Articles: low-back-pain.
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The authors studied the surface electromyographic (EMG) spectrum of the paraspinal muscles of 350 subjects. They were classified by their history as normal (n=175), chronic low back pain (n=145), or past history (n=30). They pulled upwards on a floor-mounted load cell at two-thirds of their maximum voluntary contraction for 30 s, while the EMG was measured from the paraspinal muscles at the L4/L5 level. ⋯ All of the variables of the chronic group were significantly different from the normal group, except the median frequency slope, RMS slope and mode. Half-width, age and maximum voluntary contraction were shown to be independent predictors of back pain classification. Half-width classified the subjects with a sensitivity of 0.65 and a specificity of 0.75.
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This review was undertaken to outline the procedural limitations of the randomized controlled trials (RCTs) of radiofrequency (RF) neurotomy for low back pain. Second, the literature related to patient selection, diagnostic testing, and the technique of performing lumbar spine RF neurotomy will be critically reviewed and analyzed. Based on these analyses, diagnostic and procedural guidelines will be proposed. ⋯ The evidence-based procedural guidelines provide consistent criteria for multisite studies that could enroll a sufficiently large homogenous study cohort.
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Am J Phys Med Rehabil · Mar 2005
Case ReportsParaplegia secondary to progressive necrotic myelopathy in a patient with an implanted morphine pump.
We present an individual with chronic low back pain who was treated with an implanted morphine pump, which provided very good pain relief for 16 mos. However, the patient developed acute paraplegia secondary to progressive necrotic myelopathy, a rare form of transverse myelitis. The cause of this patient's neurologic deficit was unclear. ⋯ There was no improvement in his neurologic status after stopping the intrathecal morphine therapy, and several consecutive magnetic resonance images of the spine demonstrated radiologic progression of spinal cord involvement. The patient developed classic opioid side effects of excessive somnolence and constipation. Intrathecal morphine therapy was re-instituted, and the patient reported a significant decrease of his pain, an improvement in quality of life, and no complications related to pump functioning.
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Multicenter Study Comparative Study
A comparison of patient characteristics and rehabilitation treatment content of chronic low back pain (CLBP) and stroke patients across six European countries.
So far no studies have been conducted on the issue of comparability of rehabilitation treatment profiles and patient characteristics across countries. These aspects might have implications for the feasibility of treating patients abroad but also for the comparison of treatment outcome on an international level. ⋯ International treatment and outcome assessment of CLBP patients is not possible unless standardisation is considered of treatment content and patient selection. For stroke treatment international traffic and multi-centre outcome assessment might be more feasible.