Articles: low-back-pain.
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The surgical decompression of a symptomatic lumbar nerve root is generally regarded as effective treatment for radiculopathy. Nevertheless this straightforward surgical procedure is not universally successful, and the results are often independent of technical factors. ⋯ Although psychosocial issues (psychiatric factor, personal injury litigation, compensation claim) are well known to affect outcome, the strength and magnitude of their negative effects was surprising. The short form McGill Pain Questionnaire can be used not only as an outcome tool, but also as a predictor of result. The pain drawing has similar utility, but it should not be used as a substitute for psychiatric evaluation. The numerous issues exerting profound effects on the outcome of a relatively simple operation suggest that specific attention be directed at them when evaluating more complex surgical procedures. Although large randomized samples might obviate this concern, it is possible that some of these factors are too powerful to be ignored.
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We report a case of lumbar radiculopathy after zygapophyseal joint injections for chronic low back pain. The management of the patient and potential causes for the radiculopathy are discussed. The case acts as a reminder that the spinal nerve roots should be considered when performing intra-articular facet joint injections and demonstrates the importance of including nerve injury in the patient consent process as a rare, but significant complication.
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Successful management of workers on sick leave due to low back pain by the general physician and physiotherapist depends on reliable prognostic information on the course of low back pain and work resumption. ⋯ Knowledge of the predictive value of these indicators by physicians and physiotherapists will help to identify subgroups of patients and will thus enhance clinical decision-making.
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Public and professional health education campaign. ⋯ There was a major shift in public beliefs and professional advice but no change in work-related outcomes.
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In the assessment and treatment of chronic low back pain (CLBP) patients, the biopsychosocial model is used worldwide. Psychological distress has been reported to have a strong relationship with disability as measured with several instruments. The relationship between psychosocial distress measured with the Symptom Checklist-90-Revised (SCL-90-R) and self-reported disability measured with the Roland Morris Disability Questionnaire (RMDQ) has not been investigated. ⋯ The relationship between psychosocial distress measured with the SCL-90-R and self-reported disability measured with the RMDQ in CLBP patients is weak.