Articles: low-back-pain.
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For the treatment of back pain, behavioral modification, pharmacotherapy, non-pharmacological conservative treatment and surgical procedures are available. Systemic and metabolic disorders require specific treatment. Medication that may be considered includes non-opioid analgesics with or without an antiphlogistic action, opioid analgesics, muscle relaxants and antidepressants. ⋯ For myofascial pain, flupirtine is to be recommended because of its analgetic and muscle-tone-normalizing actions. Local anesthetic infiltration or nerve blocks are useful in blocking nociception with its pathophysiological sequelae. For chronic back pain, opioids and some antidepressants have a more favorable benefit-risk profile than NSAIDs.
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Clinical Trial
Management of chronic discogenic low back pain with a thermal intradiscal catheter. A preliminary report.
A prospective nonrandomized clinical trial. ⋯ A statistically significant improvement in functional outcome was obtained in patients with chronic discogenic low back pain treated thermally by the SpineCath.
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Comparative Study
Lumbar disc high-intensity zone: the value and significance of provocative discography in the determination of the discogenic pain source.
Disagreement still exists in the literature as to the significance of the high-intensity zone (HIZ) demonstrated on magnetic resonance imaging (MRI) as a potential pain indicator in patients with low back pain. A prospective blind study was therefore conducted to evaluate the lumbar disc high-intensity zone with the pain provocation response of lumbar discography. Consecutive patients with low back pain unresponsive to conservative treatment and being considered for spinal fusion were subjected to MRI followed by lumbar discography as a pre-operative assessment. ⋯ The sensitivity, specificity and positive predictive value for pain reproduction were high, at 81%, 79% and 87% respectively. The nature of the HIZ remains unknown, but it may represent an area of secondary inflammation as a result of an annular tear. We conclude from our study that the lumbar disc HIZ observed on MRI in patients with low back pain is likely to represent painful internal disc disruption.
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Comparative Study
Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain.
The objective of this study was to conduct a radiological analysis of posture before and after lumbosacral fusion to evaluate the influence of spinal alignment on the occurrence and pattern of post surgical pain. The study included 81 patients, of whom 51 had a history of previous low back surgery. We excluded patients with suspected or confirmed nonunion. ⋯ Appropriate position of the fused vertebrae is also of paramount importance to minimize muscle work during posture maintenance. The main risk is failing to correct or to causing excessive pelvic retroversion with a vertical sacrum leading to a sagittal alignment that replicates the sitting position. This situation is often accompanied by loss of lumbar lordosis and adversely affects stiff or degenerative hips.