Articles: low-back-pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial.
Persistent or recurrent radicular pain after lumbosacral spine surgery is often associated with nerve root compression and is treated by repeated operation or, as a last resort, by spinal cord stimulation (SCS). We conducted a prospective, randomized, controlled trial to test our hypothesis that SCS is more likely than reoperation to result in a successful outcome by standard measures of pain relief and treatment outcome, including subsequent use of health care resources. ⋯ SCS is more effective than reoperation as a treatment for persistent radicular pain after lumbosacral spine surgery, and in the great majority of patients, it obviates the need for reoperation.
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Int J Technol Assess Health Care · Jan 2005
Spinal cord stimulation for failed back surgery syndrome: a decision-analytic model and cost-effectiveness analysis.
The aim of this study was to develop a decision-analytic model to assess the cost-effectiveness of spinal cord stimulation (SCS), relative to nonsurgical conventional medical management (CMM), for patients with failed back surgery syndrome (FBSS). ⋯ SCS was found to be both more effective and less costly than CMM, over the lifetime of a patient. In the short-term, although SCS is potentially cost-effective, the model results are highly sensitive to the choice of input parameters. Further empirical data are required to improve the precision in the estimation of short-term cost-effectiveness.
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The aim of this study was to assess the prevalence of neuropathic pain among patients suffering from chronic low back pain using the Leeds assessment of neuropathic symptoms and signs (LANSS) pain scale. ⋯ The ability to identify neuropathic pain mechanisms should lead to individualized treatment resulting in improved pain control in this group of patients with chronic low back pain.
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To assess the association of alexithymia (deficit in emotional awareness) with 12-month prevalence of low back pain (LBP) cross-sectionally in a cohort study of 1180 San Francisco transit operators. ⋯ The results support an association between alexithymia and LBP.
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Bidirectional communication between the immune system and the brain and the implications of this communication are emerging concepts in pain research. Although representing a small portion of the disc degeneration syndromes, lumbar herniated discs can cause significant symptoms that may persist even after surgical interventions. Evolving evidence demonstrates that proinflammatory cytokines are a key mediator in the process of disc degeneration as well as in the pain experienced by those afflicted with lumbar herniated discs. ⋯ Increased local cytokine production by disc tissue irritates spinal nerve roots, resulting in pain and functional changes in neural activity. This review of the current literature explores the importance of cytokine production within the context of lumbar disc degeneration and lumbar spine pain. Furthermore, the significance of the neural-immune interaction will be examined as it relates to pain management and to patient treatment.