Articles: low-back-pain.
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Oper Neurosurg (Hagerstown) · Oct 2017
Long-Term Reduction of Sacroiliac Joint Pain With Peripheral Nerve Stimulation.
We recently demonstrated that 86% of the patients treated with peripheral nerve stimulation (PNS) for therapy-refractory sacroiliac joint (SIJ) pain were satisfied with the result after 1 year of treatment. ⋯ We have shown for the first time that PNS is a successful long-term therapy for SIJ pain.
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Long-term low back pain is associated with multiple challenges to a person's identity and social position. Despite efforts to understand the challenges of low back pain, recovery remains a major problem both personally and socially. This indicate a need for a different approach. Although personal stories have been used to extend knowledge of issues that relate to low back pain, they also make it possible to learn about how people understand themselves and their lives. As such, analysis of narratives may provide further insights into people's coping processes and novel insights about how best to support them. ⋯ Health professionals can play an important role in low back pain sufferers' configuration of meaningful narratives that help in coping with pain and learning about the relationship between pain and everyday life.
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Although lumbar spinal stenosis often presents as a degenerative condition (degenerative stenosis [DS]), some patients present with symptoms from lifelong narrowing of the spinal canal. These patients have congenital stenosis (CS) and present with symptoms of stenosis at a younger age. Patients with CS often have a distinct pathophysiology with fewer degenerative changes but present with multilevel involvement. In the setting of neurologic symptoms, decompression alone while preserving stability has been proposed for both patient populations. ⋯ Patients with CS and patients with DS respond well to decompression alone, without a supplemental fusion, despite differences in pain experience and presentation. The localization of pathology requiring decompression is similar. The patients with DS were more susceptible to require another operation resulting in a fusion, which confirms the theory that initial microinstability can progress in DS, but is likely not part of the disease process in CS. At just over 2 years after decompression, patients with CS may not need to be treated by a fusion in the setting of lower back pain; however, longer-term follow up is necessary to further assess these outcomes.
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Editorial Comment
Sham opioids relieve multidimensional aspects of chronic back pain.
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Web-based cross-sectional study. ⋯ 3.