Articles: low-back-pain.
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Br J Health Psychol · Sep 2017
'I call it stinkin' thinkin'': A qualitative analysis of metacognition in people with chronic low back pain and elevated catastrophizing.
Pain catastrophizing is widely studied in quantitative pain research because of its strong link with poor pain outcomes, although the exact nature of this construct remains unclear. Focusing on its ruminative dimension, the present qualitative study aimed to explore a nascent aspect of pain catastrophizing - metacognition - by documenting people's attitudes towards rumination and examining how these metacognitions might influence the course it takes. ⋯ While most participants described pain rumination as uncontrollable and harmful, dwelling on pain could be helpful when focused on tangible and solvable problems, thereby translating into adaptive coping behaviours that eventually interrupt rumination. Future treatments may be more effective if they are based on individualized formulations of pain catastrophizing that focus on its perseverative nature and implicit function. Statement of contribution What is already known on this subject? Chronic pain affects one in five people, and psychological coping responses are key targets within gold standard biopsychosocial interventions. People who have elevated pain catastrophizing tend to have worse pain outcomes, including increased pain, disability, and emotional distress. What people believe about their own thinking (i.e., their metacognitions) influences how much they worry or ruminate. What does this study add? This is the first qualitative study exploring metacognitions in people with chronic pain and the first to target a purposive sample of people with elevated pain catastrophizing. People with elevated pain catastrophizing often see rumination as uncontrollable and harmful but may simultaneously believe it helps them to solve problems or feel prepared for future threats. Pain catastrophizing is not a stable and enduring trait but fluctuates both within and across individuals in response to pain, context, metacognitive beliefs about rumination, and coping behaviours.
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J Orthop Sports Phys Ther · Sep 2017
Case ReportsProcess of Change in Pain-Related Fear: Clinical Insights From a Single Case Report of Persistent Back Pain Managed With Cognitive Functional Therapy.
Study Design Single case report with repeated measures over 18 months. Background Management of persistent low back pain (PLBP) associated with high pain-related fear is complex. This case report aims to provide clinicians with insight into the process of change in a person with PLBP and high bending-related fear, who was managed with an individualized behavioral approach of cognitive functional therapy. ⋯ Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther 2017;47(9):637-651. Epub 13 Jul 2017. doi:10.2519/jospt.2017.7371.
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Case Reports
Intramuscular hematoma with motor weakness after trigger point injection: A case report.
Although trigger point injection is known as an easy and low-risk procedure, it is contraindicated to patients with hemorrhagic disorders or who regularly take anticoagulants/antiplatelets. However, taking clopidogrel is not a defined contraindication to this low-risk procedure. ⋯ Trigger point injection for patients taking clopidogrel should be done with a caution to prevent such complication.
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La Radiologia medica · Sep 2017
Ultra-low-dose periradicular infiltration of the lumbar spine: spot scanning and its potential for further dose reduction by replacing helical planning CT.
Computed tomography (CT)-guided periradicular infiltration has become an accepted procedure for treating radiculopathy-associated low back pain. The purpose of this study is to compare spot scanning and segmental helical planning CT in terms of dose reduction. ⋯ Dedicated spot scanning for planning reduced the total median effective dose of the intervention by more than 64% without increasing the number of images required during the interventional procedure. Significant pain reduction was achieved with both approaches. Spot scanning is recommended for dose reduction.
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The choice of appropriate treatment of discogenic low back pain (DLBP) frequently is difficult. This study sought to identify the clinical efficacy of percutaneous endoscopic lumbar annuloplasty and nucleoplasty (PELAN) to treat patients with DLBP and to investigate prognostic clinical or radiologic variables. ⋯ PELAN provided favorable outcomes in patients with DLBP who were refractory to conservative treatments. Flexion pain was good prognostic, and Modic change was a poor prognostic variable.