Articles: low-back-pain.
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Many studies have documented an association between chronic low back pain (LBP) and deficits in back muscle strength and endurance. The sub-optimal performance is believed to be the result of alterations in the size and structure of the muscle, although the long-standing issue of whether the observed changes precede or are a consequence of the pain remains unresolved. If consequent to the problem, and predominantly related to disuse of the muscles, then it may be expected that a relationship between muscle structure and symptom duration would exist. ⋯ The results suggest that, over the long term, fibre type transformations rather than alterations in fibre size are the predominant changes to be found in the muscles of chronic LBP patients. The direction of change supports the results of many previous studies that have demonstrated corresponding differences in the fatigability of the muscles. There is a strong case for the early implementation of active measures to attempt to offset the development of these changes in back pain patients.
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A longitudinal cohort study of patients with acute, work-related low back pain undergoing physical therapy treatment. ⋯ Because the nonorganic tests are purported to serve as screening tests, cut-off values were selected that minimized false-negative results. Even with optimal cut-off values, none of the nonorganic tests served as effective screening tools. Other screening tools may prove more effective for the early identification of patients at increased risk for delay in returning to work after an episode of acute 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
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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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.