Articles: low-back-pain.
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Review Meta Analysis
Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction.
The prevalence, efficacy, and risk for addiction for persons receiving opioids for chronic back pain are unclear. ⋯ Opioids are commonly prescribed for chronic back pain and may be efficacious for short-term pain relief. Long-term efficacy (> or =16 weeks) is unclear. Substance use disorders are common in patients taking opioids for back pain, and aberrant medication-taking behaviors occur in up to 24% of cases.
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A population-based, prospective cohort. ⋯ Emotional distress is a predictor for low back disability in persons with earlier LBP, but not in persons without. To prevent low back disability, emotional distress should be considered and treated in persons with LBP.
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Systematic review of randomized controlled trials. ⋯ In the long-term, multidisciplinary back training has a positive effect on work participation in patients with nonspecific chronic low back pain.
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Randomized Controlled Trial
Predicting long-term response to strong opioids in patients with low back pain: findings from a randomized, controlled trial of transdermal fentanyl and morphine.
Some patients with long-standing low back pain will benefit from treatment with strong opioids. However, it would be helpful to predict which patients will have a good response. A fixed-term opioid trial has been recommended, but there is little evidence to suggest how long this trial should be. We assessed data from a large-scale randomized comparison of transdermal fentanyl (TDF) and sustained-release oral morphine (slow-release morphine; SRM) to determine characteristics of treatment responders. ⋯ No clear pattern of baseline pain (type or severity) or patient characteristics emerged that could be used to predict responders before the start of opioid treatment. However, a 1-month trial period appears sufficient to determine response and tolerability in most cases.
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Multicenter Study Controlled Clinical Trial
Dynamic intraspinous spacer technology for posterior stabilization: case-control study on the safety, sagittal angulation, and pain outcome at 1-year follow-up evaluation.
To assess the safety and efficacy of the DIAM implant, the authors compared the mean 12-month outcomes in patients who underwent lumbar surgery with DIAM placement and in those who underwent lumbar surgery only. ⋯ After simple lumbar surgery, the placement of a DIAM interspinous process spacer did not alter disc height or sagittal alignment at the mean 12-month follow-up interval. No adverse local or systemic reaction to the DIAM was noted. No difference in VAS or MacNab outcome scores was noted between the groups treated with or without the DIAM implants, particularly when the DIAM was used to alleviate low-back pain.