Articles: low-back-pain.
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Some chronic painful conditions including e.g. fibromyalgia, whiplash associated disorders, endometriosis, and irritable bowel syndrome are associated with generalized musculoskeletal hyperalgesia. The aim of the present study was to determine whether generalized deep-tissue hyperalgesia could be demonstrated in a group of patients with chronic low-back pain with intervertebral disc herniation. Twelve patients with MRI confirmed lumbar intervertebral disc herniation and 12 age and sex matched controls were included. ⋯ The patients rated significantly higher pain intensity to supra-threshold mechanical pressure stimulation in both muscles. In patients, the pressure pain-threshold was lower in the anterior tibialis muscle compared to controls. In conclusion, generalized deep-tissue hyperalgesia was demonstrated in chronic low-back pain patients with radiating pain and MRI confirmed intervertebral disc herniation, suggesting that this central sensitization should also be addressed in the pain management regimes.
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Randomized Controlled Trial
Total dorsal ramus block for the treatment of chronic low back pain: a preliminary study.
To evaluate the use of total dorsal ramus block, which blocks all three major branches (medial, intermediate, and lateral branches) of lumbar dorsal ramus, for chronic low back pain. ⋯ The results of this preliminary study show that the total dorsal ramus block procedure may sufficiently block all three branches of the lumbar dorsal ramus at the targeted level with significant pain reduction.
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Spinal injections are commonly used to treat lumbar radiculitis and back pain. Delivery of medication to specific targeted pathology is considered important for a successful therapeutic outcome. A variety of routes of injection have been devised for epidural injection of corticosteroid. ⋯ The radiographic findings demonstrate a difference between classic infra-pedicular versus retrodiscal transforaminal epidural contrast injection patterns, particularly at relatively low volumes. The clinical advantage of one technique versus the other should be established in randomized prospective studies.
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Prolotherapy involves repeated injections of irritant solutions to strengthen lumbosacral ligaments and reduce some types of chronic low-back pain; spinal manipulation and exercises are often used to enhance its effectiveness. ⋯ There is conflicting evidence regarding the efficacy of prolotherapy injections for patients with chronic low-back pain. When used alone, prolotherapy is not an effective treatment for chronic low-back pain. When combined with spinal manipulation, exercise, and other co-interventions, prolotherapy may improve chronic low-back pain and disability. Conclusions are confounded by clinical heterogeneity amongst studies and by the presence of co-interventions.