Articles: back-pain.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 1993
Review[Problems in the treatment of back pain].
Back pain is a common disease causing tremendous costs for treatment, rehabilitation, litigation and work-loss. The reasons for back pain vary considerably and are often not clear. The effectiveness of current treatment concepts like epidural injection of steroids, blocks of facet joints, transcutaneous electrical nerve stimulation and antidepressants has not been proven. In accordance with literature, only multimodal concepts of treatment seem to be more successful as they consider somatic, psychosocial, and sports physiological aspects.
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We compared the results of two multimodal back treatment programs (program A: n = 134; program B: n = 175) using pain, functional capacity, sickness absence, subjective state of health, depression, and work status as outcome variables. Whereas in program A exercise was guided by pain, in program B a "no pain, no gain" rationale was used as a basis for intensive physical training. Neither of the programs included direct attempts to influence the patient's environment (i.e., to find employment or to modify working conditions). ⋯ In contrast to some earlier results, there was no statistically significant increase in the proportion of those employed after treatment in either group. The results indicate that intensive physical exercise does not, as such, solve the problem of back disability in a country that has a highly developed social security system. More active interventions in work and work-life are needed.
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Randomized Controlled Trial Clinical Trial
Back pain after epidural anesthesia with chloroprocaine.
Chloroprocaine has been associated with severe back pain after epidural anesthesia. Factors proposed to contribute to this problem are: 1) the preservative disodium ethylenediaminetetraacetic acid (EDTA), 2) large volumes of chloroprocaine, 3) low pH of chloroprocaine, and 4) local infiltration with chloroprocaine. ⋯ Large doses (> or = 40 ml) of chloroprocaine containing EDTA resulted in a greater incidence of deep burning lumbar back pain. Using 25 ml or less of the same solution resulted in an incidence of both types 1 and 2 postepidural anesthesia back pain similar to that in the lidocaine control group.