Articles: low-back-pain.
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Agreement between patients' and health professionals' perceptions has been shown to be low to moderate for different aspects of the patients' pain experience. Little is known, however, about patient-physiotherapist agreement in low back pain. The study objectives were to describe patient-physiotherapist agreement for low back pain intensity and functional limitations, and to identify correlates of agreement. A cross-sectional design was used. Seventy-eight patients with acute/subacute nonspecific low back pain and their respective physiotherapists were included in the study. After the initial physiotherapy consultation, patients and physiotherapists completed a Numerical Rating Scale and the Roland-Morris Disability Questionnaire. Intraclass correlation coefficients (ICC) were used to measure chance-corrected agreement. Patients' and physiotherapists' mean ratings were also compared using paired t tests. Multiple regression analyses were conducted to identify factors associated with agreement measures. The level of agreement was moderate for pain intensity (ICC = 0.55, 95% confidence interval [CI]: 0.38-0.69) and functional limitations (ICC = 0.56, 95% CI: 0.22-0.74). Both variables were rated significantly (P < .05) lower by the physiotherapists than by the patients. Higher ratings by the patients for pain and functional limitations were related to higher differences in perceptions between patients and physiotherapists. This report shows that physiotherapists' perceptions of their patients' pain intensity and functional limitations often differ from their patients'. ⋯ The findings of this study indicate that there are frequent discrepancies between patients' and physiotherapists' perceptions of the patients' low back pain experience. Gaining a better understanding of the level of patient-physiotherapist agreement and identifying the correlates of agreement may help improve physiotherapists' interventions with people with low back pain.
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The treatment for patients with low back pain varies considerably. The Dutch Physiotherapy Association issued an evidence-based physiotherapy guideline for non-specific low back pain. To establish changes in daily practice an active implementation strategy was developed. We evaluated the cost-effectiveness of this implementation strategy. ⋯ The active implementation strategy appears not to be cost effective as compared to the standard strategy.
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Infective endocarditis in association with spondylodiscitis is rarely observed. It is sometimes difficult to distinguish between rheumatologic diseases and infective endocarditis. We reported a 61-year-old male with Streptococcus viridans endocarditis suffering from low-back pain as initial symptom. ⋯ L4-5 spondylodiscitis was revealed on the lumbar magnetic resonance imaging. He responded to antibiotic treatment. Infective endocarditis should be considered in patients with fever and low-back pain due to spondylodiscitis.
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Superior cluneal nerve (SCN) entrapment is one of the infrequent etiologies of low back pain (LBP), which is rarely diagnosed. Few clinical reports have been published in the literature. We present a case of severe LBP radiating to the ipsilateral buttock after decubitus surgery. ⋯ SCN entrapment should be considered in patients who suffer from LBP radiating to the iliac crest and buttock after other causes of LBP have been excluded.
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Chronic lumbar radicular pain is the most common neuropathic pain syndrome. This was a double-blind, randomized, 2-period crossover trial of topiramate (50 to 400 mg) and diphenhydramine (6.25 to 50 mg) as active placebo to assess the efficacy of topiramate. Each period consisted of a 4-week escalation, a 2-week maintenance at the highest tolerated dose, and a 2-week taper. Main outcome was the mean daily leg pain score on a 0 to 10 scale during the maintenance period. Global pain relief was assessed on a 6-level category scale. In the 29 of 42 patients who completed the study, topiramate reduced leg pain by a mean of 19% (P = .065). Global pain relief scores were significantly better on topiramate (P < .005). Mean doses were topiramate 200 mg and diphenhydramine 40 mg. We concluded that topiramate treatment might reduce chronic sciatica in some patients but causes frequent side effects and dropouts. We would not recommend topiramate unless studies of alternative regimens showed a better therapeutic ratio. ⋯ The anticonvulsant topiramate might reduce chronic lumbar nerve root pain through effects such as blockade of voltage-gated sodium channels and AMPA/kainite glutamate receptors, modulation of voltage-gated calcium channels, and gamma-aminobutyric acid agonist-like effects.