Articles: low-back-pain.
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Multicenter Study
Straightforward consultation or complicated condition? General practitioners' perceptions of low back pain.
Low back pain is a common condition in general practice and represents a significant part of a general practitioner's workload. However, despite guidelines, back pain still presents considerable challenges to clinicians. ⋯ GPs adopt a bio-mechanistic approach to LBP which appears to work well for the majority of patients, as the natural history of low back pain dictates that most patients will recover. However, this approach to low back pain fails at the margins and this is evident by the significant minority of persistent sufferers and the GP's reaction to them. Expanding patient-centredness to explore psychological and social dimensions in relation to low back pain presents an ongoing challenge in general practice.
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Four strata of randomly selected health care providers in North Carolina (primary care MDs, Doctors of Chiropractic, orthopedic surgeons, and group model HMO primary care providers) enrolled 1633 consecutive patients with low back pain into a cohort study. ⋯ The relation of patient race to outcomes from and care for low back pain is complex. Blacks have slightly worse functional status than whites on presentation and at follow-up assessment. Blacks receive less intense diagnostic and treatment approaches from MDs, although the severity of their impairment is at least as great.
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A case series of adults with surgical treatment for adult idiopathic thoracolumbar and/or lumbar scoliosis, low back pain, and spinal stenosis was studied. ⋯ Combined symptoms of back pain and spinal stenosis require complex reconstructive surgery in adults with idiopathic thoracolumbar and/or lumbar scoliosis. Significant pain relief, functional restoration, and satisfaction can be achieved and maintained over the long term in the properly selected patient.
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To examine the association between self reported physical workload and low back pain (LBP) in younger twins. To investigate whether genetic factors interact with physical workload in relation to LBP. ⋯ There is evidence for a dose-response relation between physical workload and LBP of longer duration. Attention to clinically relevant subgroups based on duration, for example, is necessary in epidemiological studies dealing with LBP. Physical workload might be more important than genetic factors in LBP.
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Low back pain is frequent and results in major disability for patients. This anatomical study was done to understand mechanisms involved in that pain. Two kinds of innervation are present in the lumbar spine: one depends on the somatic nervous system and the other on the sympathetic nervous system. ⋯ The pain therefore takes another route through the sympathetic system. Discogenic pain is mediated by the sinu-vertebral nerves, and through the rami communicantes reaches the L2 spinal ganglion. Anatomical and clinical features reinforce this hypothesis.