Articles: back-pain.
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Objective and Importance. The subarachnoid infusion of narcotics by programmable devices in patients with chronic non-malignant pain can be a useful therapeutic method. However, certain side-effects, opioid tolerance or changes in the nature of the pain can lead to failure of the therapy. ⋯ The patient therefore needed alternative infusions of both drugs with changes of infusional parameters. Conclusion. The possibility of varying the infusion method of mixed drugs or alternating the drugs is fundamental for successful therapy since neuropathic pain must be considered a dynamic state.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Ketorolac versus acetaminophen-codeine in the emergency department treatment of acute low back pain.
Acute low back pain is a common problem in the emergency department (ED). Effective management of acute pain enhances early rehabilitation and recovery. Given the importance of inflammatory mediators in pain generation and the adverse effects associated with opioids, it is logical to expect that a non-opioid agent with antiinflammatory and analgesic properties would provide excellent analgesia with fewer adverse effects. ⋯ Patients in the ACOD group reported significantly more adverse drug events and serious adverse drug events. Seven patients--all in the ACOD group--withdrew from the study because of adverse drug events. Based on comparable efficacy and a superior adverse event profile, ketorolac was preferable to acetaminophen with codeine for the treatment of acute low back pain in the ED.
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Vertebral fractures are a hallmark of postmenopausal osteoporosis and an important end point in trials of osteoporosis treatment, but the clinical significance of these fractures remains uncertain. ⋯ New vertebral fractures, even those not recognized clinically, are associated with substantial increases in back pain and functional limitation due to back pain in older white women. Prevention of new vertebral fractures should reduce the burden of back pain and functional limitation in women with vertebral osteoporosis.
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Clinical Trial
Multimodal cognitive-behavioural treatment for workers with chronic spinal pain: a matched cohort study with an 18-month follow-up.
An outpatient multimodal cognitive-behavioural treatment program (MMCBT) for chronic spinal pain was evaluated during an 18-month follow-up period. The treatment included a 1-day course for the patients' work supervisors. The aim of the study was to evaluate the long-term effect of the treatment program as well as the effect of a work supervisor-training program on the patients' return to work. ⋯ There is not sufficient statistical support to accept the assumption of MMCBT being superior in reducing sick-leave, either with or without the education of supervisors. Even when supervisors changed their behaviour as reported by the patient, no significant effect was found on patients' return to work. In conclusion, the MMCBT do not seem to be effective in reducing sick-leave compared to no treatment, but the MMCBT program is superior in decreasing pain intensity, enhancing self-reported behavioural changes in personal life and improving pain coping ability at work.
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Disregarding pain resulting from vitamin deficiency, an analgesic effect seems to be exerted only by vitamin B1 (thiamine), vitamin B6 (pyridoxines), and vitamin B12 (cobalamine), particularly when the three are given in combination. The analgesic effect is attributed to an increased availability and/or effectiveness of noradrenaline and 5-hydroxytryptamine acting as inhibitory transmitters in the nociceptive system. In animal experiments, high doses of these vitamins administered alone or in combination inhibited nociceptive behavior and depressed the nociceptive activity evoked in single neurons of the dorsal horn of the spinal cord and in the thalamus. ⋯ The use of high doses of vitamin B6 may be limited by a neurotoxic effect. The effectiveness of B vitamins in depressing chronic pain has not been established. It would be interesting to know if the B vitamins are of use as adjuvants in the treatment of tumor pain.