Articles: low-back-pain.
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The objectives of this study were the following: to determine if fatigue is present in chronic low back pain (LBP) and chronic neck pain patients to a greater extent than in controls (nonpatients); to determine which variables are associated with the presence of fatigue; and to determine which of the above chronic pain patient (CPP) groups is more fatigued. To the authors' knowledge, this is the first such study in the literature. ⋯ The complaint of fatigue appears to be a significant problem for chronic LBP and chronic neck pain patients. This complaint may be associated with neuropathic pain, female gender, and psychiatric comorbidities.
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J Manipulative Physiol Ther · Jun 2004
ReviewCentral neuronal plasticity, low back pain and spinal manipulative therapy.
Recent experimental evidence demonstrating neuronal/synaptic plasticity and, in particular, long-term potentiation (LTP) and long-term depression (LTD) in spinal neurons is reviewed. The implications of these studies for possible mechanistic explanations of low back pain and its remediation by spinal manipulative therapy (SMT) are explored. Brief descriptions of LTP and LTD and elaboration of the key roles of calcium, glutamate, and glutamate receptors in LTP/LTD are provided as separate appendices. ⋯ The potential involvement of LTP in low back pain is discussed and a role for LTD in spinal manipulative therapy is proposed. The need for future studies is identified in the areas of spatial and temporal changes in symptomatology post-SMT of the low back; combining, sequencing, and comparing several therapeutic approaches; and demonstrating LTD in spinal cord neurons post-SMT-like stimulation.
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J Manipulative Physiol Ther · Jun 2004
Low back pain in Australian adults. health provider utilization and care seeking.
To determine the characteristics of Australian adults who seek care for low back pain (LBP), including the type of care they choose and any factors associated with making those choices. ⋯ This study shows that a majority of people did not seek care for their LBP. The reasons for care seeking proved to be independent of social or economic status.
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Randomized Controlled Trial Clinical Trial
Catastrophizing and internal pain control as mediators of outcome in the multidisciplinary treatment of chronic low back pain.
The aim of the present study was to examine (a) whether a cognitive-behavioral treatment (differentially) affects pain coping and cognition; and (b) whether changes in pain coping and cognition during treatment mediate treatment outcome. Participants in this randomized clinical trial were 148 patients with chronic low back pain attending a multidisciplinary treatment program consisting of operant-behavioral treatment plus cognitive coping skills training (N = 59) or group discussion (N = 58) or allocated to a waiting list control condition (N = 31). ⋯ Changes in catastrophizing and to a lesser degree in internal pain control mediated the reduction in level of depression and pain behavior following treatment. The use of behavioral and cognitive interventions aimed at decreasing catastrophizing thoughts about the consequences of pain and promoting internal expectations of pain control possibly constitute an important avenue of change irrespective of the type of treatment.
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Anesthesia and analgesia · Jun 2004
Randomized Controlled Trial Comparative Study Clinical TrialComparison of percutaneous electrical nerve stimulation with transcutaneous electrical nerve stimulation for long-term pain relief in patients with chronic low back pain.
The long-term effect of percutaneous electrical nerve stimulation (PENS) on chronic low back pain (LBP) is unclear. We evaluated the number of sessions for which PENS should be performed to alleviate chronic LBP and how long analgesia is sustained. Patients underwent treatment on a twice-weekly schedule for 8 wk. Group A (n = 18) received PENS for 8 wk, group B (n = 17) received PENS for the first 4 wk and transcutaneous electrical nerve stimulation (TENS) for the second 4 wk, and group C (n = 18) received TENS for 8 wk. Pain level, degree of physical impairment, and the daily intake of nonsteroidal antiinflammatory drugs (NSAIDs) were assessed before the first treatment, 3 days after Week 2, Week 4, and Week 8 treatments, and at 1 and 2 mo after the sessions. During PENS therapy, the pain level decreased significantly from Week 2 in Groups A and B (P < 0.05 or 0.01), and physical impairment and required NSAIDs decreased significantly from Week 4 (P < 0.05 or 0.01) in Group A but only at Week 4 in Group B (P < 0.05 or 0.01). These effects were sustained until 1-mo follow-up (P < 0.01) in Group A but not in Group B; these effects were not observed at 2-mo follow-up even in Group A. In Group C, pain level decreased significantly only at Week 8 (P < 0.05). Our results indicate that repeated PENS is more effective than TENS for chronic LBP but must be continued to sustain the analgesic effect. ⋯ A cumulative analgesic effect was observed in patients with chronic low back pain (LBP) after repeated percutaneous electrical nerve stimulation (PENS), but this effect gradually faded after the treatment was terminated. Results indicate that although PENS is effective for chronic LBP, treatments need to be continued to sustain analgesia.