Articles: low-back-pain.
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The overall aim of this study was to explore the natural course of pain-related fear during the early stage of a new low back pain episode, using a prospective case series design. Specific research questions addressed the existence of typical patterns in individual time series of pain-related fear and sequential relationships between the occurrence of pain-related fear, pain and pain catastrophizing. Forty-four general practice patients who consulted their physician with a new episode of non-specific low back pain were recruited. ⋯ In summary, these results fit in with previous findings in chronic patients. A relevant subgroup of patients who might benefit from early intervention could be identified. These findings support the need for further research into fear mechanisms in acute low back pain.
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Chronic low back pain secondary to involvement of the facet joints is a common problem. Facet joints have been recognized as potential sources of back pain since 1911. Multiple authors have described distributions of pain patterns of facet joint pain. ⋯ Multiple studies utilizing controlled diagnostic blocks have established the prevalence of lumbar facet joint involvement in patients with chronic low back pain, as ranging from 15% to 52%, based on type of population and setting studied. Long-term therapeutic benefit has been reported from three types of interventions in managing lumbar facet joint pain, including intraarticular injections, medial branch blocks and neurolysis of medial branches. This review will discuss chronic low back of facet joint origin and covers anatomy, pathophysiology, diagnosis, and various aspects related to treatment, including clinical effectiveness, cost effectiveness, technical aspects and complications.
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Epidural steroid injections are the most commonly used procedures to manage chronic low back pain in interventional pain management settings. The overall effectiveness of epidural steroid injections has been highly variable, and in the role has not been evaluated in patients discographically evaluated. One hundred consecutive patients, without evidence of disc herniation or radiculitis, who had failed to respond to conservative management with physical therapy, chiropractic and/or medical therapy, underwent discography utilizing strict criteria of concordant pain, and negative adjacent discs, after being judged to be negative for facet joint and/or sacroiliac joint pain utilizing comparative local anesthetic blocks. ⋯ The study showed that at 1 month, 100% of the patients evaluated showed significant improvement in both groups; this declined to 86% at 3 months in Group I, but remained at 100% in Group II, declining to 60% and 64% at 6 months in Group I and Group II, respectfully, with administration of one to three injections. Analysis with one to three injections, which included all (62) patients showed significant relief in 71% and 65% of the patients at 1 month, in 67% and 65% at 3 months, and in 47% and 41% at 6 months, in Group I and Group II, respectively. In conclusion, caudal epidural injections with or without steroids is an effective modality of treatment in managing chronic, persistent low back pain failing to respond to conservative modalities of treatments, in patients negative for facet joint and sacroiliac joint pain, whether positive or negative, on evaluation with provocative discography.
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Cochrane Db Syst Rev · Jan 2002
ReviewAdvice to stay active as a single treatment for low back pain and sciatica.
Low back pain is one of the most common conditions managed in primary care. Restricted activity, rest, and symptomatic analgesics are the most commonly prescribed treatment for low back pain and sciatica. ⋯ The best available evidence suggests that advice to stay active alone has small beneficial effects for patients with acute simple low back pain, and little or no effect for patients with sciatica. There is no evidence that advice to stay active is harmful for either acute low back pain or sciatica. If there is no major difference between advice to stay active and advice to rest in bed, and there is potential harmful effects of prolonged bed rest, then it is reasonable to advise people with acute low back pain and sciatica to stay active. These conclusions are based on single trials.