Articles: low-back-pain.
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Meta Analysis Comparative Study
Return-to-work interventions for low back pain: a descriptive review of contents and concepts of working mechanisms.
Low back pain is a major medical and social problem associated with disability, work absenteeism and high costs. Given the impact of the problem, there is a need for effective treatment interventions in occupational healthcare that aim at the prevention of chronic disability and the realisation of return to work. These so-called return-to-work (RTW) interventions are becoming increasingly popular. ⋯ No concepts were described for ergonomic measures. Finally, the plausibility of the described concepts is discussed. Future RCTs on this topic should evaluate the underlying concepts of the RTW intervention in addition to its effectiveness.
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Randomized Controlled Trial Clinical Trial
Combined physiotherapy and education is efficacious for chronic low back pain.
Manual therapy, exercise and education target distinct aspects of chronic low back pain and probably have distinct effects. This study aimed to determine the efficacy of a combined physiotherapy treatment that comprised all of these strategies. By concealed randomisation, 57 chronic low back pain patients were allocated to either the four-week physiotherapy program or management as directed by their general practitioners. ⋯ The number needed to treat in order to gain a clinically meaningful change was 3 (95% CI 3 to 8) for pain, and 2 (95% CI 2 to 5) for disability. A treatment effect was maintained at one-year follow-up. The findings support the efficacy of combined physiotherapy treatment in producing symptomatic and functional change in moderately disabled chronic low back pain patients.
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The problems of diagnosis and treatment of Failed Back Surgery Syndrome are briefly analyzed in this article. Literature overview and analysis is supplemented by the data collected at the Spinal Neurosurgery Department in Kaunas University of Medicine Hospital during the study in which clinical findings and data were analyzed and compared to the answers of patients in the special questionnaires about pain specially designed for the patients with low back pain and the Failed Back Surgery Syndrome. ⋯ The most important clinical aspects of diagnosis and treatment of Failed Back Surgery Syndrome are discussed in this article and compared to the clinical trial in order to point out the real their value, effectiveness and long term results. In addition, the clinical value and use of special pain questionnaires is discussed and their auxiliary role is established.
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Clinical Trial Controlled Clinical Trial
Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint.
To investigate the efficacy of periarticular corticosteroid treatment of the sacroiliac joint (SIJ) in non-spondylarthropathic patients with chronic low back pain in the region of the SIJ in a double blind, controlled study. ⋯ These results suggest that periarticular injection of methylprednisolone may be effective in the treatment of pain in the region of the SIJ in non-spondylarthropathic patients.
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Lumbar nerve root blocks and epidural steroid injections are frequently employed in the management of degenerative conditions of the lumbar spine, but relatively few papers have been published that address the complications associated with these interventions. Serious complications include epidural abscess, arachnoiditis, epidural hematoma, cerebrospinal fluid fistula and hypersensitivity reaction to injectate. Although transient paraparesis has been described after inadvertent intrathecal injection, an immediate and lasting deficit has not been previously described as sequelae of a nerve root block. ⋯ We present the cases of three patients who had lasting paraplegia or paraparesis after the performance of a nerve root block. We propose that the mechanism for this rare but devastating complication is the concurrence of two uncommon circumstances, the presence of an unusually low origin of the artery of Adamkiewicz and an undetected intraarterial penetration of the procedure needle.