Articles: low-back-pain.
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It has been increasingly recognized that many chronic pain conditions are associated with central sensitization (CS). The Central Sensitization Inventory (CSI) is a potentially useful tool for screening patients whose presenting symptoms are suspected of being related to CS, so that additional diagnostic evaluation can be performed and appropriate treatment can be initiated. The original English version is currently not available in Serbian. ⋯ The results of the present study indicate strong psychometric properties, including evidence of convergent and discriminant validity, of the CSI-Serb. These results correspond with those of other translated versions of the CSI that have been psychometrically evaluated and published. Due to the current interest in CS, and its relationship with many chronic pain conditions, it is anticipated that the CSI-Serb will benefit Serbian-speaking clinicians in the evaluation of patients with chronic pain conditions.
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Review Meta Analysis
Meta-analysis of transcutaneous electrical nerve stimulation for relief of spinal pain.
We conducted a systematic review and meta-analysis analysing the existing data on transcutaneous electrical nerve stimulation (TENS) or interferential current (IFC) for chronic low back pain (CLBP) and/or neck pain (CNP) taking into account intensity and timing of stimulation, examining pain, function and disability. Seven electronic databases were searched for TENS or IFC treatment in non-specific CLBP or CNP. Four reviewers independently selected randomized controlled trials (RCTs) of TENS or IFC intervention in adult individuals with non-specific CLBP or CNP. Primary outcomes were for self-reported pain intensity and back-specific disability. Two reviewers performed quality assessment, and two reviewers extracted data using a standardized form. Nine RCTs were selected (eight CLBP; one CNP), and seven studies with complete data sets were included for meta-analysis (655 participants). For CLBP, meta-analysis shows TENS/IFC intervention, independent of time of assessment, was significantly different from placebo/control (p < 0.02). TENS/IFC intervention was better than placebo/control, during therapy (p = 0.02), but not immediately after therapy (p = 0.08), or 1-3 months after therapy (p = 0.99). Analysis for adequate stimulation parameters was not significantly different, and there was no effect on disability. This systematic review provides inconclusive evidence of TENS benefits in low back pain patients because the quality of the studies was low, and adequate parameters and timing of assessment were not uniformly used or reported. Without additional high-quality clinical trials using sufficient sample sizes and adequate parameters and outcome assessments, the outcomes of this review are likely to remain unchanged. ⋯ These data highlight the need for additional high-quality RCTs to examine the effects of TENS in CLBP. Trials should consider intensity of stimulation, timing of outcome assessment and assessment of pain, disability and function.
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Randomized Controlled Trial Comparative Study
A Cost-Effectiveness Analysis of Intradiscal Electrothermal Therapy (IDET) Compared with Circumferential Lumbar Fusion.
Cost-effectiveness analysis. ⋯ Both treatments led to significant improvements in patient outcomes that were sustained for at least 24 months. Costs were lower with IDET, and for appropriate patients IDET is an effective and cost-effective treatment alternative.
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Although the importance of psychosocial factors has been highlighted in many studies in patients with chronic low back pain (CLBP), there is a lack of research examining the role of illness perceptions in explaining functional disability and physical activity in patients with CLBP. ⋯ Illness perceptions are an important factor for explaining functional disability, but not for explaining habitual physical activity in CLBP patients.
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Prospective longitudinal study. ⋯ This is the first evidence of a relationship between an "acute-phase" systemic inflammatory response and recovery at 6 months. High inflammation (CRP/IL-6) was associated with good recovery, but specific elevation of TNF, along with depressive symptoms, was associated with bad recovery. Depression and TNF may have a two-way relationship. These slides can be retrieved under Electronic Supplementary Material.