Articles: low-back-pain.
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Randomized Controlled Trial Clinical Trial
A placebo-controlled randomized clinical trial of nortriptyline for chronic low back pain.
To assess the efficacy of nortriptyline, a tricyclic antidepressant, as an analgesic in chronic back pain without depression, we conducted a randomized, double-blind, placebo-controlled, 8-week trial in 78 men recruited from primary care and general orthopedic settings, who had chronic low back pain (pain at T-6 or below on a daily basis for 6 months or longer). Of these 57 completed the trial; of the 21 who did not complete, four were withdrawn because of adverse effects. The intervention consisted of inert placebo or nortriptyline titrated to within the therapeutic range for treating major depression (50-150 ng/ml). ⋯ Also, completers with radicular pain on nortriptyline (n = 5) had significantly (P < 0.05) better analgesia and overall outcome than did those on placebo (n = 6). The results suggest noradrenergic mechanisms are relevant to analgesia in back pain. This modest reduction in pain intensity suggests that physicians should carefully weigh the risks and benefits of nortriptyline in chronic back pain without depression.
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Arzneimittel Forsch · Jun 1998
Randomized Controlled Trial Comparative Study Clinical TrialComparison of the efficacy and tolerability of a paracetamol/codeine fixed-dose combination with tramadol in patients with refractory chronic back pain.
Fifty-five patients suffering from refractory chronic back pain took part in a double-blind, multiple-dose, randomised, cross-over study to compare the efficacy and tolerability of a fixed-dose capsule preparation containing 500 mg paracetamol (CAS 103-90-2) and 30 mg codeine phosphate 1/2 H2O (CAS 41444-62-6) (talvosilen forte, test preparation) with a reference capsule preparation containing 50 mg tramadol hydrochloride (CAS 22204-88-2), in a regimen of two capsules 8-hourly. There were two treatment periods of up to 7 days each. ⋯ The test preparation was at least as efficacious as the reference in the treatment of back pain (81% of patients experienced good or satisfactory pain relief). 81% of patients tolerated the test well compared to only 69% receiving the reference, as per protocol analysis. The results of this study suggest that the test product is at least as efficacious as tramadol in the treatment of patients with refractory chronic back pain, whilst being better tolerated.
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A prospective study of patients treated with a light mobilization program for long-term low back pain. ⋯ The final discriminant function may have potential as a brief screening instrument for the number of patients with low back pain who do not benefit from the light mobilization program.
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Comparative Study
Predictive signs of discogenic lumbar pain on magnetic resonance imaging with discography correlation.
The correlation between discogenic lumbar pain and disc morphology was investigated by using magnetic resonance imaging and discography. ⋯ Although the lumbar intervertebral discs with posterior combined anular tears are likely to produce pain, the validity of these signs for predicting discogenic lumbar pain is limited.
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Data Strateg Benchmarks · Jun 1998
Comparative StudyRegional data on low back pain point to improvement potential.
Data Library: Benchmark your organization's treatment of low back pain. There's wide variation in specialty provider use, utilization of services, and costs of this high-volume medical problem--despite federal guidelines stipulating treatment recommendations. These data are broken out by specialty and on a regional basis.