Articles: low-back-pain.
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To develop a clinical practice guideline to support the management of chronic pain, including low back, osteoarthritic, and neuropathic pain in primary care. ⋯ This guideline for the management of chronic pain, including osteoarthritis, low back pain, and neuropathic pain, highlights best available evidence including both benefits and harms for a number of treatment interventions. A strong recommendation for exercise as the primary treatment for chronic osteoarthritic and low back pain is made based on demonstrated long-term evidence of benefit. This information is intended to assist with, not dictate, shared decision making with patients.
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Selective nerve root block has been widely used to treat degenerative disc disease (DDD), but no detailed research data is provided to compare the efficacy of epidural injection of anesthetics with or without steroids on the DDD treatment. ⋯ The addition of steroids to anesthetic injectates was associated with a better NRS-11 and ODI compared with LA alone within one year in patients with DDD. Furthermore, the improvement of the ODI was observed within 2 years in patients with lumbar DDD.
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Intradiscal vacuum phenomenon (IDVP), despite being ubiquitous, is poorly understood. The dynamic passage of peri-discal gases into the degenerated disc is a commonly accepted theory. But the reasons behind its selective appearance in some discs are unevaluated. ⋯ Modic disc-endplate contacts, ALL disruption and coronal translation could be pathways for the passage of peri-discal gases into the degenerated disc. In the pathogenesis of IDVP, advanced disc degeneration, the presence of pathways of gas transfer and angular/coronal instability seem to play complementary roles.
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Percutaneous endoscopic lumbar discectomy (PELD) has become a mature and mainstream minimally invasive surgical technique for treating lumbar disc herniation (LDH). During PELD, various spinal structures, such as ligamentum flavum, dural sac, nerve root, posterior longitudinal ligament, annulus fibrosus, and endplate, were exposed, removed, and decompressed. When we used different endoscopic instruments to touch, remove, and excise different spinal structures, the patient will experience varying degrees of low back pain (LBP). To the best of our knowledge, the differences of the LBP have not been investigated in detail. ⋯ During PELD, varied LBP will generate when different spinal tissues are manipulated by different endoscopic instruments, the most severe LBP always came from the posterior longitudinal ligament and nerve root /dural sac. Moreover, compared to incision and thermal stimulus, traction could provoke more severe LBP.
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Sacroiliac (SI) joint dysfunction is a common cause of low back pain and accurate diagnosis can be challenging. A complete history and physical examination are critical in differentiating other diagnoses that may have similar signs and symptoms. Positive responses to at least three physical provocation tests suggest SI joint dysfunction, and local anesthetic SI joint blocks can also be useful for confirming the SI joint as the source of pain. ⋯ These programs can be performed by physical therapists or clinicians trained in manipulative therapy. Pelvic belts may be beneficial in affected postpartum patients. Patients with symptoms that do not improve with conservative management may benefit from interventional treatment options including intra-articular corticosteroid injections, cooled radiofrequency ablation, or SI joint fusion.