Articles: low-back-pain.
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In Physical Medicine and Rehabilitation structural and functional disorders in the genesis of back pain are of great importance. From an epidemiological point of view this has great consequences. Active and passive forms of physical therapy are available. ⋯ Sometimes a combination of active and passive forms are of benefit. Every treatment concept has to pay regard to the actuality of pain, the load of every day life and the physical and social situation of the patient. Last but not least one has to learn to cope with the pain.
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Review Comparative Study
Do antidepressant medications relieve chronic low back pain?
Antidepressant medications are commonly prescribed for patients with chronic low back pain. A literature synthesis was performed to determine whether antidepressants are more effective than placebos in decreasing pain, disability, depression, and analgesic medication use in such patients. ⋯ The literature has not demonstrated that antidepressants are superior to placebos in improving low back pain or related problems. However, further randomized controlled trials are needed to determine whether antidepressants are useful for low back pain.
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Facet syndrome is an apparently common although not readily identifiable cause of low back pain. To evaluate the efficacy of corticosteroid facet joint injection for the treatment of low back pain, we retrospectively studied 206 patients with low back pain ascribed to facet syndrome. Effectiveness was evaluated on the basis of a clinical score and of a questionnaire completed 10 to 34 months after treatment. ⋯ These broad ranges denote substantial variations in evaluation criteria and patient selection. Only two placebo-controlled trials have been performed. There is a need for a prospective study with strict inclusion criteria and appropriate evaluation criteria taking quality of life into account to determine the role of facet joint injection in low back pain.
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The facet syndrome seems to be a common cause of low back pain. Percutaneous radiofrequency lumbar facet denervation, developed by Shealy, may be of therapeutic value in facet syndrome patients. This method consists in thermocoagulation of the middle branch of the dorsal primary ramus of the spinal nerve. ⋯ Success rates reported in the literature vary widely, from 14% to 76%. Interpretation of these data is difficult since studies used a broad range of treatment techniques, evaluation methods, and patient selection criteria. A prospective study using stringent inclusion criteria and appropriate evaluation criteria taking quality of life into account is needed to determine the role of percutaneous facet denervation among other treatment options available to low back pain patients.