Articles: low-back-pain.
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Arch Phys Med Rehabil · Mar 1998
The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome.
To determine the clinical validity of provocative sacroiliac joint (SIJ) maneuvers in making the diagnosis of sacroiliac joint syndrome (SIJS). ⋯ Our results do not support the use of provocative SIJ maneuvers to confirm a diagnosis of SIJS. Rather, these physical examination techniques can, at best, enter SIJS into the differential diagnosis.
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A longitudinal observational study of primary care patients with low back pain. ⋯ Nonsteroidal anti-inflammatory drugs, often augmented by muscle relaxants, are a standard medical treatment for back pain in primary care. In this observational study, patients prescribed medications, particularly muscle relaxants, reported less severe symptoms after 1 week than those receiving no medications. However, randomized trials are needed to determine which medication or combinations of medications are most effective.
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Managed care interface · Mar 1998
Chronic low back pain: new perspectives and treatment guidelines for primary care: Part II.
Low back pain is a leading cause of work-related disability and has important socioeconomic consequences. Although there is little evidence to determine the optimal treatment of chronic low back pain, treatment goals can be established. ⋯ This two-part article summarizes consensus guidelines developed by practitioners with expertise in pain management, family medicine, internal medicine, physical therapy, rheumatology, and managed care and provides direction for primary care providers on a multidisciplinary approach to the patient with chronic low back pain. This part examines pharmacologic methods.
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A wide variety of mechanical and non-mechanical disorders are associated with the clinical symptom of low back pain. Mechanical disorders are the cause of the vast majority of low back pain. Despite this frequency, the specific cause of mechanical low back pain can not be elucidated in spite of extensive diagnostic evaluation in a majority of individuals. ⋯ The diagnostic process is more successful in identifying systemic disorders as the specific cause of low back pain. Non-surgical management is effective therapy with most patients with mechanical disorders of any form. Systemic illnesses require interventions directed specifically at healing the affected organ system.
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The main challenge of surgery in the treatment of low back pain lies with the poor knowledge of the aetio-pathogenesis of this symptom. Surgical treatment requires the precise diagnosis of a surgically curable lesion. In low back disorders this research of a precise source of nociception remains elusive even in the presence of radiological abnormalities. ⋯ However, there is a wide choice of attitudes, techniques and procedures for each of those indications and numerous conflicting result reports have been published. This chapter will try to present the best available consensus regarding the indications and results of different surgical procedures in spinal disorders. Most of all, physicians should bear in mind that, in spine surgery perhaps more than in other fields, unreasonable patient (and surgeon) expectations will most likely lead to poor outcomes.