Articles: back-pain.
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Assessment and treatment responses were compared in 17 subjects with chronic low back pain assessed as showing at least one clear consciously produced inconsistency in statements and/or behaviors during their participation in an interdisciplinary treatment program and 143 subjects assessed as showing no such inconsistency. Numerous statistically significant differences emerged: Inconsistent subjects were more likely to have pending litigation and to be assessed by staff as showing a higher degree of focus on pain and more dramatized complaints, lower levels of medical findings and attention and interest in treatment, and poor compliance with treatment and assessment procedures. ⋯ Though not definitive, these results suggested a syndrome of characteristics among such subjects which are similar to those proposed as likely characterizing malingerers. The need for a particularly careful validation of self-report data in patients showing many of these characteristics was emphasized.
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The McKenzie approach to evaluating and treating low back and neck pain is an exciting development in clinical medicine. A thorough mechanical assessment as described by McKenzie is informative and appropriate for all such patients and identifies an individualized self-treatment program that is often dramatically successful. ⋯ The assessment process and McKenzie's classification of low back pain syndromes--postural, dysfunctional, and derangement--are described. Therapeutic regimens emphasizing patient self-treatment for the current episode are presented, with the long-range goal of preventing recurrences.
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To examine the relation between epidural anaesthesia and long term backache after childbirth. ⋯ The relation between backache and epidural anaesthesia is probably causal. It seems to result from a combination of effective analgesia and stressed posture during labour. Further investigations on the mechanisms causing backache after epidural anaesthesia are required.
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Two hundred fifty patients with low-back pain who underwent lumbar discography followed by computed tomography (CT) are the subject of this prospective study. In 93% of the patients, these combined imaging techniques provided additional useful diagnostic information that affected patient management and the selection of treatment alternatives. Lumbar discography followed by CT proved valuable in determining the significance of equivocal or multiple level abnormalities, determining the type of disc herniation, defining surgical options, and evaluating the previously operated spine. ⋯ The radiographic morphology of the normal herniated and degenerative lumbar discs shown by CT-discography gives unique insight into the pathogenesis of disc degeneration. The complications that followed the 750 discograms were one case of urticaria and one disc space infection. Even with the availability of high resolution CT and MRI, lumbar discography remains the only pain provocation challenge to the lumbar disc.