Articles: back-pain.
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Comparative Study Clinical Trial Controlled Clinical Trial
Tizanidine and ibuprofen in acute low-back pain: results of a double-blind multicentre study in general practice.
This study reports on 105 patients with acute low-back pain given tizanidine (4 mg three times daily) plus ibuprofen (400 mg three times daily) or placebo plus ibuprofen (400 mg three times daily). Patients assessed their pain using visual analogue scales in a daily diary and the doctor assessed their condition at baseline and on days 3 and 7. Both groups were treated effectively, but earlier improvement occurred in patients given tizanidine/ibuprofen, particularly regarding pain at night and at rest. ⋯ More patients given tizanidine/ibuprofen suffered drowsiness and other central nervous system effects (P = 0.025). In patients with severe acute low-back pain, however, some sedation and bed rest is advantageous. This study shows that tizanidine/ibuprofen is more effective in the treatment of moderate or severe acute low-back pain than placebo and ibuprofen alone.
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J Bone Joint Surg Br · Mar 1988
Provocation discography as a guide to planning operations on the spine.
In a prospective study we attempted to define the role of lumbar discography in the investigation of patients with low back pain with or without non-dermatomal pain in the lower limb. The records of 195 patients were studied at least two years after a technically successful operation. ⋯ Of 25 patients whose discs showed morphological abnormality but had no provocation of symptoms on discography only 52% had clinical success. These findings support the continued use of lumbar discography for the investigation of this particular group of patients.
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Comparative Study
A comparison between the Minnesota Multiphasic Personality Inventory and the 'Mensana Clinic Back Pain Test' for validating the complaint of chronic back pain.
Reports on the efficacy of the Minnesota Multiphasic Personality Inventory (MMPI) for selecting patients with valid complaints of pain have been equivocal. The Mensana Clinic Back Pain Test (MPT) was able to predict, with some degree of success, patients who had a definite organic pathologic condition. However, the MMPI measures personality traits, whereas the MPT measures the impact of pain on a patient's life. ⋯ Of the 31 patients scoring 18 points or greater on the MPT, only 26% had objective physical findings that were considered moderate or severe. Only the F scale (faking badly) of the MMPI correlated with objective physical abnormalities (r = .21340, P less than .033). However, 60% of the patients with T scores of less than 70 on the F scale had objective findings, whereas 75% of patients with T scores greater than 70 had objective physical findings.(ABSTRACT TRUNCATED AT 250 WORDS)
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Chronic low back pain (CLBP) patients with pain and symptomatology incongruent with physical pathology have been found to have a poorer outcome to medical treatment and rehabilitation, and to use health care resources excessively. To examine possible psychological and behavioral bases for this pattern, this investigation contrasted 40 CLBP patients who displayed non-organic physical signs, inappropriate symptoms, and/or anatomically incongruent pain drawings with 40 'control' CLBP patients without incongruent pain criteria. Multivariate analyses revealed that the incongruent CLBP group reported greater pain intensity and depression, received higher observer ratings of pain, displayed more ambulatory/postural pain behavior, and reported more dysfunctional cognitions during pain. ⋯ Incongruent CLBP patients still displayed more maladaptive and dysfunctional cognitions. These findings indicate that incongruent CLBP patients may be conceptualized as ineffective and overwhelmed in their attempts to cope and as more physically disabled as a result of their pain. The role of cognitive factors, reasons for failure of physically based interventions, and implications for patient management are discussed.