Articles: back-pain.
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In order to define the onset of a new episode of low back pain (LBP), the definition of a "non-episode" must be clear. De Vet et al reviewed the scientific literature but found no evidence-based definitions of episodes or non-episodes of LBP. However, they suggested that pain-based episodes should be preceded and followed by a period of at least one month without LBP. As LBP is an episodic disease, it is not clear whether a sufficient number of patients with LBP will be LBP-free for at least one month ("non-episode") to justify the use of this duration in the definition of pain free episode. ⋯ The vast majority of these secondary care sector patients had a profile of more or less constant LBP. The estimates for non-episodes during the study period and at the end of the study were very similar for participants with LBP who also had Modic changes and those with non-specific LBP. It is possible that a definition of pain-free periods is pointless in patients seeking care in the secondary care sector.
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Revista de neurologia · Mar 2012
Letter Review Case Reports[Spontaneous epidural haematoma, an infrequent cause of cervicodorsal pain].
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Randomized Controlled Trial
Exercise and Auricular Acupuncture for Chronic Low-back Pain: A Feasibility Randomized-controlled Trial.
To evaluate the feasibility of a randomized-controlled trial (RCT) investigating the effects of adding auricular acupuncture (AA) to exercise for participants with chronic low-back pain (CLBP). ⋯ Findings of this study showed that a main RCT is feasible and that 56 participants per group would need to be recruited, using multiple recruitment approaches. AA was safe and demonstrated additional benefits when combined with exercise for people with CLBP, which requires confirmation in a fully powered RCT.
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How outcomes of clinical trials are reported alters the way treatment effectiveness is perceived: clinicians interpret the outcomes of trials more favourably when results are presented in relative (such as risk ratio) rather than absolute terms (such as risk reduction). However, it is unclear which methods clinicians find easiest to interpret and use in decision making. ⋯ Clinicians stated that additional reporting methods facilitate the interpretation of trial results, and using a variety of methods would make results easier to interpret in context and incorporate into practice. Authors of future back pain trials should report data in a format that is accessible to clinicians.
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Two studies, each consisting of large sample sets, were recently published on radiation exposure in percutaneous spinal cord stimulation (SCS) trialing procedures. A more rigorous use of statistical methods in the second study more accurately defined benchmark reference levels. Principally, one physician implanter-considered an advanced interventional pain physician-performed all such procedures to nullify inter-physician variability. However, the literature is sparse in articles comparing exposure levels of radiation in pain procedures conducted by novice and advanced interventionally trained physicians, and inferential statistical analysis is seldom included in radiation exposure studies. ⋯ Radiation exposure levels in SCS trialing procedures remain negligible. While no differences in fluoroscopy times for such procedures were detected based on physician experience, the expert implanter demonstrated the ability to use less fluoroscopy time than that of the benchmark reference level.