Articles: low-back-pain.
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AJNR Am J Neuroradiol · Feb 2007
Comparative Study Clinical TrialComparison of the temporary diagnostic relief of transforaminal epidural steroid injection approaches: conventional versus posterolateral technique.
Conventional transforaminal epidural steroid injection (TFESI) has several problems. The purpose of this study was to compare the temporary diagnostic relief and advantages of TFESI performed using the conventional and posterolateral approaches. ⋯ Our findings suggest that the posterolateral approach is an alternative method for TFESI in cases where needle tip positioning in the anterior epidural space is difficult.
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The objective of the study was to assess inter-rater reliability of one palpation and six pain provocation tests for pain of sacroiliac origin. The sacroiliac joint (SIJ) is a potential source of low back and pelvic girdle pain. Diagnosis is made primarily by physical examination using palpation and pain provocation tests. ⋯ In conclusion this study has shown the reliability of the pain provocation tests employed were moderate to good, and for the palpation test, reliability was poor. Clusters out of three and five pain provocation tests were found to be reliable. The cluster of tests should now be validated for assessment of diagnostic power.
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Low back pain is estimated to affect 80% of the general population at least once in their lifetime. It is the fifth leading cause of medical clinic visits and the leading work-related disability. Lumbar discography has been used to diagnose the source of low back pain when non-invasive imaging, such as magnetic resonance (MR), does not reveal morphologic abnormality consistent with symptoms. ⋯ These causes of positive pain provocation are not amendable to invasive treatment. In these cases, an invasive diagnostic procedure to identify problems best treated with conservative management is not practical. The conclusion of this review found no clear evidence-based purpose for discography in the diagnosis and treatment of low back pain.
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J Clin Neurophysiol · Feb 2007
Central processing of acute muscle pain in chronic low back pain patients: an EEG mapping study.
The presence of perceptual sensitization and related brain responses was examined in 14 chronic low back pain (CLBP) patients and 13 healthy controls comparable in age and sex. Multichannel EEG recordings and pain ratings were obtained during the presentation of 800 painful electrical intramuscular and intracutaneous stimuli each to the left m. erector spinae and the left m. extensor digitorum. Perception and pain thresholds were not significantly different between the two groups, though patients showed significantly more perceptual sensitization. ⋯ These results indicate enhanced perceptual sensitization and enhanced processing of the sensory-discriminative aspect of pain, as expressed in the N80 component, in CLBP patients. This may be one neurophysiologic basis of sensitization and the chronicity process. The lower P260 component in the patients may be explained in terms of tonic pain inhibiting phasic pain or may be related to the affective distress observed in this patient group.