Articles: low-back-pain.
-
Comparative Study
Muscle response pattern to sudden trunk loading in healthy individuals and in patients with chronic low back pain.
A quick-release method in four directions of isometric trunk exertions was used to study the muscle response patterns in 17 patients with chronic low back pain and 17 matched control subjects. ⋯ Patients with low back pain, in contrast to healthy control subjects, demonstrated a significantly different muscle response pattern in response to sudden load release. These differences may either constitute a predisposing factor to low back injuries or a compensation mechanism to stabilize the lumbar spine.
-
Comparative Study
Herniated lumbar disc material as a source of free glutamate available to affect pain signals through the dorsal root ganglion.
Combined prospective human cohort and prospective controlled animal model. ⋯ Glutamate originating from degenerated disc proteoglycan may diffuse to the dorsal root ganglion and effect glutamate receptors. Consideration may be given to treating disc radiculopathy with epidural glutamate receptor antagonists.
-
Clinical Trial Controlled Clinical Trial
Setting up a pain management programme. The Ayrshire experience.
A controlled trial of an outpatient cognitive behavioural pain management programme for sufferers of non-cancer chronic pain is described. A multidisciplinary team set up a programme of ten half day sessions for groups of ten to fourteen patients aiming to improve activity levels and control over pain; to reduce maladaptive pain behaviours and drug intake; to mitigate negative mood; to modify unhelpful beliefs and to maintain treatment gains by operant and cognitive methods. ⋯ Fifty-eight patients entered the study group and 39 patients completed the programme and initial follow up with further attrition in long term follow up. There were no changes in the waiting list control group of twelve subjects but the study group made significant short and long term improvements in pain severity, activity levels, mood, coping and experienced fewer catastrophizing thoughts.
-
Internal disc disruption is a common cause of disabling low back pain in a substantial number of young, healthy adults. Crock described this painful entity and reported annular fissures that distort the internal architecture of the disc; Externally the disc appears relatively intact and undeformed. A clinical diagnosis of internal disc disruption, in absence of objective clinical findings, is extremely difficult. ⋯ Recent studies indicate the existence of a biochemical/ biomechanical model of discogenic pain, which explains the disabling low back pain in some subjects with no objective evidence of nerve-root compromise. However, a reluctance to acknowledge internal disc disruption as a valid clinical entity delays diagnosis and treatment. Failure to identify and treat this entity early and aggressively results in longterm disability, thereby perpetuating the enigma of chronic low back pain.
-
Facet joints, as a source of low back pain, have attracted considerable attention and been a source of controversy in recent years. Significant progress has been made in precision diagnosis of chronic low back pain with neural blockade. In the face of less than optimal diagnostic information offered by imaging and neurophysiologic studies, and in the face of mounting evidence showing lack of correlation between clinical features, physical findings, and diagnosis of facet joint mediated pain, controversial features have been described to validate the assumption of facet joint mediated pain by set criteria. ⋯ However, these six feature involved only a small number of patients. In conclusion, facet joint mediated pain is a common entity in patients suffering with chronic low back pain nonresponsive to conservative care, who present to a nonuniversity pain management practice. However, the history, clinical features, and radiological features are of no significance or assistance in making the diagnosis of facet joint mediated pain with certainty.