Articles: low-back-pain.
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Implementation of guidelines in clinical practice is difficult. In 2003, the German College of General Practitioners and Family Physicians (DEGAM) released an evidence-based guideline for the management of low back pain (LBP) in primary care. The objective of this study is to explore the acceptance of guideline content and perceived barriers to implementation. ⋯ Promoting adherence to the LBP guideline requires more than enhancing knowledge about evidence-based management of LBP. Public education and an interdisciplinary consensus are important requirements for successful guideline implementation into daily practice. Guideline recommendations need to be adapted to the infrastructure of the health care system.
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Case Reports
Adriamycin injection into the medial cord of the brachial plexus: computed tomography-guided targeted pain therapy.
Recent advances in radiographic imaging technology allow for therapeutic agents to be placed within the subepineurium of peripheral nerve tissue. Adriamycin, a chemotherapeutic agent, is retrogradely transported by nerves to their cell bodies residing in the dorsal root ganglia. The combined process of radiological approach, an understanding of the anatomy of the brachial nerve plexus, and the use of agents that are retrogradely transported by nerves allows for targeted neuroablation of nerves. ⋯ Here, we report on the transcutaneous computed tomography (CT)-guided injection of adriamycin into specific branches of the brachial plexus in a patient with metastatic cervical cancer involving the lower plexus whose pain was untreatable by aggressive medical therapy that included epidural trials of opioids. Identification of the medial brachial cord was achieved using CT-guided techniques that included accurate localization with intra-neural dye injection, followed by injection of 0.5 mg of adriamycin. The patient reported complete pain relief within 12 h of the injection.
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The management of chronic low back pain (CLBP) has proven to be very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing among available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. ⋯ Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.
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Several prospective studies examining patients receiving physical therapy support the predictive validity of FABQ subscale scores. This has lead to the proposition that the FABQ would be a useful screening tool, permitting early identification of patients at risk for a poor outcome with an opportunity to modify the treatment accordingly. However, the predictive validity of the FABQ within physical therapy practice has yet to be examined. ⋯ Only the FABQ-W subscale was predictive of poor outcome and this was only identified in the worker's compensation group. The results suggest that the work subscale of the FABQ might be an appropriate screening tool to identify patients with work-related LBP who are at risk for a poor outcome with routine physical therapy. Neither FABQ subscale was predictive of outcome for patients with private insurance, and the use of the FABQ, as a screening tool for patients with non-work-related LBP was not supported.
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Whether individuals with chronic low back pain (CLBP) are willing to accept their pain, is of interest to pain management, but how far is the acceptance of pain related to a good quality of life (QoL)? Recently available measures now enable this question to be investigated; these are (1) the Chronic Pain Acceptance Questionnaire (CPAQ) and a revised version, here described as a short-form (SF-CPAQ), and (2) the World Health Organization Quality of Life Assessment (WHOQOL)-Pain, which is composed of the generic WHOQOL-100 profile (25 facets in 6 domains), and 4 additional facets within a specific pain and discomfort module (PDM). ⋯ The results indicate that present pain level and whether or not pain is accepted play an important role in the QoL of patients with chronic pain. Additionally, the results provide construct validity for the WHOQOL-Pain and SF-CPAQ measures, especially dimensions of pain willingness and activities engagement. The findings have implications for the way health care is delivered, particularly for the role of acceptance-based treatments for individuals with CLBP.