Articles: low-back-pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Does the method of injection alter the outcome of epidural injections?
A pilot study involving 44 patients with low back and leg pain was performed to compare the relative efficacy of epidural caudal and lumbar injections.
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J Altern Complement Med · Dec 2001
The diagnosis and treatment of patients with chronic low-back pain by traditional Chinese medical acupuncturists.
The selection of appropriate treatments in clinical trials of acupuncture requires understanding how acupuncturists diagnose and treat specific conditions. We examined the Traditional Chinese Medical (TCM) diagnoses and treatments for patients with chronic low-back pain using two separate sets of treatment records. Information from more than 150 initial visits was available for analysis. ⋯ There was substantial variability in treatments among providers. Such diversity will make it challenging to select a single treatment that has wide applicability. We recommend that researchers attempt to develop a treatment that is considered credible by expert acupuncturists and has broad features characteristic of patterns of common clinical practice.
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Jt Comm J Qual Improv · Dec 2001
Implementing guidelines for interdisciplinary care of low back pain: a critical role for pre-appointment management of specialty referrals.
Improving health care will require more effective guideline implementation and redesign of delivery processes and systems. Patient referral for specialty care is a key component of health system function that needs to be improved. Low back pain care is a widely documented example of the need for improvement. An interdisciplinary systemwide back pain program was developed using process improvement methods. Proactively managing referrals for specialty care-a departure from traditional referral processes-played a critical role in implementing the program. ⋯ Pre-appointment referral management offers an approach for improving guideline implementation, access to specialty services, and the effectiveness of care for complex health problems. It deserves broader study and adoption.
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Surgery in acute and/or chronic low back pain is still a matter of intensive and controversial discussions. A vast number of minimally invasive or so called semi-invasive procedures have been published in the last 3 decades, but evidence-based data on efficacy and benefit of most of these techniques are still lacking. However, empirical data suggest good or at least satisfactory clinical results for a limited number of procedures if they are applied under restrictive indication criteria. ⋯ In general a restrictive indication for surgery must be recommended especially for spinal fusion procedures. Non-fusion techniques such as intradiscal electro thermal therapy or spine arthroplasty with replacement of nucleus pulposus or total disc show promising early results; however, little is known about the long-term effect. It should be a principle to apply surgery in the least invasive way.
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Evaluation of the age related prevalence of persistent low back pain has been estimated to be consistently higher in the elderly compared to the younger population. Facet joints have been shown to be the cause of chronic low back pain in 15% to 45% of the patients in controlled studies. Prevalence of facet joint mediated pain has not been studied in the elderly. ⋯ Facet joints were investigated with diagnostic blocks initially using lidocaine 1% followed by bupivacaine 0.25%, usually 2 weeks apart. The prevalence of facet joint mediated pain was determined to be 30% in the adults and 52% in the elderly, which was significantly higher with a false positive rate of 26% in adults and 33% in the elderly. In conclusion, the results of this study show that facet joint mediated pain is a significant problem in all patients suffering with chronic low back pain with the prevalence of 52% in the elderly and 30% in adults.