Articles: low-back-pain.
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The reasonable clinical approach to the patient who has low back pain includes a search for any of the red flags that would prompt consideration of additional diagnostic testing for serious underlying disease. The common patterns of back pain would be explored in an effort to categorize the patient's symptoms and to begin formulation of a diagnostic impression. Re-evaluation of the patient in light of his response (or lack of response) to these measures is an essential component of the clinical assessment. Finally, some consideration must be given to the various biopsychosocial factors that may affect prognosis, particularly in patients who have more chronic pain and disability-related issues.
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Asia Pac J Public Health · Jan 1999
ReviewThe prevalence of low back pain in Australian adults. A systematic review of the literature from 1966-1998.
The objective of this study was to conduct a systematic review of the literature on the prevalence of low back pain in Australian adults. All Australian low back pain prevalence studies published between 1966 and 1998 were identified. General and methodological criteria using current best practice were applied to each prevalence study. ⋯ These studies were Australian Government Health studies conducted over the past 12 years. However, even these studies were flawed, and thus the true prevalence of low back pain in Australia remains uncertain. A methodologically sound study for Australia is recommended as are best practice guidelines for other studies.
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Systematic reviews and meta-analyses are becoming increasingly important in informing clinical practice and commissioning. Two systematic reviews of a treatment for low back pain and sciatica using epidural steroid injections, published in the same year, arrived at conflicting conclusions. Only one was reported in a digest for evidence-based medicine. ⋯ Estimation of summary odds ratios in one review led to stronger conclusions about effectiveness. In conclusion, the choice of methods for systematic review may alter views about the current state of evidence. Users should be aware that systematic reviews include an element of judgement, whatever method is used.
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Neurological research · Jan 1999
ReviewEpidural fibrosis and the failed back surgery syndrome: history and physical findings.
Patients who present with recurrent symptoms after surgical intervention aimed at correcting their lumbosacral disease pose a therapeutic challenge. A heterogeneous group of factors may underlie symptom recurrence and formulation of a therapeutic strategy depends on an accurate diagnosis of the patient's underlying problem. In this review, the authors discuss the relevant historical and physical findings in patients with epidural fibrosis and the failed back surgery syndrome.
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Low back pain (LBP) among children and adolescents has become the subject of an increasing amount of literature over the last 15 years. This topic, which was considered almost insignificant less than two decades ago, was the focus of a recent international meeting organised in Grenoble (France) in March 1999. This review paper is the result of an literature update search performed by members of three groups which have been active in this field for many years. Current epidemiological data on LBP is summarized as well as the role of the major risk factors according to studies published in the principal peer reviewed journals interested in the topic.