Neuromodulation : journal of the International Neuromodulation Society
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The issue of low back pain (LBP) is as common as it is perplexing. LBP is thought to be a chronic issue in approximately 10% of the U.S. population. This condition has wide-reaching social and economical reverberations. Despite the availability of modern diagnostic tools, the cause of the pain generator is often unidentifiable. The authors were asked to create an overview of the etiology of LBP for physicians who implant neurostimulation devices for the treatment of chronic pain patients. Some prevalence data, based on the current available literature, have been provided for the more common structural conditions causing LBP. However, a comprehensive review of prevalence of various conditions and their respective manifestations as LBP is beyond the scope of this article. ⋯ LBP is an extremely common condition associated, as a symptom, with various disease processes, regardless of their relationship with the lumbar spine or its innervation. This article underscores the broad nature of LBP as a symptom of many diagnoses. The primary conclusion reached by the authors is the most important recommendation by all mentors in medicine, which is to obtain a comprehensive history and perform a complete physical examination on each patient. Despite the fact that there is an emerging school of thought questioning the validity of the physical examination, this tool continues to be the current standard of care and used by a majority of clinicians around the world. The physician must analyze the information obtained from his/her history, physical examination, and diagnostic tools with the recognition of the broad nature of the differential diagnoses of LBP in order to be able to best treat the patient.
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Chronic low back pain (CLBP) is common and contributes to significant disability and healthcare costs. The mechanism and etiology of CLBP are frequently unclear, and treatment choices vary. ⋯ Personalized treatment plans should be informed by response to therapies previously tried, the severity and persistence of symptoms, and the availability of specialist expertise.
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Percutaneous spinal cord stimulation electrodes have a propensity to migrate longitudinally, which is a costly complication that often compromises therapeutic effect. After implementing simple changes to our percutaneous electrode anchoring technique, we no longer encounter this migration. The current retrospective study updates previously reported results. ⋯ Improvements to our simple, inexpensive technique apparently have eliminated the most common complication of spinal cord stimulation.