Articles: back-pain.
-
Randomized Controlled Trial Comparative Study
Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery.
Ketamine is an N-methyl-d-aspartate receptor antagonist that has been shown to be useful in the reduction of acute postoperative pain and analgesic consumption in a variety of surgical interventions with variable routes of administration. Little is known regarding its efficacy in opiate-dependent patients with a history of chronic pain. We hypothesized that ketamine would reduce postoperative opiate consumption in this patient population. ⋯ Intraoperative ketamine reduces opiate consumption in the 48-h postoperative period in opiate-dependent patients with chronic pain. Ketamine may also reduce opioid consumption and pain intensity throughout the postoperative period in this patient population. This benefit is without an increase in side effects.
-
With improvements in neurological imaging, there are increasing reports of symptomatic spinal synovial cysts. Surgical excision has been recognized as the definitive treatment for symptomatic juxtafacet cysts. However, the role for concomitant fusion and the incidence of recurrent back pain and recurrent cyst formation after surgery remain unclear. ⋯ Surgical decompression results in symptomatic resolution in the vast majority of patients; however, recurrent back pain occurs in a significant number of patients. Cyst recurrence occurs in less than 2% of patients but has never been reported after cyst excision with concomitant fusion. The lack of cyst recurrence after concomitant fusion supports the need to investigate the value of fusion of the involved motion segment in the treatment of symptomatic synovial cysts of the spine.
-
Randomized Controlled Trial
Catastrophizing moderates the effect of exposure in vivo for back pain patients with pain-related fear.
This investigation was an initial attempt to explore psychological factors that might help or hinder the effect of exposure in vivo for patients with musculoskeletal pain and pain-related fear. The study was based on data from a randomized-controlled trial for patients with non-specific spinal pain (Linton et al., 2008). First, catastrophizing, anxiety, and depression were studied as possible treatment moderators. ⋯ Next, patients were divided into high change participants and low change participants based on their improvement in disability after treatment in order to investigate the change in psychological variables during treatment. Descriptive data indicated that high change participants had large improvements across treatment on depression, anxiety, catastrophizing, and fear-avoidance beliefs whereas low change participants virtually did not change at all on these variables across treatment. These findings denote that catastrophizing is a moderator of treatment outcome in exposure whereas several psychological variables might be important for the treatment process.
-
The objective of the current study was to adapt and validate the Roland Morris disability questionnaire (RMDQ) to the Portuguese patients because there are no European Portuguese psychometric instruments to evaluate patients suffering from low back pain. After translation and back translation the Portuguese version of the RMDQ was tested in 112 patients with low back pain (30 males and 82 females) to analyse psychometric characteristics. ⋯ The results revealed a large correlation between the RMDQ and END (r = 0.73) and a medium correlation with TS and GFA (in this order, r = -0,52 and r = 0,42). The psychometric analysis showed that the RMDQ gives reliable measures for the disability of patients with back pain and was successfully adapted and validated to the European Portuguese patients.