Articles: back-pain.
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Randomized Controlled Trial Clinical Trial
Changes in innominate tilt after manipulation of the sacroiliac joint in patients with low back pain. An experimental study.
The purposes of this study were to 1) propose a method to detect sacroiliac joint dysfunction (SIJD), 2) test the interrater reliability of the method on a group of patients with low back pain (LBP), and 3) document changes in innominate tilt after manipulation of the sacroiliac joint. Criteria for SIJD were established by the authors. Twenty-six patients with unilateral LBP were examined independently for presence of SIJD by two examiners. ⋯ Data were analyzed using a mixed three-factor analysis of variance. The data analysis revealed that the manipulation procedure resulted not only in an altered innominate tilt of the same side but also in an equal and opposite tilt of the opposite side (F = 67.07; df = 1.18; p less than .05). The results indicate that SIJD can be identified reliably in patients with LBP and that a manipulative procedure purported to be specific to the sacroiliac joint changes innominate tilt bilaterally and in opposite directions.
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Epidural injection of steroid and local anesthesia can be used to treat low back pain. The injection is best performed with fluoroscopic control, with needle placement documented by means of a limited epidurogram. The technique was used in 116 patients; there were only three failures (2.5%) and one complication.
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According to myogenic models that relate abnormal EMG patterns to the experience of pain, lumbar paravertebral muscle activity has been considered to play an important role in chronic low back pain. In the present study, 40 chronic low back pain patients and 40 matched non-patient controls were compared on lumbar paravertebral EMG during mechanically stabilized static and dynamic postures. ⋯ In addition, most patients did not show the flexion-relaxation response or the expected pattern of EMG responses during trunk rotation, most likely because of restricted range of motion and/or compensatory posturing. These findings provide support for the biomechanical model of chronic pain and indicate the need for further research pertaining to pain behavior and movement-related lumbar muscle activity.
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The pain drawings of 54 low-back-pain patients were examined to find out if it is possible to use them as a brief screening test in order to assess the psychological impairment of the patients. We were using the scoring system of Ransford et al, which we slightly changed, and chose as a criterion variable the ERMSS (Erweiterte Revidierte Mehrdimensionale Schmerzskala) of Cziske. ⋯ A correlation was found between pain drawing score and the sensory-discriminative dimension of pain perception, whereas there was no such correlation between drawing score and the affective dimension. These results indicate that the pain drawing score might not be a sufficiently valid instrument for assessing psychological disturbances in pain patients to allow it to be used for individual diagnosis without hesitation.
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Psychological methods for the treatment of chronic pain have been developed within the contextual framework of behavioral medicine during the past few years. Some of these self-control approaches focus on the patient's capacity to cope actively with pain. Standardized self-control training for outpatient group treatment for patients with chronic pain is described. ⋯ Thirty-three patients with chronic back pain were assigned either to one of four treatment groups (n=22) or to a waiting list control group (n=11). After 12 sessions of group treatment, patients showed significant improvement regarding daily ratings of pain intensity and mood and a significant decrease in depression and general physical complaints other than pain; the waiting list patients remained the same. Results showed good maintenance at the half-year follow-up.