Articles: back-pain.
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Bull NYU Hosp Jt Dis · Jan 2012
ReviewOutcomes of interlaminar and transforminal spinal injections.
Epidural spinal injections can be administered via a translaminar or transforaminal route, depending on the clinical scenario. When it is more desirable to target a specific nerve root, a transforaminal approach is typically used, and when the target is more diffuse, a translaminar method is chosen. Both are commonly used and can be utilized similarly in the lumbar or cervical spine. ⋯ In the lumbar spine, both translaminar epidural steroid injections (TLESI) and transforaminal epidural steroid injections (TFESI) have been shown to provide up to 6 months of pain relief, though long-term benefits are less reliable. In the cervical spine, translaminar injections may provide longer relief and have a lower complication rate than cervical transforaminal injections. Proper technique is essential to minimize the rate of these rare but occasionally severe complications.
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Recent research has found individual differences in back pain patients due to behavioral avoidance vs persistence. However, there is a lack of prospective studies of nonspecific low back pain patients. The avoidance-endurance model (AEM) suggests at least 3 pathways leading to chronic pain: fear-avoidance response, distress-endurance response, and eustress-endurance response. ⋯ All 3 maladaptive groups revealed a higher pain intensity than the adaptive patients at follow-up after 6 months; however, disability at follow-up was elevated only in the fear-avoidance and distress-endurance patients. The study provides preliminary evidence for the construct and prospective validity of AEM-based subgroups of subacute, nonspecific back pain patients. The results suggest the need for individually targeted cognitive behavioral treatments in the maladaptive groups.
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This study undertook an economic analysis of the costs of early retirement due to back problems, with the aim of quantifying how much lower the value of accumulated wealth of individuals who exit the workforce early due to back problems is by the time they reach the traditional retirement age of 65 years--compared to those who remained in the workforce. This was done using the output dataset of the microsimulation model Health&WealthMOD. It was found that over 99% of individuals who are employed full time will have accumulated some wealth at age 65 years, whereas as little as 74% of those who are out of the labour force due to back problems will have done so. ⋯ This is far lower than the median value of accumulated wealth for those women aged 55-64 years who remained in the labour force full time, who will have $214,432 of accumulated wealth at age 65 years. Not only will early retirement due to back problems limit the immediate income available to individuals, but it will also reduce their long-term financial capacity by reducing their wealth accumulation. Maintaining the labour force participation of those with back problems, or preventing the onset of the disease, should be a priority in order to maintain living standards comparable with others who do not suffer from this condition.
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Bmc Health Serv Res · Jan 2012
Consumers' experiences of back pain in rural Western Australia: access to information and services, and self-management behaviours.
Coordinated, interdisciplinary services, supported by self-management underpin effective management for chronic low back pain (CLBP). However, a combination of system, provider and consumer-based barriers exist which limit the implementation of such models into practice, particularly in rural areas where unique access issues exist. In order to improve health service delivery for consumers with CLBP, policymakers and service providers require a more in depth understanding of these issues. The objective of this qualitative study was to explore barriers experienced by consumers in rural settings in Western Australia (WA) to accessing information and services and implementing effective self-management behaviours for CLBP. ⋯ Consumers in rural WA experienced difficulties in knowing where to access relevant information for CLBP and expressed frustration with the lack of service delivery options to access interdisciplinary and specialist services for CLBP. Competing lifestyle demands such as work and family commitments were cited as key barriers to adopting regular self-management practices. Consumer expectations for improved health service coordination and a workforce skilled in pain management are relevant to future service planning, particularly in the contexts of workforce capacity, community health services, and enablers to effective service delivery in primary care.
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Reg Anesth Pain Med · Jan 2012
ReviewBeyond opioid patient-controlled analgesia: a systematic review of analgesia after major spine surgery.
Postoperative pain control in patients undergoing spine surgery remains a challenge for the anesthesiologist. In addition to incisional pain, these patients experience pain arising from deeper tissues such as bones, ligaments, muscles, intervertebral disks, facet joints, and damaged nerve roots. ⋯ The problem is compounded by the fact that many of these patients are either opioid dependent or opioid tolerant, making them less responsive to the most commonly used therapy for postoperative pain (opioid-based intermittent or patient-controlled analgesia). The purpose of this review was to compare all published treatment options available that go beyond intravenous opiates and attempt to find the best possible treatment modality.