Articles: low-back-pain.
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Poor results after lumbar spinal surgery have been recorded in compensation cases throughout the world medical literature. It seems that psychosocial factors play an important role in the delay in returning to gainful employment but that chronic postoperative lumbar and lower extremity pain is blamed for this state of affairs. The present series of late outcomes is based on actual physical examination by independent neurosurgical and orthopedic experts appointed by the Workman's Compensation Board, providing an impartial opinion as to the discrepancy between objective findings and failure to reintegrate into the work force. ⋯ Although motivational (that is, psychosocial) factors undoubtedly play a role in failure to return to work, the role of chronic pain cannot be ignored. Increased attention must be devoted to ascertaining the etiology of this pain and ways to prevent it.
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Ned Tijdschr Geneeskd · Jul 2000
Meta Analysis[Chronic low back pain: exercise therapy, multidisciplinary programs, NSAID's, back schools and behavioral therapy effective; traction not effective; results of systematic reviews].
To inventory the current state of the art regarding the effectiveness of conservative treatment of chronic low back pain. ⋯ There was strong evidence that exercise therapy and multidisciplinary treatment programmes were effective in chronic low back pain, and moderate evidence that non-steroidal anti-inflammatory drugs (NSAIDs), back schools and behavioural therapy were effective in chronic low back pain. There was also strong evidence that traction was not effective in chronic low back pain. Strong evidence for effectiveness of many other commonly used interventions was lacking.
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Ned Tijdschr Geneeskd · Jul 2000
Comment Meta Analysis[Acute low back pain: activity, NSAID's and muscle relaxants effective; bedrest and targeted exercise not effective; results of systematic reviews].
To inventory the current state of the art regarding the effectiveness of conservative treatment of acute low back pain. ⋯ Approximately two-thirds of the randomised trials in the field of back pain were of poor methodological quality. There was strong evidence that advice to stay active, non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants were effective in acute low back pain. There was also strong evidence that bed rest and specific exercises were not effective in acute low back pain. Strong evidence for effectiveness of many other commonly used interventions was lacking.
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Clinical Trial Controlled Clinical Trial
Can discography cause long-term back symptoms in previously asymptomatic subjects?
A prospective controlled study of patients without low back pain observed after experimental lumbar discography. ⋯ Discography in a subject group without low back pain but with significant emotional and chronic pain problems may result in reports of significant back pain for at least 1 year after injection. Subjects with normal psychometric test results had no reports of significant long-term back pain after discography.
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Epidural neuroplasty (lysis of epidural adhesions) is an interventional technique that has emerged over the last 10 years as part of a multidisciplinary approach to treating radiculopathy with low back pain when conservative management has failed. Neuroplasty was at one time performed as a single-catheter technique using the caudal approach. It now has many variations, including placement of the catheter tip in the anterior epidural space. This article will discuss the evolution and refinement of epidural neuroplasty at our institution.