Physical medicine and rehabilitation clinics of North America
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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.
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Imaging is an integral part of the clinical examination of the patient with back pain; it is, however, often used excessively and without consideration of the underlying literature. The primary role of imaging is the identification of systemic disease as a cause of the back or limb pain; magnetic resonance imaging (MRI) excels at this. Systemic disease as a cause of back or limb pain is, however, rare. ⋯ The zygapophysial (facet) and sacroiliac joint are thought to be responsible for axial back pain, although with less frequency than the disc. Imaging findings of the structural changes of osteoarthritis do not correlate with pain production. Physiologic imaging, either with single-photon emission CT bone scan, heavily T2-weighted MRI sequences (short-tau inversion recovery), or gadolinium enhancement, can detect inflammation and are more predictive of an axial pain generator.
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Phys Med Rehabil Clin N Am · Nov 2010
ReviewPharmacologic treatment for low back pain: one component of pain care.
Analgesic medications are commonly used for low back pain (LBP). Evidence on the efficacy of pharmacologic therapy for LBP comes from clinical trials that have many limitations, including short-term studies and selective trial populations. Evidence currently supports the use of short-term pharmacologic treatment for LBP. However, the safety and efficacy of long-term pharmacologic therapy for LBP is uncertain and therefore best used with caution, monitoring, and as one component of a comprehensive paincare approach emphasizing rehabilitation.