Articles: low-back-pain.
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Review Meta Analysis
Is transcranial direct current stimulation (tDCS) effective for chronic low back pain? A systematic review and meta-analysis.
Transcranial direct current stimulation (tDCS) has been used to reduce pain in range of chronic pain states. The aim of this review is to evaluate the effectiveness of tDCS on pain reduction and related disability in patients with non-specific chronic low back pain (CLBP). A computer-based systematic literature search was performed in five databases according to PRISMA guidelines. ⋯ No significant adverse events were reported. The current results do not support the clinical use of tDCS for the reduction of pain and related disability in non-specific CLBP. However, the limited number of available evidence limits our conclusions on the effectiveness of these approaches.
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Randomized Controlled Trial
Efficacy of Intradiscal Ozone Therapy with or without Periforaminal Steroid Injection on Lumbar Disc Herniation: A Double-Blinded Controlled Study.
Intradiscal ozone therapy, a minimally invasive technique, is used in patients that do not respond to standard conservative therapies for low back pain due to degenerative disc-induced lumbar disc herniation (LDH). Many studies on clinical efficacy lack a standardized injection method and are limited by inadequate study design. ⋯ This study showed that intradiscal ozone injection alone was sufficient to treat low back and leg pain caused by LDH and that periforaminal steroid injection does not provide additional benefit, which is contrary to the literature.
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A 37-year-old military service-member was referred to physical therapy with a greater-than-6-month history of low back pain with intermittent and worsening left posterolateral lower-leg pain and paresthesia with activity. He was diagnosed by his primary care physician with exertional compartment syndrome and referred to orthopaedic services. Following examination, the physical therapist ordered a duplex ultrasound, which demonstrated an anomaly at the popliteal artery, resulting in a diagnosis of popliteal artery entrapment syndrome, confirmed by computed tomography angiography and magnetic resonance imaging. J Orthop Sports Phys Ther 2020;50(9):531. doi:10.2519/jospt.2020.9568.
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Case Reports
Needle-through-needle technique in lumbar interlaminar epidural steroid injection: a case report.
When performing lumbar epidural steroid injection on obese patients, needle placement can be challenging due to the difficulty in estimating the appropriate needle length to utilize. Often times, the standard 3.5-inch Tuohy needle is too short to reach its target. ⋯ This technique can facilitate quicker needle placement by avoiding the need for restarting the procedure with a longer needle. Thus, procedural time and radiation exposure may be decreased, as may patient discomfort from repeat needle insertions.
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Chronic low back pain (cLBP) is a prevalent disorder. A growing body of evidence linking the pathology of the reward network to chronic pain suggests that pain sensitization may contribute to cLBP chronification via disruptions of mesocortical and mesolimbic circuits in the reward system. Resting-state (RS) functional magnetic resonance imaging (fMRI) data was acquired from 90 patients with cLBP and 74 matched pain-free controls (HCs) at baseline and after a manipulation for back pain intensification. ⋯ Mediation analysis further isolated the mesolimbic (VTA-hippocampus/parahippocampus) dysconnectivity as a neural mechanism mediating the association between mechanical pain sensitivity (indexed by P40 pressure) and cLBP severity. In sum, the current study demonstrates deficient mesocorticolimbic connectivity in cLBP, with mesolimbic dysconnectivity potentially mediating the contribution of pain sensitization to pain chronification. These reward network dysfunctions and purportedly, dopaminergic dysregulations, may help us to identify key brain targets of neuromodulation in the treatment of cLBP.