Articles: low-back-pain.
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The caudal approach to the epidural space was first reported in 1901. Injection of steroids to treat low back pain was introduced in 1952. ⋯ Caudal epidural injections are associated with inaccurate needle placement when performed blindly in a substantial number of patients, resulting in intravascular injections as well as other complications. This review will discuss anatomic and technical considerations of caudal epidural injections, along with advantages, disadvantages, complications, and indications.
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Spinal pain is an important public health problem affecting the population indiscriminately. The structures responsible for pain in the spine include the vertebrae, intervertebral discs, spinal cord, nerve roots, facet joints, ligaments, muscles, atlanto-occipital joints, atlanto-axial joints, and sacroiliac joints. Even though disc herniation, facet joints, strained muscles, and torn ligaments have been attributed to be the cause of most spinal pain, either in the neck and upper extremities, upper and mid back, or low back and lower extremities, disorders of the disc other than disc herniation have been implicated more frequently than any other disorders. ⋯ The three primary components of diagnostic disc injection are: provocation/analgesia, discometry, and nucleography. Despite the recent exponential growth of noninvasive spinal technology, diagnostic disc injection remains the sole direct method for definitively determining whether a disc is a physiological pain generator. It is clear that discography is a safe and powerful complement to the overall clinical context.
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Clinical biomechanics · Jul 2000
ReviewThe relationship between psychosocial work characteristics and low back pain: underlying methodological issues.
To evaluate the current epidemiological evidence linking psychosocial work characteristics with low back pain. ⋯ This review attempts to identify and address methodological issues in the literature evaluating the relationship between psychosocial work characteristics and lower back pain. Implications for future research are presented.
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J Orthop Sports Phys Ther · Jul 2000
Intertester reliability of the McKenzie evaluation in assessing patients with mechanical low-back pain.
Prospective intertester reliability study investigating the ability of 2 therapists to agree on a low back pain diagnosis using examination techniques and the classification system described by McKenzie. ⋯ A form of low back evaluation, using patterns of pain response to repeated end range spinal test movements, was highly reliable when performed by 2 properly trained physical therapists.
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Randomized Controlled Trial Comparative Study Clinical Trial
Ketorolac versus meperidine: ED treatment of severe musculoskeletal low back pain.
The study objective was to assess the efficacy and patient acceptance of ketorolac as an alternative to meperidine for the treatment of severe musculoskeletal low back pain (LBP). A double blinded prospective trial in a convenience sample of patients >18 years of age presenting to an urban university hospital emergency department (ED) was conducted over a 19-month period. Patients were included if the pain was musculoskeletal in origin and was severe enough to warrant parenteral analgesics. ⋯ Sedation level and adverse effects were significantly greater in the meperidine group. Ketorolac shows comparable single dose analgesic efficacy to a single moderate dose of meperidine with less sedation and adverse effects in an ED population with severe musculoskeletal LBP. The trend for greater pain reduction and patient satisfaction with meperidine needs further investigation.