Articles: low-back-pain.
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Background. Spinal cord stimulation (SCS) is being used with increasing frequency in the treatment of various chronic pain conditions. There is a paucity of reliable outcome data regarding changes in pain tolerance and peripheral sensory nerve function. ⋯ The results of this study appear to substantiate the postulates that both segmental and suprasegmental effects are involved in SCS-mediated analgesia. SCS modulates segmental large afferent fiber input as reflected by a statistically significant increase in large fiber CPTs (2000 Hz) at the symptomatic site post-SCS. A statistically significant increase in small fiber (5 Hz) CPTs at the control site suggests a central sensory (suprasegmental) modulating effect on nociceptive fiber activity. sNCT testing provided reliable outcome data for evaluating response to SCS.
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Epidural steroid injection is a safe outpatient procedure, which is performed best using image guidance in conjunction with epidurography. Using the techniques described earlier, complications are minimized, and serious complications can be avoided, in experienced hands. The author has performed several thousand procedures in an outpatient setting without any serious complications. ⋯ The use of sedation to perform these procedures is unnecessary, and deep sedation may be dangerous when injections are performed in the vicinity of the spinal cord. The author's experience, which includes clinical feedback and formal trials, shows the technique described in this article to be performed safely without sedation in an outpatient setting, with a high success rate for alleviating pain symptoms. When properly performed, epidural steroid injections have a clinically established role in the management of neck and back pain.
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Flexion and extension movements or positions have been advocated in the treatment of various forms of low back dysfunction due to the potential pain relieving effects attributed to displacements of the intervertebral disc (IVD). Objective in vivo determination of the segmental behaviour of the disc to contrasting positions has until recently been difficult. Magnetic resonance imaging (MRI) was used in this study to evaluate the influence of sagittal plane positions on lumbar IVD height and nucleus displacement in a small asymptomatic population. ⋯ Lumbar spine position was found to be associated with small measured changes in anterior disc height and nucleus position, however, this response was variable within and between individuals. The theoretical concept of a stereotypical effect of spinal position on the lumbar IVD is challenged by these initial data. Since the health of the disc is often unknown in clinical practice, manual therapy treatment for lumbar spine pain should be based on the symptomatic response to movement and position rather than biomechanical theory.
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Comparative Study
A comparison study of the back pain functional scale and Roland Morris Questionnaire. North American Orthopaedic Rehabilitation Research Network.
To determine whether the measurement properties of the Back Pain Functional Scale (BPFS) are superior to the Roland-Morris Questionnaire (RMQ). ⋯ The BPFS is a competitive functional status measure for patients with low back pain.
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Although guidelines for the management of low back pain have been published in the past decade, there is potential for further improvement in back pain care. ⋯ The management of low back pain met the guidelines to a large extent. Management decisions were often related to characteristics in which the guidelines lack differentiation. Important reasons for non-adherence were perceived patients' preferences. Further implementation of guidelines will be difficult unless doctors' and patients' views are more explicitly known.