Articles: low-back-pain.
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The diagnostic assessment of the low back pain patient is often unsatisfactory because a clear morphological alteration explaining the patient's symptoms can only be found in 10-20% of the cases. The majority of the patients is suffering from non-specific low back pain. ⋯ Furthermore, the aim of the diagnostic work-up is to diagnose and treat specific causes of back and leg pain (e.g. disc herniation and spinal stenosis) to avoid chronicity. In the majority of the cases, history and clinical examination alone allow to differentiate between specific and non-specific low back pain and may lead to a further diagnostic work-up by imaging studies.
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Aim of the present prospective longitudinal study was the statistical foundation and thus further replication of recent findings of Hasenbring [13], who postulated a significant importance of specific, within the psychological pain research long neglected pain coping strategies as risk factors concerning pain chronification: appeals to "stick it out" on the cognitive level and endurance strategies on the behavioural level. ⋯ These results corroborate the finding that this subgroup of chronic low back pain patients might indeed carry a bad prognosis and call for further research into this area, especially with regard to rehabilitation potential and facilities of reintegration into working life.
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Comparative Study
Effectiveness of Waddell's nonorganic signs in predicting a delayed return to regular work in patients experiencing acute occupational low back pain.
Consecutive case series. ⋯ Patients with acute, occupational low back pain exhibiting Waddell's nonorganic signs had a four times lengthier time for return to unrestricted, regular work and a greater use of physical therapy and lumbar computed tomographic scans.
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Case report of a 49-year-old woman with a lower thoracic disc herniation mimicking acute lumbosacral radiculopathy. ⋯ A case of thoracic disc herniation mimicking an acute lumbosacral radiculopathy is presented. Compression of the lumbosacral spinal nerve roots at the lower thoracic level after exit from the lumbar enlargement may be the mechanism for this unusual presentation.
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J Manipulative Physiol Ther · Feb 1999
ReviewLow back pain and the lumbar intervertebral disk: clinical considerations for the doctor of chiropractic.
Low back pain exists in epidemic proportions in the United States. Studies that demonstrate innervation to the intervertebral disk provide evidence that may account for instances of discogenic low back pain encountered in general medical and chiropractic practice. Many patients and health care practitioners believe that intervertebral disk lesions require surgery as the only method of treatment that will result in satisfactory outcome. Surgery rates vary widely across geographic regions. Only one randomized prospective study exists that compares surgical and nonsurgical treatment; it demonstrated essentially equal outcomes in the long run. ⋯ Patients should be screened for "red flags" to determine whether they are candidates for conservative treatment. Magnetic resonance imaging is perhaps the most practical imaging study for evaluation of lumbar disk lesions because it involves no use of ionizing radiation and because magnetic resonance imaging has other advantages over computed tomographic scanning such as excellent delineation of soft tissue structures, direct multiplanar imaging, and excellent characterization of medullary bone. Provocation computed tomography-diskography is an invasive procedure and should be reserved for patients with normal magnetic resonance imaging findings and continuing severe pain who have not been helped by conservative treatment attempts and for whom surgical intervention is contemplated. Both conservative and surgical interventions have been shown to be effective in the treatment of discogenic and radicular pain syndromes.