Articles: low-back-pain.
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Interventional pain management has been growing by leaps and bounds with the introduction of an array of new CPT codes, the expansion of interventional techniques, and utilization. Interventional pain management dates back to the origin of neural blockade and regional analgesia, in 1884. Over the years, pain medicine and interventional pain management have taken many approaches, including biological, biopsychosocial, and psychosocial. ⋯ Overall, the utilization of various nerve blocks (excluding epidurals, disc injections, and facet joint blocks) in Medicare recipients from 1998 to 2003 were performed approximately 50% of the time by non-pain physicians. Interventional pain management is growing rapidly, under the watchful eye of the government, and third party payors. Establishing an algorithmic approach and following guidelines may improve compliance and quality of care without implications of abuse.
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Percutaneous disc decompression using Coblation (Nucleoplasty trade mark) implements the principle of volumetric reduction to achieve disc decompression and reduce intradiscal pressure. Previous analyses have shown that Nucleoplasty achieves reduction in volume and intradiscal pressure with minimal damage to surrounding tissue in the treated disc. ⋯ Nucleoplasty for disc decompression is one of the least-invasive techniques in the minimally invasive category, thus far exhibiting a very low incidence of complications. Although no long-term data are available, these preliminary results indicate that the Nucleoplasty procedure is a safe and moderately effective procedure for reducing pain in patients presenting with predominant discogenic low back pain associated with contained disc herniation.
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Randomized Controlled Trial Clinical Trial
Comparison of a high-intensity and a low-intensity lumbar extensor training program as minimal intervention treatment in low back pain: a randomized trial.
In a randomized, observer-blinded trial, the effectiveness of 3-month high-intensity training (HIT) of the isolated lumbar extensors was compared to low-intensity training (LIT). Eighty-one workers with nonspecific low back pain longer than 12 weeks were randomly assigned to either of the two training programs. Training sessions were performed on a modified training device that isolated the lower back extensors. ⋯ The high-intensity training group showed a higher strength gain (24 to 48 Nm) but a smaller decline in kinesiophobia (2.5 and 3.4 points, respectively), compared to the low-intensity training group. It can be concluded that high-intensity training of the isolated back extensors was not superior to a non-progressive, low-intensity variant in restoring back function in nonspecific (chronic) low back pain. In further research, emphasis should be put on identifying subgroups of patients that will have the highest success rate with either of these training approaches.
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A systematic review of randomized and quasi-randomized controlled trials. ⋯ There is conflicting evidence regarding the efficacy of prolotherapy injections in reducing pain and disability in patients with chronic low back pain. Conclusions are confounded by clinical heterogeneity among studies and by the presence of co-interventions. There was no evidence that prolotherapy injections alone were more effective than control injections alone. However, in the presence of co-interventions, prolotherapy injections were more effective than control injections, more so when both injections and co-interventions were controlled concurrently.
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Case Reports
Electrical twitch obtaining intramuscular stimulation (ETOIMS) for myofascial pain syndrome in a football player.
Flare up of acute lower back pain associated with myofascial pain syndrome (MPS) may require various forms of treatment including activity restriction and bracing. Electrical twitch obtaining intramuscular stimulation (ETOIMS) is a promising new treatment. It involves the use of a strong monopolar electromyographic needle electrode for electrical stimulation of deep motor end plate zones in multiple muscles in order to elicit twitches. ⋯ ETOIMS has a promising role in pain alleviation, increasing and maintaining range of motion, and in providing satisfactory athletic performance during long term follow up.