Articles: low-back-pain.
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The purpose of this current opinion on sacroiliac joint pain and dysfunction is to assist interventional pain physicians to apply appropriate treatment decisions and rationale to their patients in pain. Discussion of relevant scientific data and controversial positions will be provided. ⋯ Discussion will provoke support or criticism of the relevant scientific data, and general recommendations for interventional pain management physicians should be considered within the context of the individual practitioners skill and practice patterns. Current Opinion is not intended to provide a standard of care.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group.
The reported complication rates after various surgical techniques used to create a lumbar fusion vary within wide ranges. In a previous paper, the Swedish Lumbar Spine Study Group have reported on the clinical outcome of lumbar spine fusion for chronic low back pain in a comparably homogeneous patient population where there were no significant differences between baseline sociodemographic, clinical and paraclinical characteristics. In this report we compared the complication rates of the surgical procedures used in that study and analyzed the association between complications and baseline variables, and between outcome results and complications. ⋯ Even though we did not find a significant association between clinical outcome and complications after 2 years, the increased morbidity inflicted on an individual patient was not negligible. In this light, and as no fusion technique produced superior clinical outcome irrespective of whether complications were included or excluded in the analyses, the patient and the treating physician should carefully discuss the possible advantages and drawbacks of the different surgical options before making a decision. In order to make valid comparisons of both complication and reintervention rates after lumbar fusion, there is a need for a consensus in the spinal society regarding the definition of these entities.
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This study compared the relative efficiency of lumbar x-ray and rapid magnetic resonance (MR) imaging for diagnosing cancer-related low back pain (LBP) in primary care patients. ⋯ There is currently not enough evidence to support the routine use of rapid MR to detect cancer as a cause of LBP in primary care patients.
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The precise cause of low back pain based on clinical history, physical examination, radiological imaging, and electrophysiological testing can be identified in only 15% of patients in the absence of disc herniation and neurological deficit. The prevalence of chronic lumbar zygapophysial (facet) joint pain ranges from 15% to 45% utilizing comparative local anesthetic blocks in controlled settings in accordance with the criteria established by the International Association for the Study of Pain. Currently, facet joint injection procedures are considered as the gold standard in the diagnosis of facet joint pain. ⋯ Since we are unable to apply reference standards of biopsy, surgery, or autopsy, and pain relief has been argued as an inconsistent feature, long-term follow-up has been considered as the best indicator. This study was undertaken to evaluate stability of the diagnosis of lumbar facet joint pain following comparative local anesthetic blocks at a follow-up after 2 years. The results showed that 85% of the patients available for follow-up withstood the diagnosis of facet joint pain at the end of 2 years, whereas this proportion decreased to 75%, if all the patients in the study were included in the analysis.
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Clinical therapeutics · Apr 2003
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialTramadol/acetaminophen combination tablets for the treatment of chronic lower back pain: a multicenter, randomized, double-blind, placebo-controlled outpatient study.
Tramadol and acetaminophen (APAP) have both shown efficacy in the treatment of lower back pain. The combination of these 2 agents has demonstrated synergistic analgesic action in animal models at specific ratios. ⋯ In this study, tramadol 37.5 mg/APAP 325 mg combination tablets were effective and had a favorable safety profile in the treatment of chronic lower back pain.