremely desirable effect considering
the fact that bone mineral density tends to diminish at
this stage of woman’s life [24].
A meta-analysis by Hayden et al. [25] reviewed
available research on exercise therapy for low back pain
and concluded that the therapy is effective at slightly
decreasing pain. However, it should be noted that the
therapy was defined as “a series of specific move-
ments with the aim of training or developing the body
by aroutine practice or as physical training to promote
good physical health” [26]. This suggests anon-specific
character of exercises in the treatment of lumbar spine
pain. Nevertheless, recommending general physical
exercises is beneficial because they undoubtedly pro-
mote weight loss, which is important in perimenopau-
sal women who tend to be less physically active [24].
Moreover, Hayden et al. also concluded that the most
effective exercise therapy strategy for chronic LBP was
supervised and individually-tailored, high-dose stretch-
Tab. I. Summary of reviewed literature
Study Number
of participants
Group specific therapy/
Study groups
Comparison between
groups
Outcomes, conclusions
Dugan et al.
[10]
2218 women Group 1: Premenopausal
(294 women)
Group 2: Early perimenopausal
(856 women)
Group 3: Late perimenopausal
(137 women)
Group 4: Postmenopausal
(152 women)
Premenopausal women were
least affected by symptoms.
The biggest increase in pain
symptoms was observed
in early perimenopausal
women.
Aches and pain are significantly
and independently related with
the postmenopausal status.
Mitchell et al.
[12]
540 women Group 1: Late reproductive
stage (196 women)
Group 2: Early transition stage
(171 women)
Group 3: Late transition stage
(106 women)
Group 4: Early postmenopause
(67 women)
The most severe pain symp-
toms in the low back were
observed in groups 3 and 1.
Back pain increased in severity
as women progressed through
the menopausal transition
stages.
Szoeke et al.
[11]
438 women Australian-born women, aged
45-55 years and menstruating
at baseline
In the period of 8 years, the
number of women suffering
from back pain grew from 44%
to 59%. Apositive association
between increased BMI and in-
creased spine pain was observed.
Poomalar et al.
[1]
500 women Group 1: In menopause transi-
tion (135 women)
Group 2: Early post menopause
(133 women)
Group 3: Late post menopause
(232 women)
The highest incidence of
low back pain was observed
in the menopause transi-
tion group. The smallest
incidence rate, on the other
hand, was observed in the
early postmenopausal group.
The menopause-related symp-
toms have anegative effect
on the quality of life of the
perimenopausal and postmeno-
pausal women.
Manabe et
al. [13]
2244 women Group 1: Younger women,
25-44 years (n = 719)
Group 2: Middle-aged women,
45-64 years (n = 1153)
Group 3: Older women,
over 65 years (n = 372)
The spine pain incidence in-
creased with age, the largest
increase observed in group 3.
It can be assumed that there are
some differences in the primary
factors causing LBP between
the middle and the upper age
groups, with changes in the
condition of the lumbar spine
occurring gradually.
Brennan
Braden et al.
[15]
67 963 women Postmenopausal women aged
50-79 with chronic pain.
Increased BMI ( 30) is associ-
ated with the worsening of pain.
Park et al.
[17]
78 women Korean women hospitalized
due to spine pain.
No association between BMI and
the incidence of back pain.
M R/P M 14(3) 2015
206
ing and muscle strengthening exercise programs with
home practice [25].
The American Pain Society and American College of
Physicians stated that there is good evidence that spe-
cific physical exercises recommended by aphysiothera-
pist have amoderate positive effect in low back pain.
These organizations also pointed out that there is no
good evidence for physical therapies (transcutaneous
electrical nerve stimulation, ultrasounds) for low back
pain and so they do not recommend their use [27].
Study by Cherkin et al. [28] compared the effects
of physical therapy, chiropractic manipulation and pro-
vision of an educational booklet on low back pain. It
concluded that physical therapy and chiropractic ma-
nipulation were similarly effective in terms of symp-
toms, functioning, satisfaction with care, disability,
recurrences of back pain, and subsequent visits for
back pain. There was no significant difference between
achiropractor or aphysical therapist with regard to the
length of the therapy, which lasted for about 2.5 hours.
Meade et al. [29] also points out to the benefits of
manual therapy for low back pain.
A2010 report by Bronfort et al. on the scientific evi-
dence for manual treatment of pain (including low back
pain) in Great Britain concluded that spinal manipula-
tion and mobilization are effective in adults for acute,
subacute, and chronic low back pain. It was also noted
that as an alternative technique, massage is effective in
adults for chronic low back [30].
Suggested specific physiotherapeutic procedures
for low back pain for perimenopausal women:
• exercises in safe positions (with aminimal risk of wors-
ening the pain): supine position – exercises strength-
ening the floor of the pelvis, the transversus abdominis
and multifidus muscles, as they are the most important
stabilizers of the lower parts of the spine,
• balance exercises,
• manual therapy.
Conclusions
The perimenopausal stage of life is associated with
an increased incidence of low back pain. Increased BMI
( 30) is one of the factors increasing the prevalence
of pain. Suggested forms of treatment include physi-
otherapeutic procedures such as physical exercises,
massage, and manual therapy. Further studies are nec-
essary in the area of treatment of pain and association
between insomnia and low back pain.
Disclosure
Authors report no conflict of interest.
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p class="abstract"> Background: Menopause brings with it a cluster of symptoms and health problems. Low back ache (LBA) decreases the quality of life both socially and economically by increasing sickness absenteeism. Women are more likely to have backache and more so after menopause. Objective of the study was to find out the prevalence of LBA among postmenopausal women and also to assess the severity of the LBA. Methods: This was a cross-sectional community-based study conducted in block Hazratbal of district Srinagar, the field practice area of the department of community medicine, Government Medical College (GMC), Srinagar. The data was collected over a period of 3 months in 2018 by consecutive sampling by going door to door in the area. A woman who had attained menopause as per the definition was included in the study. Results: A total of 198 women were included. Mean age at the time of contact was 53.56 years. The prevalence of LBA among these women was 77.8% (154 of 198 women) with almost 55% women having moderate LBA and 16% women grading their LBA as severe. Those in late menopause were 4 times more likely to have severe LBA than those in early menopause. Conclusions: The magnitude of LBA among postmenopausal women is huge. About one quarter of these women have severe LBA. Therefore, to maintain a good quality of life of these women, specific measures to tackle this problem must be taken.</p
... 3 LBP largely effects women aged 45-60 years, accounting for distress on social as well as economic levels. 4 Age-predicted incidence of LBP was also found to be higher in post-menopausal women (90% between 40 and 60; mean age 50.1 years). 5 Decline in psychological and cognitive function along with other health-related conditions, like heart disease, mood swings and risk of cancer, are of particular importance in post-menopausal women affecting their quality of life (QOL). ...
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Objective: To determine the effects of core stability exercises on backache and quality of life of postmenopausal women. Methods: he comparative study was conducted at the Department of Physical Therapy, Margalla General Hospital, Rawalpindi, Pakistan, from February to June 2018, and comprised post-menopausal woman aged 40-60 years having backache who were randomly divided into experimental group A and control group B. Group A underwent core stability exercises along with traditional therapy, while group B had traditional low backache physical therapy. Each participant was treated three days a week for 12 weeks. The outcome was assessed using the manual muscle testing numerical pain rating scale, Oswestry disability index and Utian quality of life scale at baseline, week 6 and week 12. Data was analysed using SPSS 21. Results: Of the 35 subjects initially enrolled, 24(68.5%) completed the study. Of them, 14(58.3%) cases were in group A and 10(41.6%) controls in group B. The overall mean age was 54.54±5.13 years, mean menopause duration was 99.79±50.02 months, and mean duration of backache complaint was 23.95±14.85 months. Differences in outcome were significant between the groups for flexion and extension manual muscle testing and Utian quality of life scale (p<0.05) and non-significant for numerical pain rating scaleand Oswestry disability index (p>0.05). Conclusions: Core stability exercises were found to have the ability to reduce pain, disability and to improve strength and quality of life.
... There is considerable evidence that back pain in particular tends to increase during the menopause transition and earlypostmenopause [55]. Dedicated resistance and stabilization-type exercise is a recognized therapy for chronic or subacute low back pain [56,57]. ...
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Citation: Kemmler W, Hettchen M, Kohl M, Murphy MH, Shojaa M, Ghasemikaram M, et al. (2020) Effects of High Intensity Exercise during Early Postmenopause-the Randomized Controlled ACTLIFE-Study. J Osteopor Phys Act 8:228. ABSTRACT The aim of the study was to determine the effect of a dedicated exercise program on important menopausal risk factors and complaints in osteopenic early-postmenopausal women. Fifty-four women, 1-5 years postmenopause with osteopenia were randomly assigned (a) to a high impact weight bearing/high intensity, high velocity resistance training group (EG: n=27) exercising three times a week or (b) to an attention control group (CG: n=27). Study endpoints were body composition including Bone Mineral Density (BMD) at the Lumbar Spine (LS) as determined by Dual-Energy X-Ray Absorptiometry (DXA), menopausal symptoms, low back pain, lower extremity strength and power. After 28 weeks of intervention, significant effects were determined for free fat mass (EG: 0.48±0.68 kg vs CG:-0.15±0.88 kg, standardized mean differences (SMD): 0.80, p=.005), total body fat mass (EG:-1.19±1.26 kg vs CG: 0.36±1.59 kg,SMD: 1.08, p=.001), abdominal body fat rate (-1.26±1.99% vs 0.54± 1.53%, SMD: 1.02, p=.001), low back pain frequency (SMD: 0.55, p=.049) and severity (SMS: 0.66, p=.018), lower extremity strength (SMD: 1.46, p<.001) and jumping height (SMD: 0.92, p<.001) in the EG compared with the CG. Menopausal complaints improved in both groups, but changes were only significant in the EG (SMD: 0.33, p=.232). We did not determine significant exercise effects on LS-BMD (SMD: 0.26, p=.351). In conclusion, we demonstrate the general effectiveness of a multipurpose exercise protocol on various risk factors and complaints related to the menopausal transition. Future assessments have to determine the exercise effects on BMD, possibly the most challenging physiologic outcome of this ongoing project.
... The prevalence of low back pain in women increases with age, with a significant spike in prevalence during the years associated with the transition to post-menopause (TPM) [6,8]. This is seen in studies comparing men with women, as well as in studies comparing different age groups of women [8,[10][11][12]. A representative example of this trend came from a recently published 23-year long epidemiological study by Angst et al, which revealed that in a cohort of community-dwelling men and women (n = 499), chronic low back pain prevalence remained relatively steady from ages 28-41 and then spiked nearly threefold around age 50 [10,13]. ...
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Purpose of Review The purpose of this narrative review is to inform readers of the particular impact opioids have had on midlife women and to provide perspective on non-opioid treatment options for women with chronic low back pain. Recent Findings Research has shown that midlife women experience more chronic low back pain than men and other age groups of women. As a result, opioids have been particularly deleterious in this demographic group. In addition, there are no data to recommend them for long-term use, while there is a breadth of data on the negative consequences of long-term opioid use. Treatment guidelines now recommend non-pharmacologic agents as the first-line treatments, followed by non-opioid pharmacologic agents. Opioids are to be prescribed only if patients have failed non-pharmacologic and non-opioid pharmacologic agents and if the potential for benefit outweighs the potential for harms. Summary Midlife women experience more chronic low back pain than men and other age groups of women. Opioids have resulted in particularly poor outcomes in this population, with the greatest rise in opioid overdose deaths occurring in midlife women. Treatment guidelines now place emphasis on non-pharmacologic treatments and non-opioid pharmacologic treatments first, while opioids are a last resort. More and better quality research is needed on existing non-opioid treatment options in order to establish better guidelines and to determine long-term outcomes with these therapies.
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Introduction: Non Specific Low Back Pain (NSLBP) is a frequent problem faced by the majority of postmenopausal women at some stage of their lives, resulting in a significant level of disability. Aim: To evaluate the effectiveness of core stabilisation exercises compared to traditional physical treatment in postmenopausal women with NSLBP. Materials and Methods: A prospective longitudinal study was conducted from January 2022 to August 2022, including 50 postmenopausal women aged 45-60 years with NSLBP. They were placed into two groups. Conventional LBP physical therapy methods were administered to group 2. The identical traditional and Core muscle Stabilisation Exercises (CSE) were implemented in the group 1. The Modified Oswestry Disability Index (MODI) was used for the assessment of disability. The Mann-Whitney U test and Friedman Analysis of Variance (ANOVA) were conducted to analyse changes in disability scores across and among groups at the ends of the second, fourth, and sixth weeks of treatment. Results: Of 50 patients initially enrolled in the study, 33 patients were available for the final follow-up. Group 1 consisted of 16 patients, while group 2 had 17 patients. Significant reduction in disability was found across the two groups at the second, fourth, and sixth weeks of treatment (p-value
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Introduction: The transition from reproductive to post-reproductive life is part of the female life cycle that impacts well-being, with menopause as a significant milestone. Regular physical activity should be encouraged to mitigate the symptoms of menopause and prevent age-related problems. Hydrotherapy is one such alternative, since immersion in heated water facilitates exercises that would be difficult to perform on land. Objective: Assess women’s perception about the effect of hydrotherapy on the signs and symptoms of postmenopause. Methods: A qualitative study in which participants underwent 48 hydrotherapy sessions and answered a semistructured interview. Results: The participants were eight women, aged 55.75 ± 8.55 years, menopausal for 8.5 ± 7.98 years, with vasomotor symptoms (100%), mood swings (87.5%), sleep disorders (87.5%), vaginal dryness (62.5%), low sex drive (62.5%) and chronic pain (100%). Conclusion: Women’s perception about the effects of hydrotherapy on the signs and symptoms of postmenopause include less pain and muscle tension, a decline in the signs and symptoms, better quality of life and sexual pleasure, and an improvement in biopsychosocial factors such as anxiety and stress through better social interaction.
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Background: Chronic low back pain causes substantial morbidity and cost to society while disproportionately impacting low-income and minority adults. Several randomized controlled trials show yoga is an effective treatment. However, the comparative effectiveness of yoga and physical therapy, a common mainstream treatment for chronic low back pain, is unknown. Methods/design: This is a randomized controlled trial for 320 predominantly low-income minority adults with chronic low back pain, comparing yoga, physical therapy, and education. Inclusion criteria are adults 18-64 years old with non-specific low back pain lasting ≥ 12 weeks and a self-reported average pain intensity of ≥ 4 on a 0-10 scale. Recruitment takes place at Boston Medical Center, an urban academic safety-net hospital and seven federally qualified community health centers located in diverse neighborhoods. The 52-week study has an initial 12-week Treatment Phase where participants are randomized in a 2:2:1 ratio into i) a standardized weekly hatha yoga class supplemented by home practice; ii) a standardized evidence-based exercise therapy protocol adapted from the Treatment Based Classification method, individually delivered by a physical therapist and supplemented by home practice; and iii) education delivered through a self-care book. Co-primary outcome measures are 12-week pain intensity measured on an 11-point numerical rating scale and back-specific function measured using the modified Roland Morris Disability Questionnaire. In the subsequent 40-week Maintenance Phase, yoga participants are re-randomized in a 1:1 ratio to either structured maintenance yoga classes or home practice only. Physical therapy participants are similarly re-randomized to either five booster sessions or home practice only. Education participants continue to follow recommendations of educational materials. We will also assess cost effectiveness from the perspectives of the individual, insurers, and society using claims databases, electronic medical records, self-report cost data, and study records. Qualitative data from interviews will add subjective detail to complement quantitative data. Trial registration: This trial is registered in ClinicalTrials.gov, with the ID number: NCT01343927.
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Introduction: The overall health and well-being of middle-aged women has become a major public health concern around the world. More than 80% of the women experience physical or psychological symptoms in the years when they approach menopause, with various distresses and disturbances in their lives, leading to a decrease in the quality of life. The aim of our study was to assess the quality of life and the impact of hormonal changes in perimenopausal and postmenopausal women and to correlate the prevalence of the symptoms with their duration since menopause. Material and methods: A cross- sectional study was done at Sri Manakula Vinayagar Medical College and Hospital, Puducherry, from January 2012 to April 2012. Five hundred women who were in the age group of 40-65 years, who came from rural areas to our hospital, were included in the study. The women who were receiving hormonal treatment and those who refused to participate in the study were excluded. The data such as the socio-demographic information and the menstruation status, which were based on the reported length of time since the last menstrual period and the experience of the symptoms, as were tested in the Menopause Specific Quality of Life (MENQOL) questionnaire, were collected from each patient. The women who were included in the study were divided into three groups as the menopause transition, early postmenopausal and the late postmenopausal groups. All the data which were gathered were analyzed by using SAS 9.2. The Chi square test and the relative risk and the confidence interval calculations were applied to compare the frequencies of the symptoms among the women with different menopausal statuses. A p-value of less than 0.05 was considered to be statistically significant. Results: Mean menopausal age in the study group was 45 years. The most common symptom within study subjects were low back ache (79%) and muscle-joint pain (77.2%). The least frequent symptoms were increase in facial hair (15%) and feeling of dryness during intimacy (10.8%). Scores of vasomotor domain were significantly more in menopause transition group. Scores of physical domain were significantly more in late postmenopausal group. Conclusion: The menopause related symptoms had a negative effect on the quality of life of the perimenopausal and the postmenopausal women. Such regional studies can help in creating awareness and in educating women on the early identification of the common menopausal symptoms.
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The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions. The conclusions are based on the results of systematic reviews of randomized clinical trials (RCTs), widely accepted and primarily UK and United States evidence-based clinical guidelines, plus the results of all RCTs not yet included in the first three categories. The strength/quality of the evidence regarding effectiveness was based on an adapted version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs. By September 2009, 26 categories of conditions were located containing RCT evidence for the use of manual therapy: 13 musculoskeletal conditions, four types of chronic headache and nine non-musculoskeletal conditions. We identified 49 recent relevant systematic reviews and 16 evidence-based clinical guidelines plus an additional 46 RCTs not yet included in systematic reviews and guidelines.Additionally, brief references are made to other effective non-pharmacological, non-invasive physical treatments. Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation.Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic.
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Recommendation 1: Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause. The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain (strong recommendation, moderate-quality evidence). Recommendation 2: Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence). Recommendation 3: Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence). Recommendation 4: Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy) (strong recommendation, moderate-quality evidence). Recommendation 5: Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options (strong recommendation, moderate-quality evidence). Recommendation 6: For patients with low back pain, clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care. Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy (strong recommendation, moderate-quality evidence). For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs. Recommendation 7: For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits-for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence).
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With a significant number of women belonging to the status of menopause and beyond, it is imperative to plan a comprehensive health program for them, including lifestyle modifications. Exercise is an integral part of the strategy. The benefits are many, most important being maintenance of muscle mass and thereby the bone mass and strength. The exercise program for postmenopausal women should include the endurance exercise (aerobic), strength exercise and balance exercise; it should aim for two hours and 30 minutes of moderate aerobic activity each week. Every woman should be aware of her target heart rate range and should track the intensity of exercise employing the talk test. Other deep breathing, yoga and stretching exercises can help to manage the stress of life and menopause-related symptoms. Exercises for women with osteoporosis should not include high impact aerobics or activities in which a fall is likely. The women and the treating medical practitioner should also be aware of the warning symptoms and contraindications regarding exercise prescription in women beyond menopause. The role of exercise in hot flashes, however, remains inconclusive. Overall, exercising beyond menopause is the only noncontroversial and beneficial aspect of lifestyle modification and must be opted by all.
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Unlabelled: Pain complaints are commonly reported symptoms among postmenopausal women and can have significant effects on health-related quality of life. We sought to identify medical and psychosocial factors that predict changes in pain and overall physical functioning over a 3-year period among postmenopausal women with recurrent pain conditions. We examined data from postmenopausal women age 50 to 79 with recurrent pain conditions (low back pain, neck pain, headache or migraines, or joint pain or stiffness) over a 3-year period using the Women's Health Initiative Observational Study Cohort (N = 67,963). Multinomial logistic regression models controlling for demographic and clinical characteristics were used to identify baseline predictors of change in the SF-36 subscales for pain and physical functioning between baseline and 3-year follow-up. Body mass index (BMI) was associated with worsening of pain (OR [95% CI] 1.54 [1.45-1.63] for BMI ≥30) and physical functioning (1.83 [1.71-1.95] for BMI ≥30). A higher reported number of nonpain symptoms, higher medical comorbidity, and a positive screen for depression (1.13 [1.05-1.22] for worsened pain) were also associated with worsening of pain and physical functioning. Baseline prescription opioid use was also associated with lack of improvement in pain (OR .42, 95% CI .36-.49) and with worsened physical functioning (1.25 [1.04-1.51]). Perspective: This study presents prospective data on change in pain and physical functioning in postmenopausal women over a 3-year period. Our results suggest depression, nonpain physical symptoms, obesity, and possibly opioid treatment are associated with worse long-term pain outcomes in this population.
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Women going through menopause experience bone loss and increased musculoskeletal pain, including low back pain. This study explored the relationships between bone mineral density (BMD) and body mass index (BMI), postmenopausal period and outcomes of treatment for low back pain in postmenopausal Korean women. On examining the medical records of 78 postmenopausal women hospitalized for low back pain, investigators found that women with low BMD were older and had been postmenopausal for longer periods than women with normal BMD. Postmenopausal length was positively correlated with pain scores at day 15 and 20 post-admission (P = 0.011 and 0.006) and negatively correlated with T-scores (P = 0.002). BMI was positively correlated with T-scores (r = 0.283, P = 0.022). In conclusion, age, postmenopausal length and BMI correlate with BMD in Korean women suffering from LBP. Larger studies investigating the associations between menopause, BMD, BMI and LBP seem desirable. Moreover, evidence-based therapeutic approaches should be explored for BMD and LBP management.
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The aims of this study were to identify groups of women in the late menopausal transition stage who experienced the same cluster of symptoms and to identify indicators that predicted membership in these distinct groups. The sample consisted of a subset of Seattle Midlife Women's Health Study participants who were in the late menopausal transition stage and provided self-report data on symptoms experienced between 1990 and 2005. Latent class analysis (LCA) was used to identify groups of women who experienced similar clusters of the following five symptoms: problem concentrating, hot flashes, joint ache, mood changes, and awakening at night. LCA with multivariate logistic regression was used to identify covariates that predicted membership in each group. Four groups of women were identified: (1) low severity for all symptoms except for joint ache, which was moderate (65%); (2) high severity for all symptoms except for hot flashes, which was moderate (13%); (3) high severity for hot flashes, joint ache, and awakening at night (12%); and (4) high severity for problem concentrating and joint ache (10%). A clear delineation between groups based on individual characteristics was not fully elucidated. This analysis demonstrates that LCA may be useful to identify women who may experience poorer outcomes related to a higher propensity for severe symptoms. Shifting the focus from single symptoms to symptom clusters will aid in the identification of phenotypic profiles, thus facilitating symptom management strategies that can be tailored to meet the needs of individual women.