Articles: low-back-pain.
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Sensory innervation of the lumbar dura mater passing through the sympathetic trunk was investigated by neuronal tracing and immunohistochemical methods. ⋯ Sensory fibers from the upper lumbar ganglia innervated the lower lumbar dura mater directly. These sensory nerves may mediate low back pain and possibly interact with sympathetic nerves.
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Objective. This one-year pilot outcome study was designed to investigate prospectively a series of patients with chronic discogenic back pain who underwent intradiscal electrothermal annuloplasty (IDET). Patients with chronic discogenic low back pain usually respond poorly to conservative medical care. ⋯ There were no significant complications. Conclusions. One-year pilot study outcome results suggest that IDET may be an effective, minimally invasive treatment for chronic discogenic low back pain.
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Objective. The authors attempted to design and conduct a randomized, prospective study to investigate the efficacy of spinal cord stimulation (SCS) for patients with chronic back and leg pain following at least one previous surgery. While the scientific advantages of the randomized, prospective trial are considerable, the authors encountered numerous practical and ethical difficulties with conducting these trials. ⋯ Conclusions. By utilizing a randomized interventional study design, problems of comparability of procedures, provider reluctance to participate in randomized clinical trials, provider bias, detection bias, and transfer bias are eliminated. It is suggested that future investigations, particularly those which are interventionally or device-based, conform to this particular model.
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An observational study on the course of chronic and recurrent low back pain and its relation to disability and medication use performed on the basis of daily diary recording. ⋯ Pain intensity can affect disability, but the episodic nature of low back pain also affects the ability to function in both work and personal life. Intermittent increases in pain can markedly alter disability. Chronic low back pain should not be treated as a static phenomenon.
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A cross-sectional study comparing the relationship of symptoms with anatomic impairment visible on lumbar magnetic resonance imaging in 408 symptomatic subjects. ⋯ The presence of disc extrusion and/or ipsilateral, severe nerve compression at one or multiple sites is strongly associated with distal leg pain. Mild to moderate nerve compression, disc degeneration or bulging, and central spinal stenosis are not significantly associated with specific pain patterns. Although segmental distributions of pain can be determined reliably from pain drawings, this finding alone is of little use in predicting lumbar impairment. The self-report of lower extremity weakness or dysesthesia is not significantly related to any specific lumbar impairments. [Key words: back pain, diagnosis, magnetic resonance imaging, nerve compression, pain drawing, pathology]