La Revue du praticien
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La Revue du praticien · Oct 2000
[Local and general anti-inflammatory treatment of common low back pain].
Non-steroidal anti-inflammatory drugs are often prescribed with analgesics. They are proposed at the acute phase of low back pain or sciatica, or during flares of chronic back pain. ⋯ Local injections of steroids are required after failure of analgesics and NSAIDs, in patients with sciatica and chronic back pain. Different routes of injection are possible, depending of the symptoms and the mechanism of compression.
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Imaging strategy varies according to the background of acute or persistent low back pain. In case of acute low back pain with associated symptoms of a cauda equina syndrome or any atypical clinical signs PA and lateral radiographs of the lumbar spine are required. ⋯ Secondary, MRI may be performed in case of worsening and persistence of the clinical symptoms or if a specific low back pain is suspected. In case of chronic low back pain, with a severe socio-professional impact or a planed invasive treatment, plain films of the lumbar spine must be obtained, eventually with additional MRI examination.
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Surgical treatment of the low-back pain remains controversial in term of efficacy. Surgical treatment is advocated only when conservative management fails, a clearly identifiable cause of lumbar pain is identified, worker's compensations are detected, psychological disorders are treated and disability and pain are still present. ⋯ Spinal fusion provide 50-93% of clinical success in the literature, spondylolisthesis remains the better indication. Only 30% returning to work were obtained.
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Comparative judgement, which is seminal to any kind of science performing measurements, has been applied to clinical reasoning for many centuries. The need for systematizing the observational methods used in medicine in order to draw more reliable inferences about the effects of therapies has been active all along the 19th century. ⋯ A long way has been run since the first controlled randomized trial. However, half a century later, modern clinical trial remains essentially a controlled randomized prospective study using methods to limit potential biases and to establish statistical significance.