Articles: low-back-pain.
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Meta Analysis Comparative Study
Return-to-work interventions for low back pain: a descriptive review of contents and concepts of working mechanisms.
Low back pain is a major medical and social problem associated with disability, work absenteeism and high costs. Given the impact of the problem, there is a need for effective treatment interventions in occupational healthcare that aim at the prevention of chronic disability and the realisation of return to work. These so-called return-to-work (RTW) interventions are becoming increasingly popular. ⋯ No concepts were described for ergonomic measures. Finally, the plausibility of the described concepts is discussed. Future RCTs on this topic should evaluate the underlying concepts of the RTW intervention in addition to its effectiveness.
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Comparative Study Clinical Trial Controlled Clinical Trial
Provocative discography in volunteer subjects with mild persistent low back pain.
Whether discographic injections would be positive in subjects with benign persistent "backache" who are not seeking treatment is unknown. This information is important, because benign backache undoubtedly co-exists in patients with chronic low back pain (CLBP) illness that is not discogenicin origin. If these subjects had a high rate of positive discography, the high background incidence of common backache would allow many positive tests in patients in whom discogenic processes were unrelated to their severe CLBP illness. Conversely, if subjects with benign low back pain rarely if ever had significant concordant pain reproduction on disc injections, the basic tenet of discographic diagnosis would be strengthened. ⋯ In a group of volunteer subjects with persistent "backache," 36% were found to have significant pain on disc injection, which is reported to be concordant with their usual pain. The presence of positive concordant pain responses and negative control discs in 33% of subjects without CLBP illness seriously challenges the specificity of provocative discography in identifying a clinically relevant spinal pathology.
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Clinical Trial Controlled Clinical Trial
Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint.
To investigate the efficacy of periarticular corticosteroid treatment of the sacroiliac joint (SIJ) in non-spondylarthropathic patients with chronic low back pain in the region of the SIJ in a double blind, controlled study. ⋯ These results suggest that periarticular injection of methylprednisolone may be effective in the treatment of pain in the region of the SIJ in non-spondylarthropathic patients.
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Lumbar nerve root blocks and epidural steroid injections are frequently employed in the management of degenerative conditions of the lumbar spine, but relatively few papers have been published that address the complications associated with these interventions. Serious complications include epidural abscess, arachnoiditis, epidural hematoma, cerebrospinal fluid fistula and hypersensitivity reaction to injectate. Although transient paraparesis has been described after inadvertent intrathecal injection, an immediate and lasting deficit has not been previously described as sequelae of a nerve root block. ⋯ We present the cases of three patients who had lasting paraplegia or paraparesis after the performance of a nerve root block. We propose that the mechanism for this rare but devastating complication is the concurrence of two uncommon circumstances, the presence of an unusually low origin of the artery of Adamkiewicz and an undetected intraarterial penetration of the procedure needle.
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Clinicians use patients' recall of pain and disability relief as indicators of therapeutic effectiveness. Recall can change over time, however, and is influenced by factors other than true relief, including current health status. We have determined the trend in the relative contribution of current pain/disability and actual relief (current-baseline score) to relief recall over the course of 1 year. ⋯ Complaint characteristics including LBP chronicity, sciatica, LBP history, and comorbidity; psychosocial variables including stress, depression, and well being; sociodemographics; and treating provider type are not important independent predictors of pain and disability relief recall in ambulatory LBP patients. Perceived relief is too weakly related to present pain and disability to be accurate enough for use as a clinical assessment tool for individual patients. Physicians may need to use objective relief data to give the patient a realistic idea of actual improvement.