Articles: low-back-pain.
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Low-back pain is a costly illness for which spinal manipulative therapy is commonly recommended. Previous systematic reviews and practice guidelines have reached discordant results on the effectiveness of this therapy for low-back pain. ⋯ There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low-back pain.
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This was a pilot study to test the potential effectiveness of intradiscal restorative injection therapy and compare with intradiscal electrothermal therapy (IDET). Thirty-five patients for intradiscal injection and seventy-four for IDET took part in the study. All patients had intractable chronic discogenic low back pain, confirmed by discogram study. ⋯ However, the duration of pain flare-up was notably shorter for restorative injections (8.6 days) than for IDET (33.1 days). Biochemical intradiscal restorative injections may be useful to reduce pain and disability in patients with chronic discogenic low back pain, and have clinically similar efficacy to IDET, but with improved cost-benefit ratio. The results of this study indicate that controlled random prospective comparative studies need to be performed to establish the efficacy of this treatment.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparison between bupivacaine 0.125% and ropivacaine 0.2% for epidural administration to outpatients with chronic low back pain.
Epidural blocks should provide good analgesia for the treatment of chronic low back pain without any motor block to allow active physiotherapy. Epidural ropivacaine is known to produce less motor block compared to bupivacaine at anaesthetic concentrations. This prospective, randomized double blind study compares the analgesic, motor block, and haemodynamic effects of single shot epidural injections of ropivacaine 0.2% 10 mL with bupivacaine 0.125% in outpatients suffering from chronic low back pain. ⋯ Both bupivacaine 0.125% and ropivacaine 0.29% appear suitable for epidural administration to outpatients with chronic low back pain attending for epidural analgesia associated with physiotherapy (physical therapy).
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Randomized Controlled Trial Multicenter Study Clinical Trial
Implementation of RCGP guidelines for acute low back pain: a cluster randomised controlled trial.
The Royal College of General Practitioners (RCGP) has produced guidelines for the management of acute low back pain in primary care. ⋯ The management of patients presenting with low back pain to primary care was mostly unchanged by an outreach educational strategy to promote greater adherence to RCGP guidelines among GPs. An increase in referral to physiotherapy or educational programmes followed the provision of a triage service.
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Randomized Controlled Trial Clinical Trial
A randomized controlled trial of radiofrequency denervation of the ramus communicans nerve for chronic discogenic low back pain.
The objective of this study was to determine the efficacy of percutaneous radiofrequency (RF) thermocoagulation of the ramus communicans nerve in patients suffering from chronic discogenic low back pain. ⋯ In patients with chronic discogenic low back pain, percutaneous RF denervation of the ramus communicans nerve should be considered as a treatment option.