Articles: low-back-pain.
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Scand. J. Rheumatol. · Jan 2004
ReviewStabilisation surgery for chronic low back pain: indications, surgical procedures, and outcome.
Spinal fusion was introduced as a treatment option for chronic low back pain >70 years ago. However, few areas of spinal surgery have caused as much controversy. The debate about whether to use an anterior-, posterior- or anterior + posterior approach has persisted since the 1930s. ⋯ Two recent RCTs have dealt with the question of conservative versus operative treatment of patients with low back pain, and both studies have shown a significant better functional outcome for spinal fusion in situ, compared with a more or less organized exercise programme at 2-year follow-up. The choice of postoperative rehabilitation strategy has also been shown to be of importance for overall functional outcome. One study has demonstrated the importance of the inclusion of coping schemes, and questioned the role of intensive exercises in a rehabilitation programme for spinal fusion patients.
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The diagnostic evaluation of chronic LBP is at best a complex and involved undertaking. The most important part of the process lies in the knowledge of the patient and a solid history and physical examination. From there, most of the serious and life-threatening causes of LBP can be elucidated and studies may be used for confirmation. ⋯ Furthermore, surgical correction of the mechanical portion of chronic LBP. even if correctly identified, then can be expected only to relieve a portion of a patient's symptoms as long as the confounding issues continue to be significant or have become life long adaptive mechanisms. In the end, the discogram and other diagnostic tests are tools that have clear limitations. In this field, clinical judgment begins and ends with an understanding of a patient's life and circumstances as much as with their specific spinal pathology.
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We identified factors associated with radiograph evaluation for patients who presented to the Emergency Department (ED) with uncomplicated low back pain (LBP). Using 1998-2000 ED data from the National Hospital Ambulatory Medical Care Survey, a multivariate analysis was performed to assess utilization of radiographs for LBP. ⋯ There is an increased probability of receiving a radiograph for those patients 40-70 years old, being seen at a metropolitan hospital, having private insurance, and being treated by a resident in training. Multiple factors are associated with the overuse of radiographs for patients presenting with uncomplicated LBP.
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Low back pain seems to be an integral part of most human lives and cause different degrees of suffering and disability. The exact cause of the pain cannot be identified in most instances. The making of the diagnosis rests mainly on the patient's history, location, and duration of the pain. ⋯ The natural history of low back pain seems in general to be favourable, but of concern is the consequence of long term or permanent disability. Fear avoidance behaviour has been shown to be part of the disabling pathway in chronic low back pain. Cognitive interventions, designed to remove fear and uncertainty, and to give the patient the confidence that the back is robust even if it hurts, seem promising.
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In a prospective interventional study, problems with performance were evaluated in 101 consecutive patients with chronic low-back pain for more than 12 months, before and after participation in an outpatient-based multidisciplinary pain management program in Mansfield, United Kingdom. ⋯ Patients with chronic low-back pain report problems with diverse activities. The COPM provides a patient-centered outcome measure that displays good external validity and responsiveness to change when addressing the individual's goals.