Articles: back-pain.
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Review Comparative Study
Systematic review of randomized trials comparing lumbar fusion surgery to nonoperative care for treatment of chronic back pain.
Systematic review of randomized trials comparing surgical to nonsurgical treatment of discogenic back pain. ⋯ Surgery may be more efficacious than unstructured nonsurgical care for chronic back pain but may not be more efficacious than structured cognitive-behavior therapy. Methodological limitations of the randomized trials prevent firm conclusions.
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J Clin Psychopharmacol · Apr 2007
Randomized Controlled TrialEfficacy of noradrenergic and serotonergic antidepressants in chronic back pain: a preliminary concentration-controlled trial.
Although antidepressants are widely prescribed as analgesics in chronic back pain, their clinical pharmacology is not well established. Norepinephrine transporter blockade seems to be essential for analgesia, but optimal concentrations are unknown. Fixed-dose studies of serotonin reuptake inhibitors are generally negative, but such studies cannot be interpreted clearly because efficacy might be detected if concentration-response relationships were known. We evaluated (1) the feasibility of conducting a controlled-concentration study of a norepinephrine (desipramine) and a serotonin reuptake (fluoxetine) inhibitor and (2) the relationship between achieved concentrations and analgesic response. ⋯ Preliminary evidence for a low-concentration "therapeutic window" for noradrenergic analgesia may warrant additional study.
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Objectives. Spinal cord stimulation has been used extensively for failed back surgery syndrome, although dominant axial low back pain is difficult to treat effectively with this modality. The use of a surgically placed, double, quadripolar lead may result in better paresthesia of the low back, therefore enhancing outcomes in this difficult to treat population. Materials and Methods. Accordingly, this prospective study was designed to assess the effectiveness of placing such a lead at the T8-T10 level under general anesthesia without intraoperative testing for concordancy of paresthesia distribution. ⋯ The ability to lead a more active and social life was increased and 85% of patients said they would undergo spinal cord stimulation again. Placing the lead higher in the spinal canal (T8) resulted in a tendency for better paresthesia coverage of the low back when compared to lower lead placements. Conclusions. Placing a double quadripolar paddle lead under general anesthesia resulted in good clinical outcome similar to other implant techniques.
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When performing epidural steroid injections for the management of chronic back pain, imaging guidance and a limited epidurogram improve accuracy of needle placement and ensure appropriate delivery of the injectate into the epidural space. We describe our experience using a gadolinium chelate as an alternative contrast agent for limited epidurography in patients with a history of an iodinated contrast reaction. ⋯ Gadolinium chelate represents a safe and useful alternative contrast agent for confirmation of epidural needle placement in patients with an iodinated contrast allergy.