Spine
-
Back pain is an important problem for primary care physicians; it is common, costly, and controversial. Back pain is the second leading symptom prompting all physician visits in the United States. There are wide geographic variations in medical care for this problem, and surgical rates in the United States are twice those of most developed countries. ⋯ Second is to develop a better theory to explain the large majority of episodes of nonspecific low back pain. At present, competing theories generate competing and conflicting treatments, generating frustration among patients and loss of credibility for clinicians. Third, we need better science, with greater methodologic rigor in the evaluation of the many nonsurgical treatments used for back pain in the primary care setting.
-
Despite greater knowledge, expertise, and health care resources for spinal pathologies, chronic disability resulting from nonspecific low back pain is rising exponentially in western society. Medical care certainly has not solved the everyday symptom of low back pain and even may be reinforcing and exacerbating the problem. An historic review shows that there is no change in the pathology or prevalence of low back pain: What has changed in our understanding and management. ⋯ Despite the different health care systems, treatment availability, and costs, there seems to be little difference in clinical outcomes or the social impact of low back pain in the two countries. There is growing dissatisfaction with health care for low back pain on both sides of the Atlantic. Future health care for patients with nonspecific low back pain should be designed to meet their specific needs.
-
Randomized Controlled Trial Clinical Trial
Predicting poor outcomes for back pain seen in primary care using patients' own criteria.
A prospective cohort study of patients seen in primary care for low back pain. ⋯ The proportion of primary care patients with back pain who have poor outcomes appears to be higher than generally recognized. Ways of improving how primary care responds to patients with persisting pain should be investigated.
-
Multicenter Study Clinical Trial
The Quebec Task Force classification for Spinal Disorders and the severity, treatment, and outcomes of sciatica and lumbar spinal stenosis.
A prospective cohort study of patients in Maine with sciatica and lumbar spinal stenosis treated surgically and nonsurgically. ⋯ For patients with sciatica, the Quebec Task Force classification was highly associated with the severity of symptoms and the probability of subsequent surgical treatment. Nonsurgically treated patients in Quebec Task Force classification categories reflecting nerve root compression had greater improvement than those with pain symptoms alone. Among surgical patients, the Quebec Task Force classification was not associated with outcome. These results provide validation for the classification and its wider adoption. Nonetheless, improved diagnostic classifications are needed to predict outcomes better in patients with sciatica who undergo surgery.
-
Review paper of outcome studies among primary care back pain patients. ⋯ Results from existing studies suggest that back pain among primary care patients typically runs a recurrent course characterized by variation and change, rather than an acute, self-limiting course.