Occupational medicine (Philadelphia, Pa.)
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A significant need exists for quality independent medical evaluations (IMEs). The examiner must understand disability issues to specifically answer the questions of the client who requested the IME. The authors discuss these issues and outline step-by-step the performance of a thorough evaluation and the compilation of a complete report.
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A high-performing, effective health care delivery system is critical to the recovery of injured workers within a workers' compensation insurance system. Timely and effective health care has the potential to minimize indemnity costs and therefore contribute to the insurer's financial state. While costs remain a concern to insurers, cost-containment initiatives within the health care arena have evolved from a strict "deep discount" approach to more sophisticated health care strategies that follow managed care-style models. ⋯ Insurers who begin to evaluate the true impact of a comprehensive health care strategy will find it necessary and advantageous to modify their business relationship with health care providers. Those who are able to articulate a business strategy that capitalizes on the skills of the health care community are likely to gain a competitive advantage. Most importantly, this bridging of intellectual capacity across the insurance and health care domains will result in a delivery system that is valued by, and contributes to, its key participants--the employers and the injured workers.
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McKenzie methods stress self-treatment through correct posture and repeated end-range movements performed at a high frequency. Dr. Simonsen describes the basic principles and outlines the three syndromes and specific treatment protocols identified by McKenzie.
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Commonly prescribed drugs for the treatment of low back pain have varying success rates, costs, and complications. This chapter presents current information on acetaminophen, nonsteroidal anti-inflammatory agents, muscle relaxants, opioids, corticosteroids, antidepressants, and colchicine to help the physician in determining a pharmacologic strategy.
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Lumbar spine injections have a role in the evaluation and treatment of low back pain. These injection procedures have been demonstrated to be effective in determining whether certain structures are responsible for low back pain. There is still debate as to the long-term pain relief from epidural and intra-articular facet joint injections, and there are no controlled studies examining the long-term effects of SI joint injections. ⋯ This duration of pain relief creates an opportunity to maximize rehabilitation efforts while symptoms are minimal. There is a need for more controlled studies to evaluate the long-term effectiveness that these lumbar spine injections have on controlling low back pain. Future studies also need to assess in a controlled manner the impact that these injections have no rehabilitation and their role in functional restoration of lumbar spine disorders.