Articles: low-back-pain.
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Eur J Orthop Surg Tr · Sep 2004
Correlative analysis of reliability and validity of plain radiology, MOS short-form health survey and surgical examination in making decision for treatment of chronic low back pain patients.
The aim of this study was to determine inter- and intraobserver agreement between spine surgeons and orthopedic radiologists in recognizing distinct degenerative pathology on plain lumbosacral roentgenograms; to estimate the validity (sensitivity and specificity) to make a surgical decision by correlating Short form-36 Health Survey (SF-36) scores and roentgenographic degenerative pathology; and to determine the intra- and interobserver agreement between radiologists, surgeons, and authors in making a surgical decision for treatment on the basis of distinct roentgenographic pathology, SF-36 scores, clinical findings derived from physical examination, or combined. The authors followed three routes to objectively assess the reliability and validity of the surgical decision in chronic low back pain patients: First, 100 consecutive male patients who suffered from low back pain were examined by the authors physically, using imaging techniques (including plain roentgenograms, CT-scan, or/and MRI), and SF-36 survey. Two senior orthopedic radiologists and two senior spine surgeons were asked to read blinded a set of 100 roentgenograms of the lumbar spine in two sessions. ⋯ This investigation showed that distinct degenerative lumbar spinal pathology can be identified on plain roentgenographs with similarly high accuracy by orthopedic, radiologists, and spine surgeons. The sensitivity and specificity of recognizing abnormal and normal roentgenograms using normal and abnormal SF-36 data was low because of the subjective nature of the SF-36 survey. This study additionally concluded that any surgical decision should not be taken on the basis of any roentgenographic pathology or on what the patient says in the SF-36 questionnaire, but on the basis of matched SF-36 scores, roentgenographic and imaging evaluation, and physical examination data.
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Reg Anesth Pain Med · Sep 2004
Randomized Controlled Trial Comparative Study Clinical TrialRadiofrequency lumbar facet denervation: a comparative study of the reproducibility of lesion size after 2 current radiofrequency techniques.
Radiofrequency facet denervation procedures are widely used for the treatment of chronic low-back pain. Currently, both temperature-controlled and voltage-controlled techniques are used. In this combined in vivo and in vitro study, the electrophysiologic consequences and the effects on lesion size of these techniques were determined. ⋯ There is no consistent relation between voltage and the temperature obtained during radiofrequency lumbar facet denervation. Temperature-controlled radiofrequency lesioning is preferred to create reproducible lesion sizes.
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized controlled trial of intensive neurophysiology education in chronic low back pain.
Cognitive-behavioral pain management programs typically achieve improvements in pain cognitions, disability, and physical performance. However, it is not known whether the neurophysiology education component of such programs contributes to these outcomes. In chronic low back pain patients, we investigated the effect of neurophysiology education on cognitions, disability, and physical performance. ⋯ Education about pain neurophysiology changes pain cognitions and physical performance but is insufficient by itself to obtain a change in perceived disability. The results suggest that pain neurophysiology education, but not back school type education, should be included in a wider pain management approach.
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Randomized Controlled Trial Comparative Study Clinical Trial
Endogenous opioids and chronic pain intensity: interactions with level of disability.
To test whether endogenous opioid antinociceptive system dysfunction evidenced in response to acute pain stimuli is associated with increased clinical pain intensity in chronic pain sufferers, and to determine whether this association is moderated by disability level. ⋯ These results suggest that endogenous opioid antinociceptive system dysfunction may contribute to elevated acute and chronic pain sensitivity among more disabled chronic pain patients. Among less disabled patients, chronic pain may serve as a primer producing up-regulated opioid antinociceptive responses to acute pain
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Clinical therapeutics · Sep 2004
Review Comparative StudyCommonly used muscle relaxant therapies for acute low back pain: a review of carisoprodol, cyclobenzaprine hydrochloride, and metaxalone.
Low back pain is a leading reason for primary care visits. Many treatment options are available, but some lack scientific support. ⋯ Analgesic pain management for low back pain due to muscle spasm may be combined with a muscle relaxant. Cyclobenzaprine hydrochloride has the most recent and largest clinical trials demonstrating its benefit, but carisoprodol and metaxalone also appear to be effective. However, carisoprodol's usefulness is mitigated by its potential for abuse.