Articles: back-pain.
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Internal disc disruption is a common cause of disabling low back pain in a substantial number of young, healthy adults. A clinical diagnosis of internal disruption, in absence of objective clinical findings, is convincingly established only by means of provocation discography. Intradiscal electrothermal therapy has been shown to be effective in managing chronic disabling discogenic pain. ⋯ Further, the assessment of functional status showed significant improvement with standing and walking, whereas sitting also demonstrated significant improvement in 62% of the patients, though it was not statistically significant. No complications were noted in the perioperative period or during the follow-up period. In conclusion, intradiscal electrothermal therapy is a safe and effective procedure in patients suffering with chronic functionally limiting discogenic pain who fail to respond to aggressive conservative modalities of treatments as well as interventional therapy with injections.
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Low back pain is an important medical, social, and economic problem involving approximately 15% to 39% of the population. Of the numerous therapeutic interventions available for treatment of chronic low back pain, including surgery, epidural administration of corticosteroids is one such intervention commonly used. Several approaches available to access the lumbar epidural space are the caudal, interlaminar, and transforaminal, also known as nerve root or selective epidural injection. ⋯ Reports of the effectiveness of epidural corticosteroids have varied from 18% to 90%. However, reports of the effectiveness of transforaminal epidural steroids have shown it to be superior, with outcome data indicating cost effectiveness as well as safety. This review describes various aspects of transforaminal epidural steroid injections in managing chronic low back pain.
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Spinal cord stimulation (SCS) for the treatment of painful peripheral neuropathy (PN) has been met with mixed results. It has been suggested that early-stage symptoms that are sympathetically maintained (SMP) are more likely to respond to SCS, while progressive sympathetically independent symptoms (SIP) will not. Peripheral nerve stimulation (PNS), however, has successfully treated certain SIP presentations. With the advent of new selective nerve root stimulation (SNRS) strategies, the possibility of utilizing epidural, peripheral neurostimulation was investigated in a patient with endstage, diabetic, "dying back" peripheral SIP.
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A prospective study was undertaken to evaluate the efficacy of spinal cord stimulation (SCS) in the management of chronic pain syndrome. The study included all patients who underwent this procedure at the Royal Melbourne Hospital and the Melbourne Private Hospital over a period of two years. A total of 29 patients were managed by the end of June 1996. ⋯ From the group of 29 patients, four patients failed to obtain any relief during the trial phase of the procedure and thus did not have the stimulator implanted permanently. From the 25 patients who proceeded to have the stimulator implanted, 11 patients had a variable beneficial response, three patients found it to be of marginal benefit, six had no benefit, three patients initially had a good response but subsequently gained no benefit whilst two patients were uncertain of its benefit. It thus appears that SCS was of benefit in 50% of our carefully selected patients with chronic pain syndromes.