Articles: low-back-pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Facet joint injection and facet nerve block: a randomised comparison in 86 patients with chronic low back pain.
Eighty-six patients with refractory chronic low back pain were randomly assigned to receive either facet joint injection or facet nerve block, using local anaesthetic and steroid. There was no significant difference in the immediate response. ⋯ Patients who had complained of pain for more than 7 years were more likely to report good or excellent pain relief than those with a shorter history (P less than 0.005), but no other clinical feature was of value in predicting the response to infiltration. Facet joint injections and facet nerve blocks may be of equal value as diagnostic tests, but neither is a satisfactory treatment for chronic back pain.
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In a retrospective, controlled clinical study the life events of 35 patients suffering from chronic low back pain (LBP) and a matched sample of 23 patients with neurotic depression (ICD 300.4) were investigated. The pain patients formed two groups: 19 patients with definite organic diagnosis (IASP code 530.96) and 16 without (adequate) organic lesion (IASP code 510.99). Somatic diseases (other than LBP), injuries and operations, as well as psychic trauma (feelings of shame, narcissistic traumatisations and object losses) were defined and counted as documented in the patient's histories. ⋯ Object losses occur equally often in all groups, apart from the initial year, when depressive patients have to cope with even more losses than the others. These results are discussed considering the development of chronic pain syndromes, the influence of age and their consequences for models of illness. There is convincing evidence, that physical injury is neither a necessary nor a sufficient condition for the development of chronic pain and that chronic pain is in essence an emotional disease based on unresolved unconscious conflicts requiring psychotherapy.
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Case Reports
Acute rupture of an aortic aneurysm mimicking the discus hernia syndrome. A case report.
Aneurysms of the abdominal aorta have been recognised as a cause of back pain and vertebral erosion. However back pain and paraplegia are uncommon, presenting complaints in patients with aortic aneurysms. A case of acute rupture of an abdominal aortic aneurysm is presented mimicking the symptoms of a discus hernia syndrome and paraplegia.
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We report the case of a ten year old female student who complained of chronic back pain and morning stiffness of several months duration. She failed to respond to non-steroidal anti-inflammatory drugs (NSAIDS). Further investigations which included bone and CT scan revealed the presence of an osteoid osteoma at the first sacral vertebra (S1 vertebra). The patient made an excellent recovery after surgical excision.