Articles: back-pain.
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Complex regional pain syndromes (CRPS) represent curious and difficult syndromes for both patient and clinician. CRPS presents as a triad of signs and symptoms, usually after a seemingly trivial injury to a peripheral joint or appendage. The clinical triad includes severe pain, vasomotor changes in and around the affected area, and trophic changes in the affected limb. Many of the acute symptoms are similar to those seen after many acute injuries, which makes an early diagnosis often times difficult. Current treatment protocols revolve around aggressive physical therapy plus pharmacologic interventions aimed at limiting sympathetic nervous system activity. ⋯ Recent research calls into question the predominant theories that view excessive sympathetic nervous system activity as the cause of CRPS. No evidence of an increase in sympathetic nervous system activity has been found, and new theories suggest that an increase in the sensitivity of neurotransmitter receptors may be the cause of CRPS. Alternatively, other research has suggested that a local inflammatory process may in fact cause CRPS. Although no research has been completed examining the role of chiropractic care in the treatment of CRPS, there is reason to believe that spinal manipulation may be beneficial to patients with CRPS.
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The literature on psychological factors in neck and back pain was systematically searched and reviewed. ⋯ Psychological factors play a significant role not only in chronic pain, but also in the etiology of acute pain, particularly in the transition to chronic problems. Specific types of psychological variables emerge and may be important in distinct developmental time frames, also implying that assessment and intervention need to reflect these variables. Still, psychological factors account for only a portion of the variance, thereby highlighting the multidimensional view. Because the methodologic quality of the studies varied considerably, future research should focus on improving quality and addressing new questions such as the mechanism, the developmental time factor, and the relevance that these risk factors have for intervention.
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Epidural steroid injections for the treatment of low back pain and associated leg pain have been used for half a century. Initial use was empirical and not without controversy. ⋯ A growing body of literature suggests that they exert some of their clinical effect by reducing epidural and perineural inflammation. More current studies using fluoroscopy with radiographic contrast and precise epidural steroid placement suggests they may obviate surgery in some patients with true radicular pain.
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Wien Med Wochenschr · Jan 2000
Review[Acupuncture and other forms of treatment for patients with chronic back pain].
As in all pain sites, one has to distinguish between acute and chronic pain in spinal pain syndromes. The treatment of chronic spinal pain is dominated by non-operative procedures. There are three main procedures in this field of treatment: the manual medicine, the therapeutic application of local anesthetics and acupuncture. ⋯ The symptomatology of these diseases is described. The indications for the individual cases and circumstances are discussed. Lastly, the various operative techniques are also described shortly.
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Over the years, a number of treatments for persistent low back pain following spine surgery, the failed back surgery syndrome (FBSS), have been developed. The complexity of the clinical problem, the multidimensional nature of chronic pain, and general lack of rigorous study design, however, have obscured outcome assessment and hampered efforts to optimize patient selection criteria. Recent work has focused on refinement of existing therapies for FBSS and identification of factors that influence outcome and improve patient selection criteria. In combination with more rigorous study methodology, these efforts have led to improved understanding of the clinical response to a number of pharmacologic, surgical, and neuromodulation therapies for FBSS.