Pain practice : the official journal of World Institute of Pain
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Low back pain has long been described as a challenge for both primary care physicians and specialists. Management of low back pain has also been criticized as frequently arbitrary, inappropriate, or ineffective. Contributing factors have been an inadequate evidence base and a need for more rigorous appraisals of the available literature. ⋯ Despite these advances, the best available evidence often does not inform everyday clinical decisions for low back pain. Nonetheless, there is widespread agreement that adherence to evidence-based practice will help improve low back pain patient outcomes and reduce arbitrary variations in care. This article reviews basic principles of evidence-based medicine, discusses evidence-based medicine in the context of low back pain management, and summarizes some useful evidence-based medicine resources.
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Pulsed radiofrequency (PRF) has been used for the treatment of radicular pain, due to a herniated intervertebral disc, but so far the data are anecdotal. This is a retrospective study on 13 consecutive patients with this type of pain, at levels L3 to S1. All patients had a diagnosis confirmed by imaging, all had neurological abnormalities, and all were scheduled for surgical intervention. ⋯ Neurological abnormalities resolved except in one patient, who had decreased sensibility in a small area in the L3 dermatome at the last follow-up. All professionally active patients went back to work after 0.49 months (0.1 to 1). It is concluded that PRF may potentially be a viable alternative for epidural steroid injections in the treatment of acute radicular pain, due to a herniated intervertebral disc, and that further studies, including a control group, should be carried out to establish the value of this method.
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Pregabalin is a new analog of the neurotransmitter gamma-aminobutyric acid (GABA). It is an alpha2-delta (alpha2-delta) ligand that has analgesic, anticonvulsant, and anxiolytic activity. ⋯ Pregabalin binds potently to the alpha2-delta subunit resulting in modulation of calcium channels and reduction in the release of several neurotransmitters, including glutamate, norepinephrine, serotonin, dopamine, and substance P. This review discusses the pharmacology of this medication as well as available studies in patients.
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Chronic pain has only recently been recognized as an important health care issue. There is no widely shared agreement as to the best ways to diagnose and treat chronic pain patients. ⋯ The current chaotic state confuses patients, health care providers, and payers. It is possible that pain management may disappear from health care if we do not improve our understanding of chronic pain and how to best treat those who suffer.