Articles: low-back-pain.
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Bmc Musculoskel Dis · Jan 2007
Randomized Controlled TrialChiropractic and exercise for seniors with low back pain or neck pain: the design of two randomized clinical trials.
Low back pain (LBP) and neck pain (NP) are common conditions in old age, leading to impaired functional ability and decreased independence. Manual and exercise therapies are common and effective therapies for the general LBP and NP populations. However, these treatments have not been adequately researched in older LBP and NP sufferers. The primary aim of these studies is to assess the relative clinical effectiveness of 1) manual treatment plus home exercise, 2) supervised rehabilitative exercise plus home exercise, and 3) home exercise alone, in terms of patient-rated pain, for senior LBP and NP patients. Secondary aims are to compare the three treatment approaches in regards to patient-rated disability, general health status, satisfaction, improvement and medication use, as well as objective outcomes of spinal motion, trunk strength and endurance, and functional ability. Cost-effectiveness and cost-utility will also be assessed. Finally, using qualitative methods, older LBP and NP patient's perceptions of treatment will be explored and described. ⋯ To our knowledge, these are the first randomized clinical trials to comprehensively address clinical effectiveness, cost-effectiveness, and patients' perceptions of commonly used treatments for elderly LBP and NP sufferers.
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Objective and Importance. Several previous reports have documented cord compression resulting from the formation of an intrathecal inflammatory mass in patients using intrathecal drug delivery systems. We present the first reported case of an intramedullary abscess and intrathecal inflammatory mass associated with an intrathecal drug delivery system. Clinical Presentation. A 47-year-old man was transferred to our institution from an outside hospital with a 3-week history of the inability to ambulate or move his legs. ⋯ The abscess was linked to infection with Streptococcus anginosus. Conclusion. Generally, inflammatory masses forming along the catheter tip are not associated with infections. We report the first case of an intramedullary abscess associated with an intrathecal drug delivery pump.
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Pain arising in the lumbar spine can have many etiologies, nearly 80% of which cannot be established with certainty. We present a very rare cause of back pain. ⋯ Hydatid cyst can be included in the differential diagnosis of lumbar back pain, especially in the endemic areas.
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Minimally invasive injection therapy is an effective approach for the treatment of sciatica with less complications. This therapy is a sufficient option in cases without absolute indications for operation. The paper describes in detail the different injection techniques like spinal nerve analgesia, epidural dorsal/perineural injections, vertebral joint infiltrations, and radiculographies.
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Over the past decade, psychosocial issues have been increasingly identified as risk factors that are associated with the development of chronicity and disability. These psychosocial risk factors are known as Yellow Flags. In New Zealand, in 1997, the Accident Compensation Corporation (ACC) published the Acute Low Back Pain Guide and the Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain. The aim of this qualitative study is to understand the experiences of general practitioners (GPs) in the identification and management of psychosocial Yellow Flags in patients with acute low back pain. ⋯ GPs did not use the Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain or the screening questionnaire to identify psychosocial risk factors in their patients with low back pain. Investment of resources in GPs is needed to empower them to be effective gatekeepers guarding against chronicity. This demonstrates a need to alter the current ACC Guideline dissemination and implementation.