Articles: back-pain.
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Randomized Controlled Trial Clinical Trial
Does 48 hours' bed rest influence the outcome of acute low back pain?
Bed rest is a traditional treatment for back pain, yet only in recent years has the therapeutic benefit of this been questioned. ⋯ The results of this pilot study did not indicate whether bed rest or remaining mobile was superior for the treatment of acute low back pain; however, the study sample was small. Subjects in the control group possibly fared better as they appeared to have better lumbar flexion at day seven. It appears that 48 hours' bed rest cannot be recommended for the treatment of acute low back pain on the basis of this small study. Large-scale definitive trials are required to detect clinically significant differences.
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Case Reports Randomized Controlled Trial Clinical Trial
Ketamine as an adjunct to morphine in the treatment of pain.
A double-blind multidose trial of the addition of ketamine (0-40 mg, i.m., 8 times per day) to intramuscular morphine therapy was undertaken in a 61-year-old man with chronic back pain related to osteoporosis who had received inadequate pain relief from anterior interbody fusion, dorsal column stimulation and morphine alone. The patient reported only mild side effects. ⋯ In addition, the amount of morphine used by the patient was significantly reduced as the ketamine dose increased. This patient experienced substantial benefit from the addition of ketamine to intramuscular morphine therapy.
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Randomized Controlled Trial Clinical Trial
Long-term results of cervical epidural steroid injection with and without morphine in chronic cervical radicular pain.
To evaluate the long-term effectiveness of a single cervical epidural steroid injection (CESI) performed with or without morphine, 24 patients, without need of surgery, but suffering for more than 12 months from cervical radicular pain, were included in a prospective and randomised study. The cervical epidural space was injected (C7-D1; 18-ga needle) with an increasing volume (10 ml maximum) of isotonic saline solution to exacerbate the patient's radicular pain. The patients were then randomly allocated to 2 groups: the steroid group (group S, n = 14) received an equivalent volume of 0.5% lidocaine plus triamcinolone acetonide (10 mg/ml) and the steroid plus morphine group (group S + M, n = 10) received the same combination plus 2.5 mg of morphine sulphate. ⋯ Despite observing a better transient improvement the day after CESI in the S + M group, long-term results did not differ. The success rate was 78.5% in group S and 80% in group S + M providing pain relief of 86.8 +/- 14.7% and 86.9 +/- 17.9%, respectively. Pain relief remained stable with time (mean follow-up: 43 +/- 18.1 months).(ABSTRACT TRUNCATED AT 250 WORDS)
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Stereotact Funct Neurosurg · Jan 1994
Randomized Controlled Trial Comparative Study Clinical TrialA prospective, randomized study of spinal cord stimulation versus reoperation for failed back surgery syndrome: initial results.
Spinal cord stimulation (SCS) has been reported to be effective treatment for the failed back surgery syndrome in a number of retrospective case series. Its retrospectively reported results compare favorably with those of neurosurgical treatment alternatives, such as reoperation and ablative procedures. There has been no direct prospective comparison, however, between SCS and other techniques for pain management. ⋯ The primary outcome measure is the frequency of crossover to the alternative procedure, if the results of the first have been unsatisfactory after 6 months. Results for the first 27 patients reaching the 6-month crossover point show a statistically significant (p = 0.018) advantage for SCS over reoperation. This is one of many potentially important outcome measures, which are to be followed long-term as a larger overall study population accrues.
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Randomized Controlled Trial Comparative Study Clinical Trial
Single-dose, randomized, double-blind, double-dummy cross-over comparison of extradural and i.v. clonidine in chronic pain.
We studied 10 patients with chronic back pain who had claimed benefit with a previous extradural dose of clonidine 150 micrograms combined with local anaesthetic. We compared a single dose of clonidine 150 micrograms given by either the extradural or i.v. route in a double-blind, randomized, double-dummy and cross-over fashion, with 80% power to detect a difference in the analgesic effect of the two routes. ⋯ Clonidine given by either route produced statistically significant sedation and significant decreases in arterial pressure and heart rate. In this study, extradural clonidine had no significant clinical advantages compared with i.v. clonidine; clonidine 150 micrograms by either route produced a high incidence of adverse effects.