Spine
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A brief review of current literature and issues on drug therapy for low back pain. ⋯ It seems reasonable to recommend acetaminophen or nonsteroidal anti-inflammatory drugs for patients with acute back pain, with efforts to minimize costs and complications. Muscle relaxants and narcotic analgesics may be appropriate for some patients, but selection criteria are unclear, and these drugs should be prescribed for fixed periods. Drug treatment for chronic low back pain is less clear, and a current controversy centers on the use of chronic narcotic analgesics for such patients. Future research should include evaluating combinations of medications, combinations of medication and physical therapy, systemic corticosteroid therapy, trigger point injections, and narcotic use for patients with chronic pain. Spinal stenosis is common in the older population, and more drug trials are needed for this condition.
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Review paper of outcome studies among primary care back pain patients. ⋯ Results from existing studies suggest that back pain among primary care patients typically runs a recurrent course characterized by variation and change, rather than an acute, self-limiting course.
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Back pain is an important problem for primary care physicians; it is common, costly, and controversial. Back pain is the second leading symptom prompting all physician visits in the United States. There are wide geographic variations in medical care for this problem, and surgical rates in the United States are twice those of most developed countries. ⋯ Second is to develop a better theory to explain the large majority of episodes of nonspecific low back pain. At present, competing theories generate competing and conflicting treatments, generating frustration among patients and loss of credibility for clinicians. Third, we need better science, with greater methodologic rigor in the evaluation of the many nonsurgical treatments used for back pain in the primary care setting.
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This paper is based on a review, analysis, and discussion of the extensive literature on indications, technique, and complications of discectomy (macro and micro) for lumbar disc herniation. Outcomes for lumbar discectomy for disc herniation depend on patient selection. ⋯ A review of the literature reveals success rates for lumbar discectomy ranging from 80-96%. The outcome of lumbar discectomy does not appear to be affected by the use of a microscope and depends more on patient selection than on surgical technique.
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Review Comparative Study
Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials.
Systematic review of randomized clinical trials. ⋯ The efficacy of spinal manipulation for patients with acute or chronic low back pain has not been demonstrated with sound randomized clinical trials. There certainly are indications that manipulation might be effective in some subgroups of patients with low back pain. These impressions justify additional research efforts on this topic. Methodologic quality remains a critical aspect that should be dealt with in future studies.