Articles: back-pain.
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The Institute of Medicine has reported that greater than 115 million adults in the United States are living with some form of chronic pain. Back pain is the most prevalent and is associated with high individual morbidity and increased healthcare costs. One approach for the management of chronic back pain involves the injection of corticosteroids in the epidural space. ⋯ Epidural steroid injections are considered safe and effective, and are supported by evidence for the treatment of radicular pain. Complications from epidural steroid injections are rare but can be catastrophic, including permanent disability and death. The focus of this article is to understand how technique and selection of specific corticosteroids used for epidural injection can manage chronic back and radicular pain effectively while minimizing risk that leads to unnecessary harm.
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Observational Study
Prognostic factors associated with best outcomes (minimal symptom state) following fusion for lumbar degenerative conditions.
Previous studies suggest that a postoperative symptom state with Oswestry Disability Index (ODI)≤20 and pain Numeric Rating Scales (NRS)≤2 following surgery for lumbar degenerative conditions are reasonable thresholds for best outcomes in which patients will be unlikely to seek additional medical care or require additional health-care resources. ⋯ Achieving a minimal symptom state, defined here as a postoperative ODI≤20 and pain NRS≤2, following fusion for lumbar degenerative conditions is more likely in an older patient with a lower baseline ODI undergoing a single level lumbar fusion for spondylolisthesis.
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Randomized Controlled Trial
Effects of Multiple Waveforms on Patient Preferences and Clinical Outcomes in Patients Treated With Spinal Cord Stimulation for Leg and/or Back Pain.
We present the results of a prospective, randomized, crossover, single-blind, study in which each patient is in control of himself. The aim was to evaluate subperception-based (SP-SCS) waveforms in previously implanted spinal cord stimulation (SCS) patients with leg and/or back pain due to failed back surgery syndrome, who experienced only paresthesia-based stimulation (PB-SCS). Patients with PB-SCS experience in SCS was 4.7 years (SD 2.9). ⋯ There was a high heterogeneity regarding waveform preference, with patients who preferred to feel the tingling sensation and those who chose a SP-SCS option, mainly for greater pain relief. In general, SCS is successful, resulting in high pain relief, improvements in quality of life, and little depression. Overall, 42% patients benefited from the novel SP-SCS stimulation waveforms.
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Neck and back pain are common reasons for seeking evaluation and treatment in the emergency department. Within both systems there exist several time-sensitive diagnoses that the emergency provider should be familiar with in order to prevent significant morbidity and mortality. In this article we provide a general overview of these complaints by discussing problems in a systems-based fashion as well as discussing the initial evaluation, work-up, and treatment options for these diagnoses.
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To examine the prevalence of musculoskeletal back pain among older adults stratified by pain medication intensity to 1) review treatment patterns and 2) consider targeted back pain prevention interventions. ⋯ New and recurring back pain patients can be stratified by pain medication intensity to review treatment patterns and target back pain prevention programs. Those with back pain but taking no prescription pain medications may benefit from back pain prevention programs. More research on guidelines for treatment options for those on high levels of pain medications is warranted.