Articles: low-back-pain.
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Chinese Med J Peking · Dec 2009
Meta AnalysisImaging of low back pain: comparative role of high intensity zone in diagnosing the discogenic low back pain with evidence-based radiology.
Discography is a gold standard for the diagnosis of the low back pain (LBP), but it has potential dangers for the development of discitis, cerebral spinal fluid leakage, retroperitoneal bleeding, acute new back pain and the tremendous radiation exposure to the patient. Using "evidence-based radiology" methods, the comparative roles of high intensity zone (HIZ) in diagnosing discogenic LBP were evaluated. ⋯ For suspected discogenic LBP, HIZ is limited for the diagnosis if HIZ is positive, which suggests further discography. In contrast HIZ is a good test for diagnosis if HIZ is negative, which indicates the disease can be excluded.
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GRADE A RECOMMENDATIONS (based on good-quality patient-oriented evidence): Advise patients to stay active and continue ordinary activity within the limits permitted by pain, avoid bed rest, and return to work early, which is associated with less disability. Consider McKenzie exercises, which are helpful for pain radiating below the knee. Recommend acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) if medication is necessary. ⋯ Discuss the use of proper body mechanics and safe back exercises for injury prevention. Refer for goal-directed manual physical therapy if there is no improvement in 1 to 2 weeks, not modalities such as heat, traction, ultrasound, or transcutaneous electrical nerve stimulation. Do not refer for surgery in the absence of red flags.
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Randomized Controlled Trial
No effect of traction in patients with low back pain: a single centre, single blind, randomized controlled trial of Intervertebral Differential Dynamics Therapy.
Low back pain (LBP) poses a significant problem to society. Although initial conservative therapy may be beneficial, persisting chronic LBP still frequently leads to expensive invasive intervention. A novel non-invasive therapy that focuses on discogenic LBP is Intervertebral Differential Dynamics Therapy (IDD Therapy, North American Medical Corp. ⋯ None of the parameters showed a difference between both protocols. Both treatment regimes had a significant beneficial effect on LBP, leg pain, functional status and quality of life after 14 weeks. The added axial, intermittent, mechanical traction of IDD Therapy to a standard graded activity program has been shown not to be effective.
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Osteoarthr. Cartil. · Dec 2009
p38 MAPK inhibition selectively mitigates inflammatory mediators and VEGF production in AF cells co-cultured with activated macrophage-like THP-1 cells.
Recent data have suggested that macrophages are involved in the pathogenesis of discogenic back pain and enhance the secretion of inflammatory mediators in co-cultured annulus fibrosus (AF) cells. The purpose of these studies is to determine the role of p38 mitogen-activated protein kinase (p38 MAPK) signaling in the interactions between macrophage and AF cells. ⋯ Annular injury can result in macrophage infiltration, and this can cause enhanced inflammatory mediator and VEGF production by AF cells. The p38 MAPK pathway signals are responsible for much of IL-6 and PG secretion from AF cells with macrophage-like cells, suggesting that blockade of this signal may serve as a therapeutic approach to discogenic pain.
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Randomized Controlled Trial Comparative Study
Comparison of the effectiveness of acupuncture treatment and local anaesthetic injection for low back pain: a randomised controlled clinical trial.
To compare the effectiveness of repeated acupuncture stimulation and local anaesthetic injection at the most painful points in patients with low back pain. ⋯ Both injection and acupuncture relieved pain, but acupuncture was superior for the immediate and sustained effects, suggesting that it is a useful treatment for low back pain. The difference in the effects may be attributable to differences in the mechanism of pain suppression.