Introduction

There has been a recent surge in the interest of the role of vitamin D in chronic musculoskeletal pain however there are limited studies that have investigated the link of vitamin D hypovitaminosis with low back pain. The aim of our study was to determine the prevalence of low vitamin D levels in patients who present with low back pain in an outpatient setting in the UK.

Introduction: Etanercept is a selective competitor of TNF alpha which is a pro-inflammatory cytokine. It is currently used alone or in combination with other medication for the treatment of chronic inflammatory disease.

Aim: To establish the treatment effect of etanercept in acute sciatica secondary to lumbar disc herniation.

Method: Triple blind randomised controlled study. Inclusion criteria were acute unilateral radicular leg pain secondary to herniated nucleus pulposus confirmed on MRI scan. Exclusions were previous back surgery, spinal stenosis and any contraindications to the use of etanercept such as immunosuppression. The patient, the injector and assessor were blinded to the agent being used. Follow up was at 6 weeks and 3 months post treatment. Oswestry Disability Index (ODI) and Visual analogue scores (VAS) were among the assessment criteria.

Results: 15 patients were recruited in a 4 year period with a 3 month follow up of 80%. The Etanercept group had 8 patients whilst the placebo group had 7. The average ODI for the Etanercept group pre-intervention was higher than that in the placebo group (56.1 vs. 50.4) and this remained the same after 6 weeks (50.5 vs 31) and 3 months of follow up (39.2 vs. 27.3). VAS was also higher in the Etanercept group vs. placebo; pre-injection (8.5 vs. 7.4), 6 weeks (5.6 vs. 3.8), and 3 months (7.0 vs. 4.5).

Conclusion: Small numbers of trial participants limited statistical analysis. The trend appears to show no benefit to the use of Etanercept over placebo in the pharmacological treatment of sciatica.

Purposes of Study and Background: To survey beliefs and attitudes about the management of mechanical back pain in General Practitioners (GPs) in two cities in the East Midlands, and to compare the findings with a similar recent Australian study. We also conducted a ‘found experiment’ on the use of ‘The Back Book’ by the GPs in the two cities following the purchase and distribution of its copies to the GPs in Leicester by the local Primary Care Trusts.

There has been a paradigm shift in the management of mechanical low back pain in the last ten years. Several different clinical guidelines are available based on current evidence in the literature. There is little to show how far these guidelines are being implemented. There are no studies of the barriers to implementation in the British population.

Methods and Results: A postal questionnaire consisting of ten questions, eight of which were taken from a questionnaire used in a similar survey from Australia. Two additional questions relating to the ‘Back Book’ were included. 164 GPs in the city of Leicester and 353 in the city of Nottingham were surveyed in August – September 2001.

The response rate was 70.1% (115) from Leicester and 65.7% (232) from Nottingham. The majority of GPs from both cities were aware of the current concepts about the management of mechanical back pain. The awareness and usage of “The Back Book” was significantly better amongst the GPs in Leicester (p < 0.001).

Conclusion: General practitioners in two cities in Trent region are well aware of current best practice in the management of acute back pain. Their attitudes and beliefs towards back pain management compared well if not better in some aspects, with those of their Australian counterparts. If the resource of ‘The Back Book’ is made available then GPs will use it, in keeping with current best evidence.