Articles: back-pain.
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Neck and back pain are among the most common overuse injuries in cyclists. Bicycle fit, improper equipment, training errors, and individual anatomic factors are important evaluation considerations. By learning how to recognize and treat contributing factors, as well as learning a few simple bike-fitting techniques, physicians can treat and prevent many common problems of this popular activity.
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Caudal epidural steroid injections are often used for low back pain. Fluoroscopic guidance has been frequently cited as a requirement for this procedure. ⋯ We detected intravenous leakage of the drug in 4 cases of 10 when real-time fluoroscopic imaging was used. Thus, real-time imaging may be recommended in addition to routine fluoroscopic guidance for caudal epidural procedures, as it may improve efficacy and safety by assuring accurate drug deposition.
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Low back pain has long been described as a challenge for both primary care physicians and specialists. Management of low back pain has also been criticized as frequently arbitrary, inappropriate, or ineffective. Contributing factors have been an inadequate evidence base and a need for more rigorous appraisals of the available literature. ⋯ Despite these advances, the best available evidence often does not inform everyday clinical decisions for low back pain. Nonetheless, there is widespread agreement that adherence to evidence-based practice will help improve low back pain patient outcomes and reduce arbitrary variations in care. This article reviews basic principles of evidence-based medicine, discusses evidence-based medicine in the context of low back pain management, and summarizes some useful evidence-based medicine resources.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Low-dose cyclobenzaprine versus combination therapy with ibuprofen for acute neck or back pain with muscle spasm: a randomized trial.
This prospective, randomized, open-label, multicenter, community-based study was conducted to compare cyclobenzaprine 5 mg three times daily (TID) orally (CYC5) given for 7 days as monotherapy or in combination with ibuprofen 400 mg TID (CYC5/IBU400) or 800 mg TID (CYC5/IBU800) in adults with acute neck or back pain with muscle spasm. ⋯ This randomized, community-based clinical trial demonstrated that combination therapy with cyclobenzaprine 5 mg TID plus ibuprofen was not superior to cyclobenzaprine 5 mg TID alone in adult patients with acute neck and back pain with muscle spasm. All treatments were well tolerated.
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Functional Capacity Evaluation (FCE) is used to determine return-to-work readiness. We investigated the ability of the Isernhagen Work Systems' FCE to predict sustained return-to-work and future pain and disability in workers' compensation claimants with chronic back pain. ⋯ Better FCE performance was mildly associated with indicators of faster return-to-work. However, FCE is not related to recurrent back problems, future pain intensity, or self-reported disability.