Articles: back-pain.
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Pain relief in children during the perioperative period can be provided by means of peripherally or centrally acting analgesics or of regional anaesthetic techniques. Narcotics or regional blockde are indicated when peripherally acting analgesics prove inadequate to abolish pain. Side effects of narcotics must be taken into account: opioids must not be administered unless continuous safety monitoring of the child's respiration is assured. ⋯ All advantages and drawbacks of the various techniques that might be appropriate must be considered: the technique involving the least risk and side effects is the anaesthetic technique with a broad margin of safety when applied by an anaesthesiologist who has experience with paediatric regional blocks include topical anaesthesia, local infiltration, peripheral nerve blocks (e.g. nervi dorsalis penis, plexus axillaris) and caudal epidural blockade. Caution must be exercised whenever narcotics are administered systemically or epidurally; side effects must not be underestimated, even under conditions of intensive care observation. The provision of effective pain relief is a rewarding task-and particularly in little children.
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The therapeutic objectives of conventional back schools are a) instruction of people with and without back pain to use their backs according to currently accepted ergonomic principles, b) improvement of the cardiovascular performance of back school participants and c) acquisition of knowledge of simple methods of pain and stress management. Due to the diversity of back pain causes and the biopsychosocial complexity of back pain as the therapeutic target, back schools can never be the sole solution of a multifaceted problem. The prime objectives of this review are to describe the recent back school curriculums and to define possible therapeutic components of future back schools.
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Nociceptive stimuli are modulated at the dorsal horn of the spinal cord. This modulation is performed by various systems working independently complementarily, additively or supra-additively. Non-opioid analgesics relieve pain without a motor blockade. ⋯ Lysine acetylsalicylic acid (L-ASA) has been given intrathecally for the therapy of severe cancer pain and chronic back pain. In most patients good analgesia was observed up to 2 months after a single injection. If neurotoxity can be excluded, L-ASA may be an alternative in the therapy of cancer pain before neurodestructive therapy is done.
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Low Back Pain Rating scale is an index scale which includes measurements of pain intensity, disability, and physical impairment. The scale was designed to monitor the outcome of clinical trials of low back pain treatment. It has been validated in 58 patients following first-time discectomy. ⋯ In the study, a high rater agreement (97.7%) was found without level difference between two observers using the scale. The validation process included: construct validity, criterion-related validity and item bias, relative to Global Assessments pronounced by the patient and an experienced clinician. Low Back Pain Rating scale hs been shown to be valid and reliable in the assessment of low back pain.