Articles: low-back-pain.
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J Electromyogr Kinesiol · Apr 2002
Evaluation of measurement strategies to increase the reliability of EMG indices to assess back muscle fatigue and recovery.
The purpose of this study was to assess different measurement strategies to increase the reliability of different electromyographic (EMG) indices developed for the assessment of back muscle impairments. Forty male volunteers (20 controls and 20 chronic low back pain patients) were assessed on three sessions at least 2 days apart within 2 weeks. Surface EMG signals were recorded from four pairs (bilaterally) of back muscles (multifidus at the L5 level, iliocostalis lumborum at L3, and longissimus at L1 and T10) while the subjects performed, in a static dynamometer, two static trunk extension tasks at 75% of the maximal voluntary contraction separated by a 60 s rest period: (1) a 30 s fatigue task and (2) a 5 s recovery task. ⋯ The averaging of measures across two fatigue tests is predicted to increase the reliability by about 13%. With regards to EMG indices of fatigue, the identification of the most fatigable muscle also lead to satisfactory results (ICC range: 0.74-0.79; SEM range: 21-26%). The assessment of back muscle impairments through EMG analysis necessitates the use of multiple electrodes to achieve reliable results.
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The clinical introduction of cortisone in 1949 revolutionized medical care of patients with a host of diseases. Soon after that, the first use of steroids in epidural injections was described in 1952 and 1953. A variety of corticosteroid agents (hydrocortisone, methylprednisolone, triamcinolone, betamethasone) have been applied neuraxially to treat spinal pain and other types of painful conditions. ⋯ These include neural toxicity, separation of pituitary-adrenal axis, weight gain, osteoporosis, as well as many other complications. However, a review of the literature on epidural steroids or other types of neuraxial blockade mentions very few complications that can be directly attributed either to the chemistry or the pharmacology of the steroids, except for reports of adrenal suppression. This review describes various aspects of neuraxial steroids including historical concepts, mechanism of action, pharmacological aspects, side effects, complications and their role in treatment.
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This paper reports on 80 patients using dual electrode, spinal cord stimulation (SCS) over a four-year period Implant status, stimulation mode, anode-cathode configuration (array), cathode position, paresthesia overlap, explantation rates, complications, Visual Analog Scores (VAS), and overall satisfaction were examined in patients implanted with dual 8 contact, staggered, percutaneous electrodes. All patients had undergone implantation for chronic axial and extremity pain [e.g., Failed Back Surgery Syndrome (FBSS), Complex Regional Pain Syndrome (CRPS)]. Outcomes were evaluated in view of our previous reports in this same group at 24 and 30 months (1,2). ⋯ Thirty-five percent of patients with thoracic implants achieved paresthesia in the low back at 48 months. Explantation rates and overall patient satisfaction were significantly affected by painful radio frequency (RF) antenna coupling. This data supports the efficacy of dual electrodes in optimizing long-term SCS paresthesia overlap and complex pain outcomes.