chronic back pain

Subjective and Objective Categorization of Chronic Low Back Pain in Professional Nurses: Research Proposal
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Subjective and Objective Categorization of Chronic Low Back Pain in Nursing Professionals
Introduction
Nursing is a challenging profession and staff nurses are entrusted with the responsibility of extending and safe and quality healthcare. Safe and quality healthcare are essential for ensuring positive health outcomes for patients. Nurses should be physical, physiologically and psychologically fit for ensuring safe and quality healthcare for their patients. However, the presence of low back pain amongst staff nurses limits delivery of safe and quality healthcare. Prevalence of low back pain (LBP) is quite high amongst staff nurses. Management of chronic low back pain (CLBP) is often challenging. Such challenges stem from the inability of categorizing CLBP. CLBP may be nociceptive or neuropathic in nature. Nociceptive pain refers to the pain that originates due to stimulation of nociceptors (Eghbali et al., 2012).
Nociceptors refer to the pain receptors that are present in the somatic or visceral organs of our body. On the other hand, neuropathic pain originates from damage to the nerves or hypersensitivity of the nerves to painful stimuli. Different types of neuropathic pain are witnessed in clinical settings. For example, diabetic peripheral neuropathy develops from damage to the peripheral nerves due to lack of glucose in the concerned nerves.

Post-herpetic neuralgia is caused by Herpes Zoster virus. On the other hand, radiculopathy is a neuropathic pain that stems from compression of the spinal nerves. Radiculopathy is strongly associated with poor postural hygiene and poor postural habits. Nurses are prone to radiculopathy due to prolonged standing. CLBP or LBP decreases the productivity and physical competence of staff nurses. The present study would focus on the subjective and objective categorization of chronic low Back pain in nursing professionals.
Literature Review
Freynhagen and Baron (2009) reported that the prevalence of CLBP is very high in Western societies. Epidemiological studies have indicated that neuropathy is prevalent in 20% to 35% cases of CLBP. It has been estimated that chronic lumbar radicular pain is the most common form of neuropathic pain that accounts for CLBP (Freynhagen & Baron, 2009).
Ghadvani et al. (2016) indicated that LBP is the most prevalent health hazard in professional nurses. The authors implicated that low back pain should be evaluated through a structured questionnaire. The multi-factorial questionnaire should be aligned with the social cognitive theory (Ghadvani et al., 2016).
Yassi and Lockhart et al. (2013) conducted a systematic review to evaluate the causative factors for CLBP amongst nursing professionals. The authors evaluated 987studies, and 89 studies were finally included in the analysis. Manual handling of patients was strongly associated with CLBP amongst professional nurses. However, the other nursing duties were also responsible for the development of CLBP. The risk of CLBP amongst nurses ranged from 1.2 to 5.5 (p<0.001) compared to their control counterparts.
Eghbali et al. (2012) evaluated the role of reflexology in alleviating the intensity of chronic low back pain amongst professional nurses. The authors indicated nursing represents the top ten careers that impose the risk of WMSDs.
3. Methodology
Study Design and Site of Study
The present research would be conducted as a prospective randomized control study. Based on appropriate approval the study participants would be selected from 4 tertiary care hospitals. The NNT (number needed to treat) would be selected to achieve a power of 90% for the proposed study. The study participants would be selected through Stratified Random Sampling. Stratified Random Sampling would be based on the specialty of nursing. Age-matched controls would be appropriately selected for the present study. The age-matched controls would not belong to the nursing profession. These subjects would include administrative staffs, patient counselors, and consulting physicians.
Procedure
Evaluation of existing evidence
Evidence on the prevalence and etiology of low back pain would be collected from review of existing literature. The literature review for the proposed research would be based on keyword search strategy. The keywords were linked through Boolean connectors for selecting the appropriate articles. The keywords and the Boolean connectors that were used are “Chronic Low back Pain” OR “Neuropathic Pain” OR “Nociceptive Pain” AND “Subjective Categorization” OR “Objective Categorization” AND “Nurses” OR “Women”. The keywords were used to visit different clinical and nursing databases. These databases were “OVID online” “Medline Search” “Pubmed Central” “Cochrane Database” and “Google Scholar”. The literature review indicated different articles related to chronic low back pain in nurses. However, no studies categorized chronic low back pain in nurses either subjectively or objectively. These findings provided the guiding framework for the proposed research.
Prospective Study
The study participants would be selected after appropriate screening for diabetes mellitus/history of accidental injury/ history of depressive disorders/ or history of anxiety. These individuals would not be included in the study to prevent the effects of confounding variables. The present study would aim to identify the prevalence and cause of LBP or CLBP as a function of postural stress amongst staff nurses. Evidence indicates that nurses suffering from diabetes mellitus or psychological disorders may complain of LBP or CLBP which is not associated with postural stress. Hb1Ac levels would be assessed for diagnosing diabetes mellitus. History of accidental injury would be evaluated from the verbatim of the study participants. However, the history of accidental injury would be evaluated through radiological findings. The presence of depressive disorders would be screened through the “Prime-MD” tool. On the other hand, the “State-Trait Anxiety Scale” would be used to assess the presence of anxiety disorders in an individual. The study participants (both experimental subjects and their age-matched control) would be subjectively and objectively assessed for the presence of chronic low back pain. The Visual Analogue Scale would be used for subjective assessment of chronic low back pain. “Pain Detect” tool would be implemented for objective assessment of chronic low back pain. The medication history of study participants would also be collected for objectifying the etiology of the low back pain. This is because nurses suffering from neuropathic pain would not be managed by non-steroidal anti-inflammatory drugs (NSAIDs).
Statistical Tests for the Proposed Research
Different statistical measures would be implemented for analyzing the findings of the study. Paired and one-sample t-tests would be conducted for appraising the findings of the study in comparison to age-matched controls and also from the literature search. However, if a prospective randomized study is not approved, the present study would be conducted as a meta-analysis.
Research Questions
The proposed study would evaluate 3 research questions. These questions are:
1st Research Question: Whether the risk of neuropathic pain is significantly higher in nurses compared to their age-matched controls?
(Screening of neuropathic pain would be based on the ‘Pain Detect Tool”)
2nd Research Question: Whether objective pain score is significantly higher in nurses compared to their age-matched controls?
(The objective pain score refers to the alphanumeric pain score as obtained through the Pain Detect Tool).
Hypothesis Testing and Statistical Inference
Hypothesis Testing For Evaluating the Prevalence of Neuropathic Pain
The null hypothesis contends that the prevalence of neuropathic pain is not significantly higher in nurses compared to age-matched controls. The null hypothesis is accepted if the p-value for the statistical test of inference is greater than 0.05 (p>0.05). The alternative hypothesis is accepted if the p-value for the statistical test of inference is less than 0.05 (p<0.05).
Hypothesis Testing For Evaluating the Risk Factors for Neuropathic Pain
The risk factors for neuropathic pain include postural stress, accidental injury, focal neuropathy, hereditary neuropathy and PHN. The null hypothesis contends that the objective pain score is not significantly higher in staff nurses compared to age-matched controls. The null hypothesis is accepted if the p-value for the statistical test of inference is greater than 0.05 (p>0.05). The alternative hypothesis is accepted if the p-value for the statistical test of inference is less than 0.05 (p<0.05).
Statistical Software
The results of the proposed study would be represented and analyzed through MS-excel software.
Ethical Approval
The ethical approval for the proposed research would be obtained from the research and ethical committees of the respective healthcare organizations.
4. Proposed Outcomes of the Study
Till date, no studies have been conducted for objective categorization of CLBP or LBP in nursing professionals. Classification and categorization of CLBP or LBP would be highly beneficial for planning intervention strategies. Appropriate interventions should be implemented for mitigating the prevalence and intensity of CLBP or LBP amongst nursing professionals. Alleviation of CLBP is essential for ensuring productivity amongst staff nurses. The study would help to deploy nursing professionals in their practice settings. Appropriate deployment of nurses is essential for ensuring safe and quality healthcare in patients.
References
Eghbali M, Safari R, Nazari F, Abdoli S. (2012)The effects of reflexology on chronic low
back pain intensity in nurses employed in hospitals affiliated with Isfahan University of
Medical Sciences.Iran J Nurs Midwifery Res.  17(3),239-43.
Freynhagen R, Baron R. (2009) The evaluation of neuropathic components in low back pain.
Curr Pain Headache Rep.  13(3):185-90.
Ghadyani L, Tavafian SS, Kazemnejad A, Wagner J (2016)Development and Psychometric
Evaluation of Nursing Low Back Pain Predictor Questionnaire Focusing on Nurses
Suffering from Chronic Low Back Pain in Iran.Asian Spine J. 10(4),697-704
Yassi, A & Lockhart K. (2013) Work-relatedness of low back pain in nursing
personnel: a systematic review International Journal of Occupational and
Environmental Health 19(3), 223-244