Articles: low-back-pain.
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The main challenge of surgery in the treatment of low back pain lies with the poor knowledge of the aetio-pathogenesis of this symptom. Surgical treatment requires the precise diagnosis of a surgically curable lesion. In low back disorders this research of a precise source of nociception remains elusive even in the presence of radiological abnormalities. ⋯ However, there is a wide choice of attitudes, techniques and procedures for each of those indications and numerous conflicting result reports have been published. This chapter will try to present the best available consensus regarding the indications and results of different surgical procedures in spinal disorders. Most of all, physicians should bear in mind that, in spine surgery perhaps more than in other fields, unreasonable patient (and surgeon) expectations will most likely lead to poor outcomes.
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A wide variety of mechanical and non-mechanical disorders are associated with the clinical symptom of low back pain. Mechanical disorders are the cause of the vast majority of low back pain. Despite this frequency, the specific cause of mechanical low back pain can not be elucidated in spite of extensive diagnostic evaluation in a majority of individuals. ⋯ The diagnostic process is more successful in identifying systemic disorders as the specific cause of low back pain. Non-surgical management is effective therapy with most patients with mechanical disorders of any form. Systemic illnesses require interventions directed specifically at healing the affected organ system.
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Lumbar spine injections have a role in the evaluation and treatment of low back pain. These injection procedures have been demonstrated to be effective in determining whether certain structures are responsible for low back pain. There is still debate as to the long-term pain relief from epidural and intra-articular facet joint injections, and there are no controlled studies examining the long-term effects of SI joint injections. ⋯ This duration of pain relief creates an opportunity to maximize rehabilitation efforts while symptoms are minimal. There is a need for more controlled studies to evaluate the long-term effectiveness that these lumbar spine injections have on controlling low back pain. Future studies also need to assess in a controlled manner the impact that these injections have no rehabilitation and their role in functional restoration of lumbar spine disorders.
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McKenzie methods stress self-treatment through correct posture and repeated end-range movements performed at a high frequency. Dr. Simonsen describes the basic principles and outlines the three syndromes and specific treatment protocols identified by McKenzie.
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Commonly prescribed drugs for the treatment of low back pain have varying success rates, costs, and complications. This chapter presents current information on acetaminophen, nonsteroidal anti-inflammatory agents, muscle relaxants, opioids, corticosteroids, antidepressants, and colchicine to help the physician in determining a pharmacologic strategy.