Articles: low-back-pain.
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Epidural steroid injections are the most commonly used procedures to manage chronic low back pain in interventional pain management settings. The overall effectiveness of epidural steroid injections has been highly variable, and in the role has not been evaluated in patients discographically evaluated. One hundred consecutive patients, without evidence of disc herniation or radiculitis, who had failed to respond to conservative management with physical therapy, chiropractic and/or medical therapy, underwent discography utilizing strict criteria of concordant pain, and negative adjacent discs, after being judged to be negative for facet joint and/or sacroiliac joint pain utilizing comparative local anesthetic blocks. ⋯ The study showed that at 1 month, 100% of the patients evaluated showed significant improvement in both groups; this declined to 86% at 3 months in Group I, but remained at 100% in Group II, declining to 60% and 64% at 6 months in Group I and Group II, respectfully, with administration of one to three injections. Analysis with one to three injections, which included all (62) patients showed significant relief in 71% and 65% of the patients at 1 month, in 67% and 65% at 3 months, and in 47% and 41% at 6 months, in Group I and Group II, respectively. In conclusion, caudal epidural injections with or without steroids is an effective modality of treatment in managing chronic, persistent low back pain failing to respond to conservative modalities of treatments, in patients negative for facet joint and sacroiliac joint pain, whether positive or negative, on evaluation with provocative discography.
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The prevalence of persistent low back pain secondary to involvement of lumbosacral facet joints has been described in controlled studies as varying from 15% to 52% based on types of population and settings studied. Previous studies have shown variances in elderly populations, and postlumbar laminectomy patients. But no variations were observed in obese patients or patients with somatization disorder. ⋯ The prevalence of facet joint pain in men was 38% (95% CI, 29% to 47%) compared to 43% (95% CI, 36% to 50%) in women; 43% (95% CI, 33% to 53%) in non-smokers, compared to 41% (95% CI, 30% to 52%) in heavy smokers; and 28% (95% CI, 18% to 38%) in occupational injury patients compared to 44% (95% CI, 36% to 52%) with a history of gradual onset. False-positive rates varied from 28% to 46%. In conclusion, based on the results of this evaluation, women and men, smokers and nonsmokers suffer with similar prevalence rates of facet joint pain in chronic low back pain; whereas occupational injury patients suffer with lesser prevalence (28%) compared to patients with gradual onset (44%) of low back pain.
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The aim of this work is to assess quality of treatment and to monitor drawbacks of SCS implantation systems through a National Observational Center. Data were obtained through a questionnaire sent by post or via telephone to each patient. All patients were affected by chronic-'vascular' and "neuropathic" pain. ⋯ We conclude that the methodology used is consistent with that of previous studies on nonmalignant chronic pain. The data obtained also reveal implantation hardware reliability, regardless of clinical outcome. A low percentage of complications and a high degree of patient satisfaction are also to be stressed.
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Comparative Study Clinical Trial Controlled Clinical Trial
Provocative discography in volunteer subjects with mild persistent low back pain.
Whether discographic injections would be positive in subjects with benign persistent "backache" who are not seeking treatment is unknown. This information is important, because benign backache undoubtedly co-exists in patients with chronic low back pain (CLBP) illness that is not discogenicin origin. If these subjects had a high rate of positive discography, the high background incidence of common backache would allow many positive tests in patients in whom discogenic processes were unrelated to their severe CLBP illness. Conversely, if subjects with benign low back pain rarely if ever had significant concordant pain reproduction on disc injections, the basic tenet of discographic diagnosis would be strengthened. ⋯ In a group of volunteer subjects with persistent "backache," 36% were found to have significant pain on disc injection, which is reported to be concordant with their usual pain. The presence of positive concordant pain responses and negative control discs in 33% of subjects without CLBP illness seriously challenges the specificity of provocative discography in identifying a clinically relevant spinal pathology.
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Multicenter Study Comparative Study
A comparison of five low back disability questionnaires: reliability and responsiveness.
The aim of this study was to examine 5 commonly used questionnaires for assessing disability in people with low back pain. The modified Oswestry Disability Questionnaire, the Quebec Back Pain Disability Scale, the Roland-Morris Disability Questionnaire, the Waddell Disability Index, and the physical health scales of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were compared in patients undergoing physical therapy for low back pain. ⋯ Measurements obtained with the modified Oswestry Disability Questionnaire, the SF-36 Physical Functioning scale, and the Quebec Back Pain Disability Scale were the most reliable and had sufficient width scale to reliably detect improvement or worsening in most subjects. The reliability of measurements obtained with the Waddell Disability Index was moderate, but the scale appeared to be insufficient to recommend it for clinical application. The Roland-Morris Disability Questionnaire and the Role Limitations-Physical and Bodily Pain scales of the SF-36 appeared to lack sufficient reliability and scale width for clinical application.