Articles: low-back-pain.
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Comparative Study
Disability determination: validity with occupational low back pain.
Disability determination for occupational low back pain challenges indemnification systems because spinal pathoanatomy is weakly related to pain intensity and functional capacity, making judgments of disability vulnerable to such confounding factors as sociodemographic variables (eg, race, socioeconomic status). To assess the contribution of impairment, race, and socioeconomic status to disability ratings and post settlement functional status, the current study investigated 580 African American and 892 white workers' compensation claimants with occupational low back pain who were surveyed an average of 21 months after claim settlement. Results indicated that diagnosis, surgery, and medical costs (indicators of impairment) were associated with disability ratings at the time of case settlement. African American race was negatively associated with disability ratings and also with diagnosis/surgery and medical costs. Disability ratings, however, correlated only weakly with post settlement status at 21-month follow-up. The association between race and disability ratings suggests that inequities operate in disability determination. Furthermore, the relative lack of association between disability ratings and postsettlement status raises questions about the validity of disability determination for workers' compensation claimants with low back pain. ⋯ Results demonstrated apparent racial/ethnic disparities in treatment and little association between disability ratings and post settlement status. Together, these results raise questions about social justice in the management of occupational back pain, as well as the validity of associated disability determination processes.
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Prospective, 5-year, cohort study of working subjects. ⋯ In this study cohort, minor trauma does not appear to increase the risk of serious LBP episodes or disability. The vast majority of incident-adverse LBP events may be predicted not by structural findings or minor trauma but by a small set of demographic and behavioral variables.
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Am J Phys Med Rehabil · Dec 2006
ReviewSacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment.
The sacroiliac joint is an underappreciated cause of low back and buttock pain. It is thought to cause at least 15% of low back pain. It is more common in the presence of trauma, pregnancy, or in certain athletes. ⋯ Fluoroscopically guided injections into the joint have been found to be helpful for diagnostic and therapeutic purposes. Conservative treatment, which also can include joint mobilization, antiinflammatory medicines, and sacroiliac joint belts, generally is effective. Surgical arthrodesis should be considered a procedure of last resort.
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Randomized Controlled Trial
Effectiveness and cost-effectiveness of adding a cognitive behavioral treatment to the rehabilitation of chronic low back pain.
To investigate return to work and cost-effectiveness of the addition of cognitive-behavioral treatment to standard therapy compared to standard 3-week inpatient rehabilitation for patients with chronic low back pain. ⋯ Adding a cognitive behavioral component to standard therapy may reduce work days lost and thus decrease indirect costs. From a societal perspective, the cost of the psychological treatment was compensated by lower indirect costs.
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Randomized Controlled Trial
Influence of ibuprofen-arginine on serum levels of nitric oxide metabolites in patients with chronic low back pain--a single-blind, placebo controlled pilot trial (ISRCTN18723747).
To determine whether ibuprofen-arginine has a cyclooxygenase-independent pain modulating property in addition to its known antiinflammatory effect. ⋯ An early lowering of the serum NO metabolite levels after ibuprofen-arginine administration could be detected in patients with chronic low back pain.