Articles: low-back-pain.
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There is no consensus on the management of low back pain in the ED and evidence suggests that these patients are likely to receive unwarranted imaging and inappropriate opioid prescription.The purpose of this study is to review the available literature pertaining to the clinical management of acute low back pain in the ED. ⋯ More high quality trials are needed to determine an evidence-based management protocol for the treatment of acute low back pain in the ED.
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Health Technol Assess · Dec 2017
Randomized Controlled TrialFacet-joint injections for non-specific low back pain: a feasibility RCT.
Pain of lumbar facet-joint origin is a common cause of low back pain in adults and may lead to chronic pain and disability, with associated health and socioeconomic implications. The socioeconomic burden includes an inability to return to work resulting in loss of productivity in addition to direct and indirect health-care utilisation costs. Lumbar facet-joints are paired synovial joints between the superior and inferior articular processes of consecutive lumbar vertebrae and between the fifth lumbar vertebra and the sacrum. Facet-joint pain is defined as pain that arises from any structure that is part of the facet-joints, including the fibrous capsule, synovial membrane, hyaline cartilage and bone. This pain may be treated by intra-articular injections with local anaesthetic and steroid, although this treatment is not standardised. At present, there is no definitive research to support the use of targeted lumbar facet-joint injections to manage this pain. Because of the lack of high-quality, robust clinical evidence, the National Institute for Health and Care Excellence (NICE) guidelines on the management of chronic low back pain [NICE. Low Back Pain in Adults: Early Management. Clinical guideline (CG88). London: NICE; 2009] did not recommend the use of spinal injections despite their perceived potential to reduce pain intensity and improve rehabilitation, with NICE calling for further research to be undertaken. The updated guidelines [NICE. Low Back Pain and Sciatica in Over 16s: Assessment and Management. NICE guideline (NG59). London: NICE; 2016] again do not recommend the use of spinal injections. ⋯ Stronger collaborations with primary care may improve the recruitment of patients earlier in their pain trajectory who are suitable for inclusion in a future trial.
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Randomized Controlled Trial Comparative Study
Treatment of low back pain: Second extended follow up of an original trial (NCT00600197) comparing a multidisciplinary group-based rehabilitation program with oral drug treatment alone up to 30 months.
The aim of this study is to investigate the effects of the extended 30-month follow-up of an original trial (NCT00600197) which has been published in the Clinical Journal of Pain. ⋯ The proposed multidisciplinary program could improve mental health and disability up to 30 months in chronic low back pain patients.
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Randomized Controlled Trial Comparative Study
Treatment of low back pain: First extended follow up of an original trial (NCT00600197) comparing a multidisciplinary group-based rehabilitation program with oral drug treatment alone up to 24 months.
This study aimed to examine the effects of the extended follow-up of an original trial (NCT00600197) which has been published in The Clinical Journal of Pain. ⋯ The designed multidisciplinary program could improve health-related quality of life and disability up to 24 months in chronic low back pain patients.