Articles: back-pain.
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Low back pain is one of the commonest disorders, yet is the most confusing. The cost in work-time lost and in the search for and treatment of its many causes amounts to billions of dollars annually. The traditional techniques for anatomic visualization have been plain-film radiography and myelography, but they have limitations. ⋯ However, invasive procedures, such as discography, percutaneous nerve-root blocking and percutaneous facet injection, may be helpful in patients with disabling pain in whom noninvasive methods give negative findings, show abnormalities that do not correlate with the symptoms or identify multiple sites of disease. The invasive procedures are believed by some to be associated with too many complications. We have attempted to clarify the strengths and weaknesses of the currently available methods of investigating low back pain and the indications for their use.
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Randomized Controlled Trial Clinical Trial
The secondary prevention of low back pain: a controlled study with follow-up.
The current investigation studied the effectiveness of a secondary prevention program for nurses with back pain who were deemed at risk for developing a chronic problem. A 2 X 3 repeated measures design was employed with 2 groups and 3 assessment periods. The treatment group received an intervention designed to reduce current problems, but above all to prevent reinjury and minor pains from becoming chronic medical problems, and it included a physical and behavioral therapy package. ⋯ These differences were generally maintained at the 6 month follow-up. In addition, the treatment group broke a trend for increasing amounts of pain-related absenteeism, while the control group did not. Taken as a whole, the results suggest that a secondary prevention program aimed at altering life style factors may represent an effective method for dealing with musculoskeletal pain problems.
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Swiss medical weekly · Jan 1989
Comparative Study[Chronic backache in migrant workers from Mediterranean countries in comparison to central European patients: demographic and psychosocial aspects].
The standardized interviews of 26 chronic back pain patients from central Europe (Switzerland, Germany, Poland) were compared with those of 28 patients from Mediterranean countries (Italy, Spain, Yugoslavia, Turkey), all of whom had been referred for participation in an integrated treatment program for chronic back pain. The two samples differed significantly in most of the psychosocial aspects studied. Patients from Mediterranean countries had a significantly lower level of education and were mostly employed as unskilled workers, while patients from central Europe were mostly housewives or skilled workers with higher levels of education. ⋯ Unskilled workers are significantly overrepresented in the latter segment of the adult working population of the study area (city of Basel, Switzerland). This overrepresentation is similar to that in our patient sample. The special situation of foreign workers from Mediterranean countries seems to account for their high incidence of chronic intractable back pain.
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Rev Chir Orthop Reparatrice Appar Mot · Jan 1989
Review Randomized Controlled Trial Clinical Trial[Lumbar facet joint syndrome. Significance of non-organic signs. A randomized placebo-controlled clinical study].
One hundred and nine patients with chronic (greater than 3 months) unilateral low back pain had less than or equal to 2/5 or greater than or equal to 3/5 inappropriate signs (IAS) in 65 and 44 cases, respectively. The patients were randomized in three therapy groups: cortison and local anaesthetic injected intra-articularly into two facet joints (28 patients), the same mixture injected pericapsularly around two facet joints as well (39 patients) and injection of physiologic sodium hydrochloride intra-articularly into two facet joints (42 patients). The effect of the treatment was evaluated within an hour, two and six weeks after the treatment with work status, pain scale, disability score and movements of the lumbar spine. ⋯ Identification of these patients may also prevent the doctor from a burn-out syndrome after many failed treatments. This study also shows that if a biological effect of a treatment is to be studied the patients with multiple IAS should be excluded from the material. There was no difference in the results when either intra-articular or pericapsular cortisone and local anaesthetic or saline intra-articularly was used.(ABSTRACT TRUNCATED AT 250 WORDS)