Articles: back-pain.
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Comparative Study
Comparison of interbody fusion approaches for disabling low back pain.
This is a study comparing two groups of patients surgically treated for disabling low back pain. One group was treated with lumbar anteroposterior fusion (360 degrees fusion), the other with posterior lumbar interbody fusion and an interbody fixation device. ⋯ Posterior lumbar interbody fusion-BAK achieves equal patient satisfaction but fiscally surpasses the 360 degrees fusion approach. Today's environment of regulated medical practice requires the surgeon to consider cost effectiveness when performing fusion for low back pain.
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The prevalence of pain combinations among school children is addressed in view of earlier findings of high pain prevalence in this population. The study considers the prevalence of combinations of three common pains headache, stomach pain and back pain-in a random national sample of 2173 Icelandic 11-12 and 15-16 year-old school children. According to the results from this study there is a 78.2% prevalence of monthly pain. ⋯ Girls have significantly more frequent overall pain than boys. The distribution of pain combinations varies by age but not overall pain. The study yields important information about the extent of the overall problem of pain among school children and indicates the need to further study the correlates of different pain combinations in this age group.
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Studies using a multimodal approach in order to prognose therapeutic success in patients suffering from back pain were seen to have highly diverse results. However, in spite of various independent health care systems, a common interest prevails in identifying determinants of therapeutic success in order to improve therapy. ⋯ Predicting successful treatment is hardly possible without analyzing individual circumstances, focusing on sociodemographic variables, workplace-related conditions, and aspects of individual motivation. With regard to objective therapeutic success, subjective perceptions proved highly influential. Treatment proved successful only when the patient's perception of functional disability was minimized. Hence, individual perceptions and experiences were more important than physical capabilities.
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Anesthesia and analgesia · Feb 1997
Randomized Controlled Trial Comparative Study Clinical TrialEpidural dexamethasone reduces the incidence of backache after lumbar epidural anesthesia.
We performed a prospective, randomized, double-blind study to compare the effect of epidural dexamethasone on the incidence of postepidural backache after nonobstetric surgery. One thousand unpremedicated ASA physical status I or II patients scheduled for hemorrhoidectomy were randomly assigned to two groups: Group I patients received 25 mL 2% lidocaine with epinephrine 1:200,000 and 1 mL dexamethasone (5 mg) epidurally. Patients were interviewed at 24,48, and 72 h postoperatively using a standard visual analog scale (VAS) for evaluation of postepidural backache. ⋯ The severity and duration of postepidural backache were also significantly decreased in Group II patients. In our study, there was a significant association between postepidural backache and multiple attempts at epidural needle insertion. In summary, epidural dexamethasone reduced the incidence and severity of postepidural backache.
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Two studies that assess fear and avoidance in patients with chronic pain are presented. In the first study, 200 patients with chronic back pain were classified, using the Multidimensional Pain Inventory (Kerns et al., 1985) clustering procedure, as dysfunctional (n = 53), interpersonally distressed (n = 37), and adaptive copers (n = 62). Groups were compared on common measures of anxiety, fear and avoidance. ⋯ In the second study, pain-specific fear and avoidance measures were used in a discriminant function analysis to predict the MPI classification of an independent sample of 55 patients with chronic pain. The measures correctly classified 76.5% of the dysfunctional group and 71.1% of a composite group of interpersonally distressed and adaptive copers. The implications of these findings are discussed.