Articles: low-back-pain.
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Systematic review. ⋯ Surgery for radiculopathy with herniated lumbar disc and symptomatic spinal stenosis is associated with short-term benefits compared to nonsurgical therapy, though benefits diminish with long-term follow-up in some trials. For nonradicular back pain with common degenerative changes, fusion is no more effective than intensive rehabilitation, but associated with small to moderate benefits compared to standard nonsurgical therapy.
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Lumbar disc prolapse, protrusion, or extrusion account for less than 5% of all low back problems, but are the most common causes of nerve root pain and surgical interventions. The primary rationale for any form of surgery for disc prolapse is to relieve nerve root irritation or compression due to herniated disc material. The primary modality of treatment continues to be either open or microdiscectomy, but several alternative techniques including nucleoplasty, automated percutaneous discectomy, and laser discectomy have been described. There is a paucity of evidence for all decompression techniques, specifically alternative techniques including nucleoplasty. ⋯ This systematic review illustrates Level II-3 evidence for mechanical lumbar percutaneous disc decompression with nucleoplasty in treatment of leg pain. However, there is no evidence available in managing axial low back pain.
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Reg Anesth Pain Med · May 2009
Multicenter StudyOutcome predictors for sacroiliac joint (lateral branch) radiofrequency denervation.
Sacroiliac (SI) joint pain is a challenging condition characterized by limited treatment options. Recently, numerous studies have reported excellent intermediate-term outcomes after lateral-branch radiofrequency (RF) denervation, but these studies are characterized by wide variability in technique, selection criteria, and patient characteristics. The purpose of this study was to determine whether any demographic or clinical variables can be used to predict SI joint RF denervation outcome. ⋯ Whereas several factors were found to influence outcome, no single clinical variable reliably predicted treatment results. The use of more stringent selection criteria was not associated with better outcomes.
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Psychoneuroendocrinology · May 2009
Comparative StudySalivary cortisol and psychological mechanisms in patients with acute versus chronic low back pain.
This study was designed to explore whether the basal adrenocortical activity is related with pain-related coping, nonverbal pain behavior, depressive mood, and fatigue in patients with acute and chronic nonspecific low back pain. 19 patients with acute low back pain (ALBP) and 24 with chronic low back pain (CLBP) participated in the study. The adrenocortical activity was assessed through the cortisol awakening response. All participants provided five saliva samples (0, 15, 30, 45, and 60min after waking) on two consecutive days off work. ⋯ Among CLBP patients, FAC, NPB, depressive mood, and fatigue were negatively associated with the cortisol awakening response, whereas EC tended to be positively associated with it. The results indicate that pain-related coping strategies which are expected to be successful appear to lower the adrenocortical activity among ALBP patients, whereas affective distress may enhance the level of cortisol in this group. Among CLBP patients, long-term maladaptive coping strategies might contribute to hypocortisolism.
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Arch Orthop Trauma Surg · May 2009
Evaluation of responsiveness of Oswestry low back pain disability index.
To assess the response of Oswestry disability index (ODI) among patients undergoing caudal epidural steroid injections for lumbosacral radicular pain. ⋯ This study shows that ODI can detect small changes in disability over time in patients undergoing caudal epidural injections for lumbosacral radicular pain. It can also differentiate between small and large changes in the level of disability.