Articles: back-pain.
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Clin. Orthop. Relat. Res. · Sep 1984
The effects of epidural injection of local anesthetics and corticosteroids on patients with lumbosciatic pain.
Although epidural cortisone injections are commonly used for treatment of lumbosciatic pain, insufficient critical analysis of the end result can be found in the literature. The present study is a retrospective critical analysis of 367 patients with leg pain who were engaged for a minimum of two weeks or an average of two months in multifaceted conservative management without relief of pain. Injections of 10 cm3 of 0.5% bupivacaine and 100 mg of methylprednisolone were given to inpatients treated by the same anesthesiologist. ⋯ The most favorable results (approaching 70% offd-excellent) were observed in patients with subacute radicular leg pain (of less than three months' duration) and chronic leg pain (of greater than three months' duration) with no prior surgery. Negative myelograms and electromyograms (EMGs), in the absence of reflex or motor deficits on physical examination, also pointed toward optimal results. Those patients with chronic pain who had had prior lumbar spine surgery had the least satisfactory results.
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Emerg. Med. Clin. North Am. · May 1984
ReviewLow back pain. Evaluation and treatment in the emergency department setting.
The author outlines the most common clinical syndromes causing back pain, including degenerative disc disease, disc herniation syndrome, and cauda equina syndrome. Also discussed are specific guidelines regarding the need for immediate orthopedic and neurosurgical consultation or admission to the hospital.
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A psychophysical analysis of acupuncture analgesia was carried out in which low back pain patients made visual analogue scale (VAS) responses both to their chronic pain and to different levels of experimental heat pain (5 sec exposures to 43-51 degrees C) before and after electroacupuncture. VAS (sensory) responses to chronic pain, direct temperature matches to chronic pain, and VAS (sensory) responses to experimental pain were reduced in an internally consistent manner 1-2 h after treatment. The magnitude of this analgesic response was similar for dermatomes within the region of chronic pain and acupuncture needle placement (lower back) as well as for dermatomes remote from needle placement and chronic pain (forearm). ⋯ VAS sensory and VAS affective analgesic responses to electroacupuncture treatment showed a delayed onset (1-24 h) to maximum effect and a duration of 10-14 days. Cumulative sensory and affective analgesic effects were observed at the end of 4 months of biweekly acupuncture treatments. The results of this analysis reveal the unique spatial and temporal properties of electroacupuncture analgesia and the extent to which it is mediated by at least two different mechanisms.