Articles: back-pain.
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Population-based cross-sectional prevalence survey. ⋯ Although typically recommended for short-term treatment of back pain, muscle relaxants are often used chronically and are prescribed to subpopulations potentially at risk for adverse effects.
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Transforaminal epidural steroid injection is one of the commonly employed modalities of treatment in managing nerve root pain. However, there have been no controlled prospective evaluations of epidural and nerve root contrast distribution patterns and other aspects of fluoroscopically directed lumbosacral transforaminal epidural steroid injections. ⋯ Lumbosacral transforaminal epidural injections, performed under fluoroscopic visualization, provide excellent nerve root filling and ventral epidural filling patterns. However, unrecognized intravascular needle placement with negative flashback or aspiration was noted in 5% of the procedures.
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Chronic, refractory low back pain is a common problem. Percutaneous adhesiolysis with hypertonic saline neurolysis was described in the management of chronic refractory low back pain, non-responsive to conservative modalities of management. ⋯ Percutaneous adhesiolysis, with or without hypertonic saline neurolysis, is an effective treatment for chronic low back pain.
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The purpose of this study is to determine what factors influence emergency physicians' decisions to prescribe an opioid analgesic for 3 common, painful conditions. ⋯ Even when faced with identical case scenarios, physicians' decisions to prescribe opioid analgesics are highly variable. Moreover, the same clinical information, such as a patient requesting a strong analgesic, changes the likelihood of prescribing opioids in opposite directions for different physicians.
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The California Workers' Compensation system mandates the use of occupational medicine practice guidelines developed by the American College of Occupational and Environmental Medicine (ACOEM). These Guidelines cover the treatment of acute (less than three months' duration) injuries. The presence in the ACOEM Guidelines of references to procedures which may be of use after the three-month acute period creates ambiguity as to whether the ACOEM Guidelines are applicable after three months. ASIPP's "Evidence-Based Practice Guidelines for Interventional Techniques in the Management of Chronic Spinal Pain" are comprehensive, focusing on management of chronic spinal pain. ACOEM guidelines, mandated by the legislature, do not deal explicitly with chronic pain. Their application in managing chronic pain may result in denial of access to appropriate treatment. Thus, ASIPP guidelines may be supplemental to the ACOEM Guidelines. Evaluation of the two Guidelines may clarify which should be followed in the event of ambiguity or conflict. ⋯ The ASIPP Guidelines may be considered the applicable Guidelines for the treatment of work-related low back activity limitations persisting beyond three months.