Articles: low-back-pain.
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Southern medical journal · May 2001
Multicenter StudyAcupuncture for chronic low back pain: diagnosis and treatment patterns among acupuncturists evaluating the same patient.
There is increasing need to examine the effectiveness of acupuncture and other alternative therapies for common conditions. However, little attention has focused on the variability in acupuncturists' assessment, diagnosis, and treatment patterns. ⋯ Seven acupuncturists agreed considerably in the diagnoses for the same patient with chronic low back pain, but treatment recommendations varied substantially. Clinicians and researchers must recognize treatment recommendation variations and the challenges they present for study design and interpretation.
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Randomized Controlled Trial Clinical Trial
The effects of failure feedback and pain-related fear on pain report, pain tolerance, and pain avoidance in chronic low back pain patients.
The aim of this study was to investigate the influence of non-pain-related failure experiences and pain-related fear on pain report, pain tolerance and pain avoidance in chronic low back pain (CLBP) patients. Moreover, the mediating and moderating role of negative affectivity (trait-NA) in the relationship between failure experiences and pain was examined. Seventy-six patients were divided into high and low pain-related fear groups and within each group they were randomly assigned to the failure or success feedback condition. ⋯ Pain-related fear did not predict pain avoidance when pre-lifting pain and gender were controlled for. Finally, pre-lifting pain turned out to be the strongest predictor with regard to all pain measures. The role of pain-related fear and unexpected findings with regard to feedback are discussed as well as some clinical implications.
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Comparative Study
Recurrent disabling work-related spinal disorders after prior injury claims in a chronic low back pain population.
Multiple compensation injury claims are an understudied phenomenon in the chronic back pain and occupational injury literature. Assumptions about poor treatment outcomes for patients presenting with prior injury can lead to denial of treatment, even though these assumptions have not been empirically addressed. Functional restoration has been demonstrated to be an effective rehabilitation treatment for disabling, work-related chronic back pain, although its' relative utility with recurrent injury (RI) patients has not been previously evaluated. ⋯ The results of this study indicate that, although patients with recurrent injuries evidence differences in demographic, psychosocial and work history/adjustment differences when compared with patients with nonrecurrent injuries, their 1-year outcomes after tertiary, medically directed rehabilitation are identical. Both groups demonstrate very low rates of further work-related injuries through the first posttreatment year. Patients with recurrent injuries appear to develop skills in dealing with the workers' compensation system with a familiarity not seen in NRI patients. Of course, these results will need to be replicated in other settings to determine whether they can be generalized to the entire workers' compensation population.
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Some researchers have found a correlation of poor treatment outcomes in patients with low back pain and abnormal psychological profiles, whereas others have failed to confirm this correlation. A critical feature of this debate has been whether abnormal psychological profiles seen in patients with back pain are the result of the ongoing back pain or whether pre-existing psychological features predispose to a poor clinical outcome. ⋯ Despite similar pain levels and pain duration, patients with the discographic diagnosis of discogenic back pain have poorer functional scores and very abnormal psychological scores compared with other subjects with chronic low back pain resulting from spondylolisthesis requiring surgery or chronic pyogenic osteomyelitis. Chronic moderately severe mechanical low back pain in healthy subjects was not associated with abnormal psychological scores or functional disability.
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Randomized Controlled Trial Clinical Trial
Can evidence change the rate of back surgery? A randomized trial of community-based education.
Timely adoption of clinical practice guidelines is more likely to happen when the guidelines are used in combination with adjuvant educational strategies that address social as well as rational influences. ⋯ We were able to use scientific evidence to engender voluntary change in back pain practice patterns across entire communities.