Articles: low-back-pain.
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We identified factors associated with radiograph evaluation for patients who presented to the Emergency Department (ED) with uncomplicated low back pain (LBP). Using 1998-2000 ED data from the National Hospital Ambulatory Medical Care Survey, a multivariate analysis was performed to assess utilization of radiographs for LBP. ⋯ There is an increased probability of receiving a radiograph for those patients 40-70 years old, being seen at a metropolitan hospital, having private insurance, and being treated by a resident in training. Multiple factors are associated with the overuse of radiographs for patients presenting with uncomplicated LBP.
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Bmc Musculoskel Dis · Jan 2004
Clinical TrialZygapophysial joint blocks in chronic low back pain: a test of Revel's model as a screening test.
Only controlled blocks are capable of confirming the zygapophysial joints (ZJ) as the pain generator in LBP patients. However, previous workers have found that a cluster of clinical signs ("Revel's criteria"), may be valuable in predicting the results of an initial screening ZJ block. It was suggested that these clinical findings are unsuitable for diagnosis, but may be of value in selecting patients for diagnostic blocks of the lumbar ZJ's. To constitute evidence in favour of a clinical management strategy, these results need confirmation. This study evaluates the utility of 'Revel's criteria' as a screening tool for selection of chronic low back pain patients for controlled ZJ diagnostic blocks. ⋯ "Revel's criteria" are unsuitable as a clinical screening test to select chronic LBP patients for initial ZJ blocks. However, the criteria may have use in identifying a small subset (11%) of patients likely to respond to the initial block (specificity 93%).
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Low back pain seems to be an integral part of most human lives and cause different degrees of suffering and disability. The exact cause of the pain cannot be identified in most instances. The making of the diagnosis rests mainly on the patient's history, location, and duration of the pain. ⋯ The natural history of low back pain seems in general to be favourable, but of concern is the consequence of long term or permanent disability. Fear avoidance behaviour has been shown to be part of the disabling pathway in chronic low back pain. Cognitive interventions, designed to remove fear and uncertainty, and to give the patient the confidence that the back is robust even if it hurts, seem promising.
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Few empirical data are available that document changes in population-based rates for the evaluation and treatment of nonspecific back pain. ⋯ The national pattern of health care for nonspecific low back pain observed in the present study serves as a basis for future investigations into the management of this major public health problem. Findings suggest that perhaps a duplication of care is partly responsible for the high degree of health care utilization in this population.
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Minerva anestesiologica · Jan 2004
Cytopathologic examination of epidural catheter for postoperative analgesia. Pathophysiology and clinical management.
The authors performed a prospective study in a series of patients undergoing combined general and epidural anaesthesia for major abdominal surgery in order to define if the epidural catheter inserted for postoperative analgesia induced in the short-term (7-8 postoperative days) any cytopathologically appreciable inflammatory response. ⋯ We were unable to detect any cytopathologically appreciable inflammatory response at the tip of the epidural catheter which could have suggested the occurrence of inflammation in the epidural tissues. Given the positive results of prophylactic epidural administration of small doses of corticosteroids in the reduction of postepidural anaesthesia back pain and their direct membrane action on nociceptive C-fibers, this kind of backache seems to be related to the stimulations of such nociceptors more than to a catheter-related inflammatory response of epidural tissues with possible evolution in peridural fibrosis, as reported following surgical intervention for lumbosacral disease.