Articles: low-back-pain.
-
Assessment of patients with complaints of low back or leg pain varies with the subspecialty of the treating physician. The evaluation of the spine patient may include magnetic resonance imaging (MRI), bone scan, or single-photon emission computed tomography (SPECT) imaging. The interpretation of these tests and the examiner's biases will impact the outcome of patient treatment and the cost to the health-care system. ⋯ MRI interpretation of the lumbar spine is comparable between specialties. Nuclear imaging studies (bone scan/SPECT) demonstrated a poorer correlation between examiners. The presence of MRI changes enables an accurate prediction of bone scan or SPECT scan findings. SPECT scan demonstrates an increased sensitivity in the detection of spinal abnormalities and the ability to localize a lesion when compared with planar bone scan.
-
We collected the specimens of lumbar intervertebral disc (i.e., the symptomatic degenerative disc) from patients with discogenic low back pain to study the histopathologic features and growth factor expressions. ⋯ The findings indicated that degeneration of the painful disc might originate from the injury and subsequent repair of anulus fibrosus. Growth factors, such as bFGF and TGF-beta1, macrophages and mast cells might play a key role in the repair of the injured anulus fibrosus and subsequent disc degeneration.
-
AJR Am J Roentgenol · Mar 2006
Axial rotation of the lumbar spinal motion segments correlated with concordant pain on discography: a preliminary study.
One possible cause of back pain in patients with intervertebral disk degeneration is decreased stability of the motion segment. Axial rotations between lumbar spinal vertebrae can be measured noninvasively with CT. We tested the hypothesis that larger axial rotations are found in motion segments with disks that test positive for concordant pain, which is considered by some investigators to be a reasonable, accurate predictor of spinal instability. ⋯ Concordant pain at discography predicts increased axial rotation at a lumbar disk level.
-
Comparative Study
Pain assessment in patients with low back pain: comparison of weekly recall and momentary electronic data.
Electronic data collection for monitoring pain has become increasingly popular in clinical research. Past research has shown that electronic diaries improve the timeliness of receipt of data, contribute to higher rates of compliance, and are preferred by patients over paper diaries, and this research suggests that electronic diaries that capture current pain at the moment of reporting result in more reliable ratings than recalled pain ratings. This study compared differences of momentary pain intensity ratings on an electronic visual analog scale (VAS) with weekly recalled pain on a 0 to 10 scale. We asked 21 patients with chronic low back pain to monitor their current pain at least once a day by using a VAS for up to 1 year with a palmtop computer. They were also called once a week and asked to rate their recalled weekly pain orally on a numeric scale from 0 to 10. Patients entered data electronically on average 357 times, for an average of 7.8 times a week. We found that (1) weekly recalled pain agreed highly (r > .90) with averaged momentary pain assessments, (2) neither frequency of electronic monitoring nor variability in momentary pain ratings (high standard deviations) contributed to degree of agreement between momentary and recalled pain, and (3) a ceiling effect was observed in VAS pain ratings as compared with numeric pain ratings. These findings suggest that, among many individuals, weekly recalled pain might be just as useful as momentary data collected through electronic data entry. ⋯ Some believe that remembered pain is problematic because of recall bias and that data from frequent momentary pain ratings with electronic diaries are more valid. This study demonstrates that recalled pain is as valid as momentary data for many patients.