Articles: low-back-pain.
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In current medical literature, most reported complications during spinal cord stimulation (SCS) concern technical problems, such as malfunction, migration or breakage of the lead, or internal pulse generator dysfunction, while reports about side-effects caused by SCS are rare. In this clinical report, we describe uncommon and unexplained gastrointestinal (GI) side-effects of constipation, abdominal pain, and distension during SCS in a patient suffering for chronic neuropathic pain caused by failed back surgery syndrome. These GI symptoms disappeared after suspension of SCS and were reduced if the stimulation settings were reduced below paresthesia threshold. The symptoms experienced by our patient could be related to a functional and reversible block of parasympathetic outflow in the GI system since SCS may involve not only dorsal horn structures but also somatic and visceral sensory afferents to these structures in an unpredictable way.
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The objective of the study was to develop a clinical prediction rule for identifying patients with low back pain, who improved with mechanical lumbar traction. A prospective, cohort study was conducted in a physiotherapy clinic at a local hospital. Patients with low back pain, referred to physiotherapy were included in the study. ⋯ A clinical prediction rule with four variables (non-involvement of manual work, low level fear-avoidance beliefs, no neurological deficit and age above 30 years) was identified. The presence of all four variables (positive likelihood ratio = 9.36) increased the probability of response rate with mechanical lumbar traction from 19.4 to 69.2%. It appears that patients with low back pain who were likely to respond to mechanical lumbar traction may be identified.
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In low back pain (LBP) treatment and research attention has shifted from a biomedical towards a biopsychosocial approach. Patients' LBP beliefs and attitudes were found to predict long-term outcome, and recently it has been suggested that the health care providers' ideas about LBP are also important predictors of treatment behaviour and outcome. ⋯ Associations were not found as expected. Still these findings are relevant and may feed a clinically important debate on widely accepted assumptions about the role and influence of health care providers in changing patients' pain behaviours.
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The objective of the study was to establish the specific use of advice and exercise by physiotherapists, for the management of chronic low back pain (LBP). A questionnaire was mailed to a random sample of 600 members of the Irish Society of Chartered Physiotherapists. Open and closed questions were used to obtain information on treatments provided to chronic LBP patients. ⋯ Pain relief was an important treatment goal. Emphasis on exercise programme supervision, incorporating reassurance that its safe to stay active and 'hurt does not mean harm', must be more effectively disseminated and promoted in practice. The influence of follow-up advice on exercise adherence warrants further investigation.
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The sacroiliac joint (SIJ) has been implicated as a potential source of low back and buttock pain. Several types of motion palpation and provocation tests are used to examine the SIJ. It has been suggested that use of a cluster of motion palpation or provocation tests is a more acceptable method than single test to assess SIJ. ⋯ PABAK for intra- and inter-examiner reliability for clusters of motion palpation or provocation tests ranged from 0.44 to 0.92 (95% CI: -0.36 to 1.2) which is considered moderate to excellent reliability. PABAK for intra- and inter-examiner reliability of composites of motion palpation and provocation tests ranged from 0.44 to 1.00 (95% CI: -0.22 to 1.12) and 0.52 to 0.92 (95% CI: -0.02 to 1.32) which is considered substantial to excellent. It seems that composites of motion palpation and provocation tests together have reliability sufficiently high for use in clinical assessment of the SIJ.