Articles: low-back-pain.
-
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group.
The reported complication rates after various surgical techniques used to create a lumbar fusion vary within wide ranges. In a previous paper, the Swedish Lumbar Spine Study Group have reported on the clinical outcome of lumbar spine fusion for chronic low back pain in a comparably homogeneous patient population where there were no significant differences between baseline sociodemographic, clinical and paraclinical characteristics. In this report we compared the complication rates of the surgical procedures used in that study and analyzed the association between complications and baseline variables, and between outcome results and complications. ⋯ Even though we did not find a significant association between clinical outcome and complications after 2 years, the increased morbidity inflicted on an individual patient was not negligible. In this light, and as no fusion technique produced superior clinical outcome irrespective of whether complications were included or excluded in the analyses, the patient and the treating physician should carefully discuss the possible advantages and drawbacks of the different surgical options before making a decision. In order to make valid comparisons of both complication and reintervention rates after lumbar fusion, there is a need for a consensus in the spinal society regarding the definition of these entities.
-
Clinical therapeutics · Apr 2003
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialTramadol/acetaminophen combination tablets for the treatment of chronic lower back pain: a multicenter, randomized, double-blind, placebo-controlled outpatient study.
Tramadol and acetaminophen (APAP) have both shown efficacy in the treatment of lower back pain. The combination of these 2 agents has demonstrated synergistic analgesic action in animal models at specific ratios. ⋯ In this study, tramadol 37.5 mg/APAP 325 mg combination tablets were effective and had a favorable safety profile in the treatment of chronic lower back pain.
-
Review
Low back pain: what is the long-term course? A review of studies of general patient populations.
It is often claimed that up to 90% of low back pain (LBP) episodes resolve spontaneously within 1 month. However, the literature in this area is confusing due to considerable variations regarding the exact definitions of LBP as well as recovery. Therefore, the claim--attractive as it might be to some--may not reflect reality. ⋯ The risk of LBP was consistently about twice as high for those with a history of LBP. The results of the review show that, despite the methodological variations and the lack of comparable definitions, the overall picture is that LBP does not resolve itself when ignored. Future research should include subgroup analyses and strive for a consensus regarding the precise definitions of LBP.
-
Orthop. Clin. North Am. · Apr 2003
ReviewIndications, techniques, and outcomes of posterior surgery for chronic low back pain.
This article summarizes a number of issues surrounding the diagnosis, indications, and techniques of posterior lumbar spine surgery for chronic low back pain. It would not be entirely unjustified for a spine surgeon to adhere to a totally avoidant approach to chronic low back pain, rationalized by a reasonably legitimate nihilism regarding the presently available means of diagnosing and surgically managing low back pain [64]. Judging by the number of lumbar fusions performed in North America and the tremendous intellectual and financial investment currently being made in technologies to enhance spinal fusion, such an approach is evidently not achieving wide-spread acceptance on this continent. ⋯ Every effort should be made to establish a pathoanatomic etiology of the back pain with a combination of diagnostic modalities. Surgical intervention should be approached cautiously and only after extensive dialog with the patient to establish realistic goals and expectations. Posteriorly performed interbody fusion procedures may provide a high fusion rate and satisfactory clinical outcomes for this challenging problem, although further research is necessary to determine more conclusively the role of surgery and the relative effectiveness of the various arthrodesis techniques.
-
This study compared the relative efficiency of lumbar x-ray and rapid magnetic resonance (MR) imaging for diagnosing cancer-related low back pain (LBP) in primary care patients. ⋯ There is currently not enough evidence to support the routine use of rapid MR to detect cancer as a cause of LBP in primary care patients.