Articles: low-back-pain.
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Randomized Controlled Trial Comparative Study
A randomized clinical trial and subgroup analysis to compare flexion-distraction with active exercise for chronic low back pain.
Many clinical trials on chiropractic management of low back pain have neglected to include specific forms of care. This study compared two well-defined treatment protocols. The objective was to compare the outcome of flexion-distraction (FD) procedures performed by chiropractors with an active trunk exercise protocol (ATEP) performed by physical therapists. ⋯ There were no significant differences between groups on the Roland Morris and SF-36 outcome measures. Overall, flexion-distraction provided more pain relief than active exercise; however, these results varied based on stratification of patients with and without radiculopathy and with and without recurrent symptoms. The subgroup analysis provides a possible explanation for contrasting results among randomized clinical trials of chronic low back pain treatments and these results also provide guidance for future work in the treatment of chronic low back pain.
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Clinical rehabilitation · Jul 2006
ReviewSegmental stabilizing exercises and low back pain. What is the evidence? A systematic review of randomized controlled trials.
A systematic review of randomized controlled trials. ⋯ For low back pain, segmental stabilizing exercises are more effective than treatment by GP but they are not more effective than other physiotherapy interventions.
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Randomized Controlled Trial Comparative Study
Comparison of a biopsychosocial therapy (BT) with a conventional biomedical therapy (MT) of subacute low back pain in the first episode of sick leave: a randomized controlled trial.
This randomized controlled clinical trial compares the effectiveness of a biopsychosocial treatment with a solely conventional biomedical therapy in patients with subacute low back pain using parameters for pain intensity, functional status, depressive dysfunction and work performance. Sixty-four patients with a first-time sick leave between 3 and 12 weeks due to low back pain were randomly assigned to either a conventional biomedical therapy (MT; n=33) group, or a biopsychosocial therapy (BT; n=31) group including a psychotherapeutic module; both in accordance with a standardized 3 weeks inpatient treatment. ⋯ During the 2-year period after therapy, 10% in MT and 59% in BT required no further sick leave due to low back pain. The results of the study indicate that a psychotherapeutic element in the treatment of low back pain appears to positively influence pain, functional status and work performance when conducted at an early stage of chronification and helps in the achievement of a better outcome.
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Comparative Study
The relationship of combined spinal-epidural analgesia and low-back pain after vaginal delivery.
In this study, we aimed to determine the effects of combined spinal-epidural block on low back pain incidence after vaginal delivery. 198 patients included into the study. Patients were separated into two groups regarding labor analgesia request. Combined spinal-epidural analgesia was performed in sitting position for the first group (CSE Group, n=104). ⋯ Totally, we determined 60 new onset low back pain cases after the delivery (32 in CSE and 28 in non-epidural group). We didn't establish any significant differences during long-time follow-ups between the groups. We concluded that, combined spinal-epidural analgesia could be performed safely without increasing the backache incidence after delivery.
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A major barrier to understanding facetogenic low back pain has been the lack of radiographic diagnostic criteria. This study investigates the correlation between radiographic findings on magnetic resonance imaging (MRI) scans and single photon emission computed tomographic (SPECT) scans in patients clinically found to have facetogenic axial back pain. ⋯ We identify four types of synovial architecture on T2-weighted MRI scans with overall high sensitivity for predicting SPECT positivity. These four grades likely represent a continuum of facet degeneration, from a normal to obliterated joint. One particular subtype, Grade 2, demonstrated a high specificity for SPECT and synovial fluid increase suggestive of inflammation. Facet hypertrophy was not predictive of bone scan positivity, perhaps suggesting the protective nature of a hypertrophied facet. Synovial abnormalities correlate with SPECT findings and a grading scale is proposed delineating the degeneration of a lumbar facet over time. A subtype of SPECT(+) inflamed joint is proposed. Further studies will be needed to improve our understanding of the natural history of the lumbar facet.