Articles: low-back-pain.
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Comparative Study
Centralization phenomenon as a prognostic factor for chronic low back pain and disability.
Two hundred twenty-three consecutive adults with acute low back pain with or without referred spinal symptoms were treated conservatively and followed prospectively for 1 year. ⋯ Dynamic assessment of change in anatomic pain location during treatment and leg pain at intake were predictors of developing chronic pain and disability.
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Low back pain, a leading cause of disability in the United States, has a significant economic impact not only on lost productivity but also on healthcare expenditures. Approximately a fifth of patients will see multiple physicians in their quest for relief of low back pain. ⋯ This article reviews the diagnosis and assessment of pain levels and a triad system of therapy involving cortical, spinal, and peripheral levels. Options include antidepressants, neuroleptics, neurostimulants, and osteopathic manipulative treatment (OMT) (cortical level); opiates, tramadol hydrochloride, and transcutaneous electrical nerve stimulators (spinal level); and nonsteroidal anti-inflammatory drugs, epidural injections, spinal blocks, antispasmodics, physical therapy, muscle relaxants, exercise, and OMT (peripheral level), By choosing a modality directed at each level, the clinician may provide the patient with a pain management program that will maximize the chosen mode of therapy and restore function and mobility.
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J. Korean Med. Sci. · Apr 2001
Cephalic spreading levels after volumetric caudal epidural injections in chronic low back pain.
The volumetric caudal epidural steroid injection has been advocated to facilitate the delivery of medications to the lesion site. This study was aimed to examine the actual spreading patterns of this technique, using epidurogram. A total of 32 patients with chronic low back pain accompanied by radiculopathy of various causes (degenerative spondylosis, herniated nucleus pulposus, spondylolisthesis, and spinal stenosis) were included. ⋯ The spreading levels of the mixture were distributed mainly at mid to lower lumbar area in the majority of the patients. During the subsequent injections, the levels were not changed significantly. This was thought to be due to the minimal resistance in cephalad direction, anatomic variations and Starling effect of epidural space.
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Journal of neurosurgery · Apr 2001
Long-lasting analgesic effect of radiofrequency treatment of the lumbosacral dorsal root ganglion.
The authors conducted a study to establish the benefit of radiofrequency (RF) treatment of the lumbosacral dorsal root ganglion (DRG) as a therapy to reduce symptomatic pain in patients with chronic spinal pain radiating to the leg. ⋯ The use of RF in the treatment of DRG appears to be a useful and safe therapy in patients with chronic spinal pain that radiates to the leg. The initial success rate is approximately 60%. It seems to lead to a time-limited effect on the target structure, and the mean duration of pain reduction is approximately 3.7 years. The mechanism of action remains unclear.