Articles: back-pain.
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Randomized Controlled Trial
Long-term safety and efficacy of closed-loop spinal cord stimulation to treat chronic back and leg pain (Evoke): a double-blind, randomised, controlled trial.
Spinal cord stimulation has been an established treatment for chronic back and leg pain for more than 50 years; however, outcomes are variable and unpredictable, and objective evidence of the mechanism of action is needed. A novel spinal cord stimulation system provides the first in vivo, real-time, continuous objective measure of spinal cord activation in response to therapy via recorded evoked compound action potentials (ECAPs) in patients during daily use. These ECAPs are also used to optimise programming and deliver closed-loop spinal cord stimulation by adjusting the stimulation current to maintain activation within patients' therapeutic window. We aimed to examine pain relief and the extent of spinal cord activation with ECAP-controlled closed-loop versus fixed-output, open-loop spinal cord stimulation for the treatment of chronic back and leg pain. ⋯ Saluda Medical.
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Low back pain is a common musculoskeletal condition with substantial individual and societal costs. Standardized self-report questionnaires are commonly used in clinical practice to identify prognostic risk factors and tailor interventions for low back pain. However, most of these low back pain questionnaires have been developed in Western cultures and may not be clinically applicable to other cultures. These cultural aspects have not been explored. This study aimed to investigate the cultural assumptions underlying back pain questionnaires and the potential implications of using standardized questionnaires with non-Western populations. ⋯ Findings suggest that questionnaires could potentially negatively affect the patient-clinician rapport and lead to inaccurate and unanticipated results when used with culturally and linguistically diverse populations. Findings are also likely to be applicable to people with low back pain more broadly, regardless of culture. Implications include a need for cultural sensitivity when using questionnaires, greater consideration of when to use these measures, and adaptations to the use/design of standardized questionnaires.
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Patients with back pain predominance (BPP) have traditionally been thought to derive less predictable symptomatic relief from lumbar fusion surgery. ⋯ Patients with low-grade spondylolisthesis who underwent an open posterior lumbar fusion had improvement in symptoms regardless of presentation with BPP or LPP. In properly indicated patients, posterior spinal fusion is effective for those with BPP in the setting of experiencing both leg and back pain, and clinicians can use this information for perioperative discussions and surgical decision-making.
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To investigate the current evidence to determine if there is an association between chiropractic use and opioid receipt. ⋯ This review demonstrated an inverse association between chiropractic use and opioid receipt among patients with spinal pain. Further research is warranted to assess this association and the implications it may have for case management strategies to decrease opioid use.
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Back pain is a very prevalent complaint, affecting two-thirds of the US population, and it accounts for $100 billion annually in health care expenditures. The occurrence of depression has been reported in existing literature among patients with back pain, but there is limited information regarding health care expenditures among patients with back pain and concurrent depression. ⋯ This study demonstrates that the presence of depression in adults with spondylosis, intervertebral disc disorders, and other back problems is associated with greater economic burden. These findings remained consistent after adjusting for all independent sets of variables. The study's findings suggest that interventions resulting in better management of depression have the potential to significantly reduce the economic burden in this population.