Articles: low-back-pain.
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Comparative Study
Back pain during war: an analysis of factors affecting outcome.
Back pain is the leading cause of disability in the world, but it is even more common in soldiers deployed for combat operations. Aside from battle injuries and psychiatric conditions, spine pain and other musculoskeletal conditions are associated with the lowest return-to-unit rate among service members medically evacuated out of Operations Iraqi and Enduring Freedom. ⋯ The likelihood of a service member medically evacuated out of theater with back pain returning to duty is low irrespective of any intervention(s) or characteristic(s). More research is needed to determine whether concomitant treatment of coexisting psychological factors and early treatment "in theater" can reduce attrition rates.
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Comparative Study
Flexion-relaxation and clinical features associated with chronic low back pain: A comparison of different methods of quantifying flexion-relaxation.
The purpose of this study was to simultaneously assess 5 surface electromyography (SEMG) ratios commonly used to quantify the flexion relaxation phenomenon in chronic low back pain patients relative to clinical and musculoskeletal abnormalities. ⋯ These data suggest that measures of flexion-relaxation that contrast SEMG during flexion or extension to MVF are more highly associated with clinical status compared with measures that contrast SEMG during flexion and extension, SEMG whereas standing to MVF, or SEMG during MVF alone.
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Randomized Controlled Trial Comparative Study Clinical Trial
The preliminary results of a comparative effectiveness evaluation of adhesiolysis and caudal epidural injections in managing chronic low back pain secondary to spinal stenosis: a randomized, equivalence controlled trial.
Lumbar surgery and epidural injections for spinal stenosis are the most commonly performed interventions in the United States. However, there is only moderate evidence to the effectiveness of surgery and caudal epidural injections. The next sequential step is adhesiolysis and hypertonic neurolysis with targeted delivery. There have not been any randomized trials evaluating the effectiveness of percutaneous adhesiolysis and targeted delivery of local anesthetic, steroid and hypertonic sodium chloride solution in lumbar spinal stenosis. ⋯ With significant pain relief in 76% of patients, percutaneous adhesiolysis utilizing local anesthetic, steroids and hypertonic sodium chloride solution may be effective in patients with chronic function-limiting low back and lower extremity pain with spinal stenosis.
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Patients with chronic low back pain (CLBP) often report a disabling decrease in their activity level due to pain. The nature of the association between disability, activity, and pain over time is however, unclear. An intriguing issue here is whether a high level of pain-related disability is associated with a low activity level or are changes in the level of activity over time pain provoking and thus more disabling? The objectives of this study were to investigate associations between disability, pain intensity, pain-related fear, and characteristics of physical activity in patients with CLBP. ⋯ To explain the level of disability regression analyses were performed with disability as dependent variable and pain intensity, pain-related fear, and consecutively the level of physical activity in daily life and fluctuations in physical activity as independent variables. Results, based on 34 patients, showed that activity fluctuations (beta=0.373, p<0.05) rather than the mean activity level over time (beta=-0.052, ns) contributed significantly in explaining disability. The results are discussed in the light of current theories, previous research, and clinical implications.
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Prospective clinical study of total lumbar disc replacement (TDR) with ProDisc II (Synthes, Paoli, PA). ⋯ Baseline ODI and early postoperative outcome parameters (< or =6 months) revealed significant and strong associations with the final results following TDR. While the vast majority of patients with an early highly satisfactory outcome maintained satisfactory results at later FU stages, any significant improvement considered as "highly satisfied" is unlikely in a group of patients which reported early unsatisfactory results. In summary, any clinically relevant changes are unlikely to occur after the early postoperative period.The current findings offer a foundation for weighing both the patients and the spine surgeons expectations against possible realistic achievements. Although the data show that the midterm outcome at a FU of 4 years (mean: 45.5 months, range: 24.1-94.4 months) is predictable following TDR, the long-term results of lumbar disc replacements still need to be established.