Articles: low-back-pain.
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Despite the popularity of epidural steroid injections for low back pain, there still remains a lack of consensus on which type of steroid to inject. Most comparison studies regarding epidural steroids are based on an assumption that different types of steroids are equal as long as equipotent doses are utilized. In the spring of 2002, a national shortage of all depo steroids allowed the authors to compare epidural methylprednisolone (Depo-Medrol) to a non depo form of betamethasone in patients with low back pain. ⋯ This study shows that the aqueous steroid betamethasone is not an effective alternative to the commonly used depo-steroid methylprednisolone (Depo-Medrol) when injected epidurally in patients with lumbar pain. The study also shows that the anti-inflammatory effect of a depo-steroid can be greater than a non-depo steroid, even at equipotent doses. This should be an important factor to consider when reviewing epidural steroid outcome studies, where the type of steroid might affect results as much as other variables such as route of administration, volume of injectate, or use of fluoroscopy.
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Randomized Controlled Trial Clinical Trial
Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration.
Single blind randomized study. ⋯ The main outcome measure showed equal improvement in patients with chronic low back pain and disc degeneration randomized to cognitive intervention and exercises, or lumbar fusion.
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Excision of the coccyx for the treatment of therapy-resistant coccygodynia is a disputable management option. Due to the low morbidity only few studies concerning the long-term follow-up after coccygectomy exist. The aim of this study is a retrospective analysis of our patients surgically managed for coccygodynia and a critical review of the results obtained in comparison to the literature. ⋯ According to our results and review of those documented in the literature, excision of the coccyx for the treatment of coccygodynia, after all conservative treatment options have been exhausted, seems a justifiable alternative. Patients with a history suggestive of traumatically induced coccygodynia are more likely to benefit from coccygectomy.
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Musculoskeletal care · Sep 2003
ReviewAn evidence-based approach to the management of low back pain and sciatica: how the evidence is applied in clinical cases.
Low back pain and sciatica are common complaints that affect a major proportion of the population at some time in their lives. The treatment and management of this condition may vary widely. ⋯ A patient-focused strategy combining best evidence and clinical expertise is suggested as the mainstay for the management of low back pain.
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J Manipulative Physiol Ther · Sep 2003
Case ReportsChiropractic management of Ehlers-Danlos syndrome: a report of two cases.
To discuss 2 patients with Ehlers-Danlos syndrome seeking chiropractic evaluation and management of their disabling musculoskeletal pain and associated disorders. ⋯ Chiropractic care may be of benefit to some patients with connective tissue disorders, including Ehlers-Danlos syndrome. Low-force chiropractic adjusting techniques may be a preferred technique of choice in patients with tissue fragility, offering clinicians a viable alternative to traditional chiropractic care in attempting to minimize risks and/or side effects associated with spinal manipulation. Psychosocial issues, including patient desire to return to work, were important factors in work disability status and perceived outcome.