Articles: low-back-pain.
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(a) To investigate how widespread is the use of long term treatment without improvement amongst clinicians treating individuals with low back pain. (b) To study the beliefs behind the reasons why chiropractors, osteopaths and physiotherapists continue to treat people whose low back pain appears not to be improving. ⋯ Long-term treatment of patients with low back pain without objective signs of improvement is an established practice in a minority of clinicians studied. This approach contrasts with clinical guidelines that encourage self-management, reassurance, re-activation, and involvement of multidisciplinary teams for patients who do not recover. Some of the rationale provided makes a strong case for ongoing contact. However, the practice is also maintained through poor communication with other professions and mistrust of the healthcare system.
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Randomized Controlled Trial
Trait anger and blood pressure recovery following acute pain: evidence for opioid-mediated effects.
Previous work has suggested that positive associations between trait anger (TRANG) and pain sensitivity are due to dysfunctional endogenous opioid analgesic systems. In this study, we examined whether TRANG is associated with impaired opioid modulation of blood pressure (BP) recovery. A total of 46 pain-free normotensive controls and 69 normotensive chronic low back pain (LBP) sufferers received opioid blockade (8 mg naloxone i.v.) or placebo in randomized, counterbalanced order in separate sessions. ⋯ In controls, low TRANG was associated with blockade-induced recovery impairments, with no blockade effect in high TRANG participants. In LBP participants, blockade did not alter recovery regardless of TRANG (interaction ps < .05). Results support dysfunctional opioid modulation of BP recovery in healthy high TRANG controls and further suggest chronic pain-related impairments in opioid-mediated cardiovascular recovery.
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Randomized Controlled Trial
Defining worthwhile and desired responses to treatment of chronic low back pain.
To describe patients' perceptions of minimum worthwhile and desired reductions in pain and disability upon commencing treatment for chronic low back pain. ⋯ Inquiring directly about patients' expectations of reductions in pain and in disability is important in establishing realistic treatment goals and setting benchmarks for success. There is a wide disparity between the reductions that they regard as minimum worthwhile and reductions that they hope to achieve. However, there is a high internal consistency between reductions in pain and disability that they expect.
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Chronic pain and cognitive impairment are prevalent and disabling in older adults (OA), but their interrelationship has not been rigorously tested. We did so in OA with chronic low back pain (CLBP). ⋯ OA with CLBP demonstrated impaired NP performance as compared with pain-free OA. Further, pain severity was inversely correlated with NP performance, and NP performance mediated the relationship between pain and physical performance. Future research should examine whether cognitive function and impaired physical performance can be improved with pain reduction.
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Case Reports
Discitis after lumbar epidural corticosteroid injection: a case report and analysis of the case report literature.
The primary objective is to document the first case report of discitis after a lumbar epidural corticosteroid injection. The second objective is to analyze the case report literature to identify clinical features and trends of patients with infectious complications after spinal injections. ⋯ The identified clinical features and trends could prove useful to the practitioner when an infectious complication is suspected or has occurred.