Articles: back-pain.
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Spinal Cord Stimulation (SCS) is a treatment option for chronic pain patients. The most common indication for SCS is the failed back syndrome with leg pain. In the last decade, advances in our understanding of appropriate stimulation programming, lead placement and the physiology of SCS, have led to changes in multi-site stimulation, and stimulation with differing programs. In the past, low back, axial neuropathic type pain was not responsive to SCS. With dual electrode arrays, and dual stimulation with alternating programs of stimulation, steering of stimulation paresthesia, and versatile programmable stimulation parameters, SCS has become a more versatile form of analgesia. ⋯ SCS is the most effective treatment for limb pain not amenable to surgical decompression. The success of SCS in this chronic pain group is 80% successful in treatment of leg pain, and much less effective in treatment of axial pain.
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Percutaneous neuromodulation therapy (PNT) is a new minimally invasive, office-based treatment for low back pain in which electrical stimulation is delivered to the paraspinal peripheral nerves. The purpose of this study was to determine the safety, tolerability, and clinical efficacy of PNT in a population of patients with subacute low back pain with radiation to the lower extremity. ⋯ For many patients with subacute radiating low back pain, PNT significantly reduced pain and self-rated disability, and improved sleep quality and activity level. PNT is safe and generally well tolerated.
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Multicenter Study
Risk factors for failure and complications of intradiscal electrothermal therapy: a pilot study.
A bi-institutional, retrospective clinical data analysis. ⋯ The only risk factor found to be associated with IDET outcome was obesity, which was a strong predictor of failure. Obesity should be considered a relative contraindication to performing IDET.
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Multiphase cross-sectional survey of musculoskeletal pain. ⋯ Adjustment for pain at other sites enabled assessment of whether observed associations were with spinal pain itself or with the other sites of pain. Obesity is an important independent predictor of back pain and its severity. This has implications for primary prevention. The prevalence of spinal pain with disability continues to rise into old age. This has implications for healthcare planning.
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The posterior zygo-apophyseal joints (facet joints) may be a significant source of back pain. Invasive treatment typically consists of injecting the joints with local anaesthetic and steroid or by radiofrequency ablation of the nerve supply to the joint. Facet joint injection is generally considered to be a very safe procedure with few significant side effects reported. ⋯ Most cases occur spontaneously but the condition may complicate epidural anaesthesia, spinal anaesthesia or epidural steroid injection. We report a case in which facet joint injections resulted in epidural abscess formation. To our knowledge this has not previously been reported.