Articles: back-pain.
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Das Gesundheitswesen · Dec 2009
Review Meta Analysis[Unspecific back pain - basic principles and possibilities for intervention from a psychological point of view].
Back pain is one of the most common and expensive health problems in Germany. Apart from somatic parameters, psychological factors are thought to influence the aetiology and, especially, the chronification of back pain. A literature search has been performed to establish which psychological procedures are used in the diagnosis, prevention and therapy for back pain, and how effective they are. ⋯ In the high risk group of patients already suffering from back pain, relapses and chronification can best be prevented by multimodal programmes. A decisive condition for the success of these physiotherapeutic, ergotherapeutic, sports therapeutic and psychotherapeutic interventions is apparently that there should be a standardised procedure in accordance with the theoretical principles of behavioural therapy, complied with by all those involved in the process. However, the principle objective of all measures should be the avoidance of the transition from acute to chronic back pain and the protracted and expensive clinical course this can lead to. Psychological intervention appears to work here as well. Further studies are needed to clarify whether the psychological program components are effective in isolation or whether they must be embedded in a multimodal (preventive) concept. It must also be investigated which target groups benefit most from which type of preventive (psychological) intervention. Provision of specific information is an alternative preventive approach. This health psychological or educative procedure corresponds to demedicalisation of this condition. Although media campaigns have been successfully performed in Australia, it is as yet unclear whether these can be transferred to Germany and which structural changes these would require in our health care system.
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Randomized Controlled Trial
[Development of a standardized back school for in-patient orthopaedic rehabilitation].
Medical rehabilitation in Germany is still lacking in patient education programmes that meet certain quality requirements such as the use of manuals, patient-oriented didactics, and evaluations of effectiveness. For patients with chronic low back pain, no standardized and evaluated back school programme has so far been available for routine use. In this paper, we demonstrate the development of a quality-assured back school based on a health-education programme of the German statutory pension insurance scheme. ⋯ Furthermore, small to medium effects were also observed among some secondary outcomes, such as motivation to physical activity, pain beliefs and pain intensity. After the programme's medium- and long-term effects have been demonstrated, it will be recommended for implementation in medical rehabilitation. The manual meets the requirements that allow for a successful transfer into clinical practice.
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Internal medicine journal · Dec 2009
Case Reports Comparative StudySpontaneous spinal infections in older people.
Back pain is common in the elderly. Spinal infection is a rare, but possibly increasing, cause. We describe a retrospective case note review of 41 patients aged 65 years and over with spontaneous spinal infections over a 6-year period. ⋯ The mean time from symptom onset to diagnosis was 34 days. Most patients presented with back pain and elevated CRP. Differentiation between discitis and other spinal infections does not appear to be important, as clinical characteristics and outcomes are similar.
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Acetaminophen is a widely used analgesic that can cause acute liver failure when consumed above a maximum daily dose. Certain patients may be at increased risk of hepatocellular damage even at conventional therapeutic doses. We report a case of a 34-year-old man on carbamazepine for complex partial seizures who developed acute liver and renal failure on less than 2.5 grams a day of acetaminophen. This raises caution that patients on carbamazepine should avoid chronic use of acetaminophen, and if required use at lower doses with vigilant monitoring for signs of liver damage.