Articles: low-back-pain.
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Low back pain ist frequently associated with malposition of the pelvis due to an imbalance of the postural muscles. In these patients functional malposition of both the sacrum and the ileum can be observed, resulting in differences in the length of the legs. We investigated whether the return to a normal position correlated with pain relief. ⋯ Differences in the length of the legs can be successfully treated by manual therapy at C0/C1 or C2/C3 in the majority of patients with pelvic malposition. However, infiltration of the iliosacral joints is often required as additional therapy for short-term and long-term pain relief. Treatment with NSAIDs alone is only seldom effective in cases of pelvic malposition and rarely affords long-term pain relief.
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A multimodal treatment program is presented in cases of functional restoration for chronic low back pain. The study comprises four parts. Part I gives an overview of the different results of the study. Part II focuses on the medical and functional examination in comparison with persons who do not suffer from back pain. Part III describes psychosocial aspects (depression, complaints, ways of coping, disability) and psychotherapy. In part IV prognostic factors and their reliability for predicting treatment outcome (return to work, pain intensity, self-assessment of success by patients) are examined. In addition the relevant effects of the program on social and health care systems are also addressed. ⋯ The results demonstrate the effectiveness of the multimodal program of functional restoration, not only concerning positive changes in somatic, psychological and physical variables, but also with respect to the number of patients who returned to work. Our methods are also compared with the discrepant results of multimodal treatment in the United States and Scandinavia.
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Clinical Trial
Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain.
This prospective study consisted of the evaluation of a double sacroiliac block in patients with low back pain. ⋯ The present study suggests the sacroiliac joint is an uncommon but real source of low back pain. The accuracy of some of the presumed "sacroiliac pain provocations tests" is questioned.
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Clinical Trial
The outcome of posterolateral fusion in highly selected patients with discogenic low back pain.
A prospective analysis of the clinical outcome of a consecutive series of patients treated with posterior lumbar arthrodesis. Preoperative data were collected retrospectively by chart review. ⋯ Posterolateral intertransverse fusion can be used to successfully manage chronic discogenic back pain. However, patient selection remains a challenge, and successful outcome appears to be limited in the subset of patients receiving worker's compensation and those chronically disabled. Prospective and randomized study with objective pain criteria, independent review, and patient-oriented outcome is recommended.
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Clinical Trial
Influence of previous pain experience on the episode incidence of low back pain: results from the South Manchester Back Pain Study.
A pathological cause cannot be identified for most new episodes of low back pain (LBP) presenting to the general practitioner. One important potential influence on susceptibility is previous pain experience. To accurately investigate the contribution of this phenomenon to the onset of new episodes of LBP a prospective population study is required. ⋯ In those currently free of LBP a previous history of the symptom substantially increases the risk of a further episode, with pain in other sites an equally strong independent predictor of subsequent LBP.