Articles: low-back-pain.
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Low back pain is a common clinical problem that may be due to a variety of causes, including disc disease. Provocative discography is an imaging-guided procedure in which a contrast agent is injected into the nucleus pulposus of the disc. Despite its controversial history, it remains the only imaging technique that provides both anatomical and functional information about a diseased disc. ⋯ It should instead be reserved for carefully- selected patients whose painful symptoms cannot be explained by findings on non-invasive imaging modalities such as magnetic resonance imaging or CT, and who are not responsive to conservative measures. Discography is helpful in selection of patients and disc levels to be operated upon. Careful application of indications and meticulous technique are however required if a successful outcome is to be expected.
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Tidsskr. Nor. Laegeforen. · Jun 2005
[Knowledge, practice and attitudes to back pain among doctors, physiotherapists and chiropractors].
In Norway, only doctors, physiotherapists and chiropractors are authorised to examine and treat patients suffering from low back pain. This study compares knowledge, attitudes and practice among these professional groups. ⋯ The chiropractors had the largest number of back pain patients in their practice and expressed the highest degree of professional interest in the field. We found no essential differences regarding knowledge between the groups. 77 % of the physiotherapists would refer acute sciatica to a doctor, while only 24 % of the chiropractors would do so. 65 % of the doctors and 10 % of the chiropractors would refer a chronic low back pain patient for physical therapy. Doctors and physiotherapists have a longstanding tradition of mutual cooperation, while chiropractors only seldom seem to refer to other care providers. One in five doctors and chiropractors, and 13 % of the physiotherapists, refer an acute unspecific low back pain to plain X-ray, which is not in accordance with the guidelines. Very few health care providers regarded low back pain as disabling. There are also few professionals who believe it possible to find an exact cause for the back pain in the individual patient.
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Clinical Trial
Long-term improvement in pain coping for cLBP and gonarthrosis patients following body needle acupuncture: a prospective cohort study.
Little is known about potential long-term effects of body acupuncture. The aim of the study was to determine such long-term effects 3 and 6 months after the end of a course of acupuncture treatment for chronic low-back pain (cLBP) or chronic pain caused by gonarthrosis. ⋯ Pain tolerability was significantly improved after acupuncture and remained so up to 6 months after treatment. The mean scores of almost all questionnaires did not change significantly between 3 and 6 months. We therefore conclude that acupuncture had a long-term effect on important aspects of cognitive and emotional pain coping.
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Comparative Study Controlled Clinical Trial
Spinal cord stimulation for axial low back pain: a prospective, controlled trial comparing dual with single percutaneous electrodes.
A prospective, controlled, clinical trial comparing single and dual percutaneous electrodes in the treatment of axial low back pain from failed back surgery syndrome. ⋯ While we observed disadvantages for dual electrodes in treating axial low back pain, we achieved technical success with single or dual electrodes in most patients and maintained this success clinically with dual electrodes in 53%.
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Prospective study with patient and physician questionnaires, clinical records, and imaging. ⋯ Despite clear average improvement, surgeons tended to give overly optimistic predictions that were not correlated with patient outcome. For patients receiving a treatment not meeting explicit criteria of appropriateness, more optimistic physician expectation was associated with better improvement of psychological dimensions. Besides prognostic ability, the influence of physician expectation on patient outcome is discussed and the concept of "curabo effect" (differentiated from "placebo effect") proposed.