Articles: low-back-pain.
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Comparative Study
The Graf ligamentoplasty procedure. Comparison with posterolateral fusion in the management of low back pain.
A retrospective case-control comparison between the Soft Tissue Stablization System according to Graf and instrumented posterolateral fusion in a consecutive series of patients operated on by a single surgeon. ⋯ Outcome after Soft Tissue Stabilization was associated with a worse outcome at 1 year and a significantly higher revision rate at 2 years. Revision was associated with a poor outcome similar to that seen in revision after fusion.
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Medical treatment of low back pain is at best palliative. While no drugs are specifically labeled for back pain treatment, analgesics, muscle relaxants, and corticosteroids are used in practice to augment rest and exercise programs. ⋯ This article reviews the available literature on the various pharmacologic therapies. In addition, newly postulated outcome measures for future back pain studies are discussed.
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One shortcoming of clinical practice guidelines is that generic, one-for-all guideline recommendations do not account for differences among patients' views about the desirability (or undesirability) of specific health outcomes, such as low back pain. Because differences in patients' preferences may lead to differences in the preferred therapy, a clinical practice guideline that does not consider patients' preferences may provide recommendations that are not optimal. Recently developed methodologic approaches enable guideline developers to assess the role of patients' preferences in clinical decisions and guideline recommendations, and to develop preference-based guidelines. ⋯ These options range from informal discussions with patients to computer-based utility assessments. Patients' preferences are an important factor in clinical decisions regarding management of low-back pain, particularly in decisions about surgical management and symptom control. Although further research is needed to define the role of techniques for assessing patients' preferences in routine clinical practice, guideline developers can determine when patients' preferences should play a prominent role in guideline recommendations.
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Arch Phys Med Rehabil · May 1998
Randomized Controlled Trial Clinical TrialCombined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial.
To assess the effect of a combined exercise and motivation program on the compliance and level of disability of patients with chronic and recurrent low back pain. ⋯ The combined exercise and motivation program increased the rate of attendance at scheduled physical therapy sessions, ie, short-term compliance, and reduced disability and pain levels by the 12-month follow-up. However, there was no difference between the motivation and control groups with regard to long-term exercise compliance.
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One hundred years ago, the sacroiliac joint was considered to be the most common cause of sciatica; over time, however, it became increasingly apparent that the major back enterprise lay in disc extractions. Still, despite the lack of specific clinical tests, the same clinical symptoms suggesting lumbar disc and lumbar facet joint pathology may also justify consideration of the sacroiliac joint as the pain generator. Treatment approaches, including manual therapies, bracing, and exercises, may benefit both the facet and sacroiliac joints as well as intradiscal pathologies. The possibility of utilizing specific local intra-articular steroid injections into the sacroiliac joint may add another useful tool to the armamentarium of back pain relief strategies.