Articles: low-back-pain.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
A randomized clinical trial of manipulative therapy and interferential therapy for acute low back pain.
A multicenter assessor-blinded randomized clinical trial was conducted. ⋯ For acute low back pain, there was no difference between the effects of a combined manipulative therapy and interferential therapy package and either manipulative therapy or interferential therapy alone.
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A systematic review of qualitative and quantitative studies. ⋯ Patients have explicit expectations on diagnosis, instructions, and interpersonal management. New strategies need to be developed in order to meet patients' expectations better. Practice guidelines should pay more attention to the best way of discussing the causes and diagnosis with the patient and should involve them in the decision-making process.
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Pain in normal labour can be relieved using many non-pharmacological methods including:- Techniques that reduce painful stimuli: Assuming various upright positions to ease the pain, encourage labour progress and increase the diameter of the pelvis. Techniques that activate peripheral sensory receptors: Of the various techniques used, intradermal injection of sterile water (ISW) results in over 50% of pain relief compared to 18% in the 'dry needling' group, Dahl V., Aarmes T. One RCT concluded that ISW is more effective than TENS for relieving low back pain in labour. Two trials, Erkkola et al and Bundsen et al found that mothers using TENS received good to moderate pain relief 48%: 37% and 31%: 55%. There were no ill effects produced in the newborn infant. The use of essential oils, lavender, frankincense and rose for relief of anxiety and fear were favourably reported by E. Burn et al. Also for the effectiveness rating of pain by parity and labour onset more women recorded a positive or equivocal score than a negative one. The use of Active Birth embraces many methods of non-pharmacological pain relief including using a humane approach and providing continuous emotional support by a companion or caregiver throughout labour. Two Bangkok hospitals, using Active Birth, showed a marked reduction in the use of pharmacological pain relief. ⋯ Pharmacological methods to help alleviate the pain of labour should only be used as a last resort.
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The objective of this paper is to assess the outcome of implanted multiple thoracolumbar lead spinal cord stimulation (SCS) in mechanical back pain without prior spinal surgery. These results are compared with intrathecal opioid drug delivery (ITDD). An anonymous third party patient questionnaire study of pain relief, function and psychosocial quality of life measures (recorded on 11-point numerical rating scales) for 12 patients with SCS and 13 with ITDD was used. ⋯ The majority of psychosocial quality of life measures were significantly more improved in the ITDD group compared with the SCS group (p < 0.05). We conclude that multiple-lead SCS improves mechanical back pain in patients unresponsive to more conservative measures. However, ITDD provides significantly more improved quality of life measures, with a trend towards greater pain reduction than SCS.
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Interventional pain management has been growing by leaps and bounds with the introduction of an array of new CPT codes, the expansion of interventional techniques, and utilization. Interventional pain management dates back to the origin of neural blockade and regional analgesia, in 1884. Over the years, pain medicine and interventional pain management have taken many approaches, including biological, biopsychosocial, and psychosocial. ⋯ Overall, the utilization of various nerve blocks (excluding epidurals, disc injections, and facet joint blocks) in Medicare recipients from 1998 to 2003 were performed approximately 50% of the time by non-pain physicians. Interventional pain management is growing rapidly, under the watchful eye of the government, and third party payors. Establishing an algorithmic approach and following guidelines may improve compliance and quality of care without implications of abuse.