Articles: back-pain.
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Int J Osteopath Med · Jan 2008
Educating osteopaths to be researchers - what role should research methods and statistics have in an undergraduate curriculum?
Evidence-based medicine (EBM) involves using research data to enhance the diagnosis and treatment of clinical disorders. Somatic dysfunction and osteopathic manipulative treatment (OMT) are two unique aspects of osteopathy that will benefit from a greater emphasis on scientific evidence. Most evidence in osteopathy is based on expert opinions, case reports, case series, and observational studies. ⋯ Although this study demonstrates the efficacy of OMT for low back pain, other clinical trials are needed to expand the evidence base in osteopathy. Undergraduate osteopathy curricula should ensure that students acquire the tools necessary to become knowledgeable consumers of the research and statistics presented in biomedical journals. Such curricula need to be supplemented with graduate training programs and research funding mechanisms to ensure that young osteopathic researchers are able to produce the research needed to practice and advance evidence-based osteopathy in the future.
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Decisions about treatment prescriptions depend on many factors. For example, the choice of once-daily or multiple administration of an analgesic, an aspect that is not determined by guidelines, depends essentially on medical practice habits, patient preferences, or both. We analyzed this treatment decision for acute back pain in a case-control study. ⋯ The choice of type of analgesic treatment for acute back pain depends not only on clinical condition (pain and disability), but also on clinical history, the future as envisioned by the physician and the patient's desires. Action to improve treatment choices must integrate these factors, especially as part of an overall education in therapeutics.
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The effects of an analgesic treatment (lidocaine patches) on brain activity in chronic low back pain (CBP) and in knee osteoarthritis (OA) were investigated using serial fMRI (contrasting fMRI between before and after two weeks of treatment). Prior to treatment brain activity was distinct between the two groups: CBP spontaneous pain was associated mainly with activity in medial prefrontal cortex, while OA painful mechanical knee stimulation was associated with bilateral activity in the thalamus, secondary somatosensory, insular, and cingulate cortices, and unilateral activity in the putamen and amygdala. ⋯ We conclude that the two chronic pain conditions involve distinct brain regions, with OA pain engaging many brain regions commonly observed in acute pain. Moreover, lidocaine patch treatment modulates distinct brain circuitry in each condition, yet in OA we observe divergent results with fMRI and with questionnaire based instruments.
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Arch Phys Med Rehabil · Jan 2008
Randomized Controlled TrialTherapeutic use of botulinum toxin type A in treating neck and upper-back pain of myofascial origin: a pilot study.
To determine the efficacy of botulinum toxin type A (BTX-A) in treating neck and upper-back pain of myofascial origin. ⋯ Trends toward improvements in VAS and NDI scores of the BTX-A group are encouraging, but they were possibly due to a placebo effect and were not statistically significant. The BTX-A subjects, at certain time points, showed statistically significant improvements in the bodily pain and mental health scales of the SF-36 compared with controls. Our study had limited power and population base, but the results could be used to properly power follow-up studies to further investigate this topic.