Articles: low-back-pain.
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Health Technol Assess · May 2004
Review Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialDoes early imaging influence management and improve outcome in patients with low back pain? A pragmatic randomised controlled trial.
To establish whether the early use of sophisticated imaging techniques influences the clinical management and outcome of patients with low back pain (LBP) and whether it is cost-effective. ⋯ The early use of sophisticated imaging does not appear to affect management overall but does result in a slight improvement in clinical outcome at an estimated cost of 870 British pounds per QALY. Imaging was associated with an increase in clinicians' diagnostic confidence, particularly for non-specialists. Further research is required to determine if more rapid referral to sophisticated imaging and secondary care is important in the acute episode and whether the use of imaging would be more beneficial for particular categories of LBP.
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Injection of 17-20 ml of local anesthetic combined with corticosteroids via hiatus canalis sacralis or epidural between spinal processes in the lumbar region leads to distribution up to the level of the thoracolumbar junction. The indication for therapeutic peridual or epidural injections are radicular symptoms as a result of disc herniation, foraminal stenosis as well as neurogenic claudication. ⋯ Complications and side effects occur extremely seldom. There is only one RCT for radiculopathy and epidural steroids.
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J Manipulative Physiol Ther · May 2004
Low back pain in Australian adults: prevalence and associated disability.
To determine the prevalence ranges of low back pain (LBP) together with any related disability in Australian adults. ⋯ LBP is a common problem in the Australian adult population, yet most of this is low-intensity and low-disability pain. Nevertheless, over 10% had been significantly disabled by LBP in the past 6 months. Data from this study will provide a better understanding of the magnitude of the LBP problem in Australia, the need for access to health care resources, and also strategic research directions.
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Anesthesia and analgesia · May 2004
Randomized Controlled Trial Comparative Study Clinical TrialThe short- and long-term benefit in chronic low back pain through adjuvant electrical versus manual auricular acupuncture.
Acupuncture is an established adjuvant analgesic modality for the treatment of chronic pain. Electrical stimulation of acupuncture points is considered to increase acupuncture analgesia. In this prospective, randomized, double-blind, controlled study we tested the hypothesis that auricular electroacupuncture (EA) relieves pain more effectively than conventional manual auricular acupuncture (CO) in chronic low back pain patients with insufficient pain relief (visual analogue scale [VAS] > or = 5) treated with standardized analgesic therapy. Disposable acupuncture needles were inserted in the auricular acupuncture points 29, 40, and 55 of the dominant side and connected to a newly developed battery-powered miniaturized stimulator worn behind the ear. Patients were randomized into group EA (n = 31) with continuous low-frequency auricular EA (1 Hz biphasic constant current of 2 mA) and group CO (n = 30) without electrical stimulation (sham-electroacupuncture). Treatment was performed once weekly for 6 wk, and in each group needles were withdrawn 48 h after insertion. During the study period and a 3-mo follow-up, patients were asked to complete the McGill questionnaire. Psychological well being, activity level, quality of sleep, and pain intensity were assessed by means of VAS; moreover, analgesic drug consumption was documented. Pain relief was significantly better in group EA during the study and the follow-up period as compared with group CO. Similarly, psychological well-being, activity, and sleep were significantly improved in group EA versus group CO, the consumption of analgesic rescue medication was less, and more patients returned to full-time employment. Neuropathic pain in particular improved in patients treated with EA. There were no adverse side effects. These results are the first to demonstrate that continuous EA stimulation of auricular acupuncture points improves the treatment of chronic low back pain in an outpatient population. ⋯ Continuous electrical stimulation of auricular acupuncture points using the new point stimulation device P-stim significantly decreases pain intensity and improves psychological well-being, activity, and sleep in chronic low back pain patients.
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Despite the many published randomized clinical trials (RCTs), a substantial number of reviews and several national clinical guidelines, much controversy still remains regarding the evidence for or against efficacy of spinal manipulation for low back pain and neck pain. ⋯ Our data synthesis suggests that recommendations can be made with some confidence regarding the use of SMT and/or MOB as a viable option for the treatment of both low back pain and NP. There have been few high-quality trials distinguishing between acute and chronic patients, and most are limited to shorter-term follow-up. Future trials should examine well-defined subgroups of patients, further address the value of SMT and MOB for acute patients, establish optimal number of treatment visits and consider the cost-effectiveness of care.