Articles: back-pain.
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The number of available diagnostic tests for patients with back and neck pain has grown dramatically over the past two decades, and their cost has increased as well. The impact of managed care and an increased understanding of the natural history of these conditions have led to close evaluation of the sensitivity and specificity of these tests and their effect on patient outcomes. ⋯ Guidelines for the testing of patients with chronic back and neck pain have yet to be developed. Stronger emphasis on psychosocial issues and the assurance that pathologic progression has not been missed without the use of repetitive testing form the mainstay of diagnostic protocols in this population.
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The possibility of a relationship between discographic pain responses and Minnesota Multiphasic Personality inventory scores was investigated. ⋯ Discographic pain reports are not only related to anatomic abnormalities, but are influenced by personality as assessed by the Minnesota Multiphasic Personality Inventory. Patients with elevated scores on the hypochondriasis, hysteria, and depression scales may tend to overreport pain during discographic injection. Among such patients, even those with a concordant computed tomography/discographic image, selection of therapeutic modalities should be made with caution.
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The most important determinant of successful treatment in all spinal disorders is accurate diagnosis. Diagnostic injection procedures, such as facet blocks, selective nerve root blocks, and discography can aid in accurately diagnosing the source of a patient's pain.
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Subjective disability is considered as the variable that reflects the impact of chronic pain on a patient's life. This study examines the questions of which syndrome or patient characteristics determine subjective disability and whether there are differences between samples of patients with chronic headaches and low back pain. Direct pain variables and depression, pain coping strategies, and pain-related self-statements (including catastrophizing) are introduced into multivariate regression analyses as potential predictors of disability using a sample of 151 pain patients. ⋯ In this study, we present a critical analysis of possible interpretations of our results. We point to an overlap of concepts underlying some of the variables used: this overlap also considerably invalidates conclusions drawn from a multitude of studies done in this field, including the one presented. We strongly argue for a conceptual clarification, and consequently for the revision of assessment instruments, before further empirical work in this area is done.