Articles: low-back-pain.
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J Am Board Fam Pract · May 1996
CommentChronic opioids for chronic low back pain--solution or problem?
The article by Brown et al does not provide data to justify long-term opioid use but does suggest a treatment option for the many patients who have chronic back pain and who want the help that our medical delivery system often does not provide. Having worked in a tertiary referral pain clinic that serves many low back pain patients who have demonstrated the ineffectiveness of chronic opiate therapy, I am strongly ambivalent about recommending prescribing ongoing opioiod therapy for chronic pain patients. The caveats about prescribing opioids for such patients are most appropriate (i.e., do not prescribe opioids for those who have a history of problems with opioid therapy or for whom increased intake is associated with decreased function); however, for patients who do not display these problems (and there could be many out there), I am sympathetic with the sentiments expressed by Brown et al. ⋯ If pain complaints are reduced and if function is improved according to the record (eg, patient is working) and the relatives' report, and if you, the prescribing physician, are happy, then a long-term regimen of opioid therapy is probably fine. Further controlled trials are needed to see whether this therapy works, and if so, what are the optimal agent(s) and dosages, what is optimal monitoring, and most important of all, who is the optimal patient who might derive not only analgesia but also functional benefit rather than compromise from this therapy. If we cannot make patients better, we must not make them worse.
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Anesteziol Reanimatol · May 1996
[The epidural administration of steroids and local anesthetics as the basis for the pathogenetic therapy of a radicular pain syndrome in the stages of its development].
The efficacy of epidural administration of a steroid drug kenalog combined with low-dose 1% lidocaine solution was assessed in 26 patients with discal hernias at various stages of the radicular pain syndrome. Registration of paired H-reflex helped define the neurophysiological criteria objectively indicating cure and normalization of the reduced activities of inhibitory structures of the spinal segmentary system as a result of therapy in patients with the radicular syndrome. The efficacy of this method ranges between 57.3 and 100% and depends on the disease duration, therefore it is preferable at the early stages of the disease (up to 4-6 months). Failure of therapy after 3 successive epidural blockings at 6-7-day intervals may be considered as an indication to surgery.
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Comparative Study
Recurrent or new injury outcomes after return to work in chronic disabling spinal disorders. Tertiary prevention efficacy of functional restoration treatment.
A large prospective longitudinal cohort study (n = 1204) to identify prevalence of new or recurrent injury and risk factors in a rehabilitated chronic disabling spinal disorder patient group with matched control subjects. ⋯ The present study suggests that even a sample of the most severe chronic disabling spinal disorder workers' compensation patients who complete a tertiary functional restoration program are at relatively low risk for either a recurrent spinal disorder or new musculoskeletal injury claim (with or without disability). No major physical or psychologic risk factors for recurrent injury could be identified in this large cohort. These findings argue powerfully against employer bias in not rehiring employees with previous chronic disabling spinal disorder or discriminating in pre- or reemployment on the basis of putative reinjury risk factors after an appropriate rehabilitation program. Literature review documents a surprising paucity of quality studies examining variables predictive of this important socioeconomic outcome variable.