Physical medicine and rehabilitation clinics of North America
-
In this article, the epidemiology of back pain and the use of a variety of treatments for back pain in the United States are reviewed. The dilemma faced by medical providers caring for patients with low back pain is examined in the context of epidemiologic data. ⋯ In addition, health-related quality of life for persons with back pain is not improving despite the availability and use of an expanding array of treatments. This dilemma poses a difficult challenge for medical providers treating individual patients who suffer from back pain.
-
Phys Med Rehabil Clin N Am · Nov 2010
ReviewFunctional anatomy and pathophysiology of axial low back pain: disc, posterior elements, sacroiliac joint, and associated pain generators.
Careful consideration of functional lumbosacral anatomy reveals the capacity for pain generation in the disc, zygapophysial joint, sacroiliac joint, and surrounding ligaments. However, the methods used to definitively implicate a particular anatomic structure in axial low back pain have limitations. ⋯ This article examines key lumbosacral anatomic structures and their functional interdependence at the macroscopic, microscopic, and biomechanical level. Particular attention is given to the capacity of each structure to generate low back pain.
-
Discography is a purely diagnostic interventional procedure performed to confirm or refute the hypothesis that a specific lumbar disc is the predominant source of a patient's low back pain. In patients with severe low back pain, unresponsive to conservative care, discography is used when clinical evaluation suggests that the pain is emanating from the intervertebral disc and other sources of pain have been ruled out. The evidence for its use remains controversial. ⋯ Recently long-term side effects have been studied, and lumbar discography seems to increase disc degeneration and herniation as detected on magnetic resonance imaging. Although the clinical significance is unclear, it is an important risk to consider prior to performing discography, and changes in discography techniques may be indicated. Discography remains the only technique, however, that can be used to determine whether a patient's low back pain is emanating from the intervertebral disc and is a valid test when coupled with careful patient selection, strict adherence to standardized technique and diagnostic criteria, and consideration of possible long-term sequelae.