Articles: low-back-pain.
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The value of caudal epidural steroid injections (CEI) in treatment of low back pain and sciatica is controversial. It is believed that CEI are mainly effective in treating acute radiculopathy at intermediate term follow up and have no long-term benefit. The objective of this study was to evaluate the role of CEI in the management of low back pain. ⋯ We found that the outcome of CEI was unpredictable. The clinical value of CEI remains unproven. The decision to perform the procedure may well remain a matter of personal choice and experience.
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Spinal cord stimulation (SCS) was performed to test the hypothesis that pain relief data during acute (15 minute intraoperative) and prolonged (5 day) SCS screening have equivalent predictive value for long-term successful SCS control of chronic low back pain and/or lower extremity pain. A retrospective series of patients with chronic low back and/or lower extremity pain underwent either percutaneous or open (ie, laminectomy) SCS implantation during which acute intraoperative followed by prolonged screening trials for percentage pain relief (%PR) were performed. Data were analyzed for (a) correlation between positive predictive value (PPV) of acute and prolonged SCS screening for %PR and (b) PPV of acute vs. prolonged screening %PR for long-term SCS %PR. ⋯ After permanent SCS implantation, at mean follow-up = 9.4 ± 1.5 months, acute and prolonged SCS screening %PR PPV's were each statistically significant for predicting long-term SCS relief of chronic pain (n = 31/38, PPV = 82% and n = 31/36, PPV = 86%, SRCC = 0.462 and 0.433, respectively, p < 0.01). We conclude that successful pain relief during acute SCS screening is highly correlated with successful prolonged SCS screening of chronic low back and/or lower extremity pain relief. Acute and prolonged SCS screening appear to have equivalent predictive value for successful long-term SCS control of chronic low back and/or lower extremity pain. These preliminary results suggest potential justification for eliminating prolonged and retaining acute (intraoperative) SCS screening for selection of permanent SCS implantation candidates.
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Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy of "therapist-selected" versus "randomly selected" mobilisation techniques for the treatment of low back pain: a randomised controlled trial.
The aim of this study was to establish whether the mobilisation technique selected by the treating physiotherapist is more effective in relieving low back pain than a randomly selected mobilisation technique. Two manipulative physiotherapists and 140 subjects suffering non-specific low back pain participated. Baseline measurements were taken before treatment allocation; the therapist then assessed subjects and nominated the preferred treatment grade, spinal level to be treated and mobilisation technique to be used. ⋯ Two-way ANOVA was used to analyse the data; the first factor was the treatment group and the second factor was the direction of the patient s most painful movement. The choice of mobilisation treatment had no effect on any outcome measure investigated in this study; however, post hoc tests revealed that mobilisation treatment applied to the lower lumbar levels had a greater analgesic effect than when applied to upper lumbar levels. The results of this study confirm that lumbar mobilisation treatment has an immediate effect in relieving low back pain, however the specific technique used seems unimportant.
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Musculoskeletal disorders in the workplace cause thousands of injuries and cost industry billions of dollars yearly. Work injury prevention programs have been developed and implemented as a means for cost containment. A variety of preventive strategies have been investigated in primary research. ⋯ The effectiveness of back belts to prevent back pain and injury remains inconclusive. Positive outcomes were associated with studies reporting high compliance that used job-specific and individualized/small group education and training approaches. Themes that arose following a critical review of primary research studies are discussed.
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Equine veterinary journal · Jan 2003
Ultrasonographic abnormalities detected in the sacroiliac area in twenty cases of upper hindlimb lameness.
The pelvis is covered with extensive musculature and often presents a challenge in diagnostic imaging. Ultrasonography provides diagnostic information about soft tissue, articular cartilage and bone surfaces, although little information exists about the normal ultrasonographic appearance of the equine sacroiliac region. ⋯ Diagnostic ultrasound is readily available to most practitioners. Therefore the findings of this study show that diagnosis of sacroiliac injuries is possible in the field.