Articles: low-back-pain.
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Randomized Controlled Trial
Generalizability of harm and pain expectations after exposure in chronic low back pain patients.
Exposure treatments are shown to be effective in reducing pain-related fear and the perceived harmfulness of physical activities. However, due to the fragility of extinction its stability is questionable. We investigated the generalizability of exposure effects in chronic low back pain (CLBP) patients by integrating a behavioral test in the context of an intervention study. ⋯ This study investigats the generalizability and stability of exposure effects in patients with CLBP by combining a behavioral test with an intervention study. We found strong and stable effects on harm expectations but not on pain expectations. Results show promising preliminary evidence that reduced harm expectations can be generalized to a novel threatening activity in a new context. Clinical implications of our findings suggest that exposure treatment would benefit from a clear focus on harm expectations.
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Lumbar facet joints are a clinically important source of chronic low back pain. There have been extensive diagnostic accuracy studies, along with studies of influence on the diagnostic process, but most of them have utilized the acute pain model. One group of investigators have emphasized the importance of the chronic pain model and longer lasting relief with diagnostic blocks. ⋯ This study demonstrated that the chronic pain model is more accurate and reliable with concordant pain relief. This updated assessment also showed prevalence and false-positive rates of 34.1% and 49.8%.
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Discogenic pain is recognized as the most important and most common cause of low back pain (LBP). Intradiscal pulsed radiofrequency (ID-PRF) is used for the treatment of chronic discogenic pain. ⋯ ID-PRF was shown to be effective for the treatment of discogenic LBP regardless of duration of ID-PRF application (7 vs. 15 minutes).
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Sacroiliac joint is one of the proven causes of low back and lower extremity pain. Prevalence estimates of sacroiliac joint pain range from 10% to 25% in patients with persistent axial low back pain without disc herniation, discogenic pain, or radiculitis based on multiple diagnostic studies and systematic reviews. Over the years, utilization patterns of sacroiliac joint injections have been increasing in comparison to other interventional techniques. Further, the development of new current procedural terminology (CPT) codes and coverage policies for sacroiliac joint nerve blocks, sacroiliac joint radiofrequency neurotomy, and evolving evidence for sacroiliac joint fusion will further increase the utilization patterns. ⋯ This study shows increases in utilization patterns of sacroiliac joint injections; however, at a significantly lower rate with an annual increase of 16.6% prior to 2009 and only 1.2% from 2009 to 2018 per 100,000 Medicare beneficiaries.
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Musculoskeletal care · Sep 2020
Pain Education in the Context of Non-Specific Low Back Pain: The Lived Experience of the Physiotherapist. An Interpretive Phenomenological Analysis.
The aim of this study was to explore the physiotherapists' lived experiences of providing pain education (PE), to people living with non-specific low back pain (NSLBP). In previous studies, PE has been associated with positive clinical outcomes within the physiotherapeutic management of NSLBP. However, the meaning of providing PE, as experienced by physiotherapists, has not been specifically explored. ⋯ The significance of subjective assessment, was a key component of PE, as experienced by participants. However, differences were noted between participants in addressing the sense of assessment; in seeking a physiotherapeutic understanding of the NSLBP, and in seeking to understand the situation of those who are in pain. Within the participant experience, the significance of 'patient' reassurance was highlighted, related to the individualisation and outcome of PE. Reassurance, as described by participants, was emotive and practically grounded and linked with physical activity promotion. Individualisation in PE was meaningfully related to language modification and developing positive therapeutic relationships. Physiotherapists described PE particularly challenging related to pain chronicity and psychosocial factors, which may have significant implications to practice.