Articles: low-back-pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Does early intervention with a light mobilization program reduce long-term sick leave for low back pain: a 3-year follow-up study.
A randomized clinical trial. ⋯ For patients with subacute low back pain, a brief and simple early intervention with examination, information, reassurance, and encouragement to engage in physical activity as normal as possible had economic gains for the society. The effect occurred during the first year after intervention. There were no significant long-term effects of the intervention. The initial gain obtained during the first year does not lead to any increased costs or increased risks for reoccurrence of illness over the next 2 years.
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Percutaneous epidural neuroplasty (lysis of epidural adhesions, epidural application of hypertonic saline) is an interventional technique for the management of pain due to spinal disorders. Epidural neuroplasty is found to be effective in removing fibrous tissue occurring in the epidural space for various reasons, however, the procedure may be prone to serious complications. We present here our retrospectively collected complications and precautions of complications of epidural neuroplasty in 250 patients. ⋯ Possible known complications include bending of the tip of the introducer needle, shearing/tearing of the catheter, misplacement of the catheter, inadvertent blockage of the catheter or catheter tip, migration of the catheter, hypotension, respiratory depression, urinary and/or fecal incontinence, urinary hesitancy, sexual dysfunction, paresthesia, epidural abscess, and meningitis. We found the following complications in our series: the tips of the introducer needle were bent in 12 patients; catheter sheaths were torn during withdrawal through the needle in three patients; 39 patients had bleeding or aspiration of blood from the epidural space; eight patients had their catheters migrate into an epidural vein; one patient's catheter migrated into the prevertebral space during the procedure; there were dural punctures in 11 patients; there were catheter blockages in six patients during consecutive applications of neuroplasty; hypotension was seen during and after drug injections in 12 patients, there was hypotension in one patient; three patients had migration and penetration of their catheters into the dura after placement and in consecutive days; 25 patients experienced numbness in dermatomal areas of the upper and lower extremities depending the level of the procedure; and there were eight infections at the entry site of the catheter, three epidural abscesses, and two patients with meningitis. In order to prevent complications such as those seen, epidural neuroplasty procedures must be performed in well-equipped centers by experienced hands.
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Randomized Controlled Trial Clinical Trial
Randomized controlled trial of education and feedback for implementation of guidelines for acute low back pain.
The effect of clinical guidelines on resource utilization for complex conditions with substantial barriers to clinician behavior change has not been well studied. We report the impact of a multifaceted guideline implementation intervention on primary care clinician utilization of radiologic and specialty services for the care of acute low back pain. ⋯ Implementation of an education and feedback-supported acute low back pain care guideline for primary care clinicians was associated with an increase in guideline-consistent behavior. Patient education materials did not enhance guideline effectiveness. Implementation barriers could limit the utility of this approach in usual care settings.
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Facet (zygapophysial) joint pain can be diagnosed by anesthetization of the medial branch divisions of the dorsal rami. In accordance with the criteria established by the International Association for the Study of Pain, lumbar facet (zygapophysial) joints have been implicated as the source of chronic pain in 15% to 45% of the patients with chronic low back pain. The reasons for the wide variations have not been systematically evaluated. ⋯ A false-positive rate of 17% in patients with low back pain only and 21% in patients with involvement of multiple regions of the spine was demonstrated with single blocks. This study demonstrated a lower incidence of facet joint pain in patients with spinal pain of a single region in the low back compared to the patients with multiple region involvement of the spine (21% vs 41%), in an interventional pain management setting. These results may not be extrapolated to the general population or chronic low back pain population at large.
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To determine the long-term efficacy of IDET in the treatment of chronic lumbar discogenic pain. ⋯ IDET appears to be an effective treatment for chronic lumbar discogenic pain in a well-selected group of patients with favorable long-term outcome.