Articles: low-back-pain.
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Among the adaptations of movement consistently associated with disability in chronic pain, guarding is common. Based on previous work, we sought to understand better the constituents of guarding; we also used the concept of flow to explore the description of un/naturalness that emerged from physiotherapists' descriptions of movement in chronic pain. The aim was to inform the design of technical systems to support people with chronic pain in everyday activities. ⋯ Drawing on the descriptions of movements of people with chronic low back pain provided by expert physiotherapists to standard stimuli, two key concepts were elaborated. Guarding was distinguished from stiffness (a physical limitation) or slowness as motivated by fear or worry about movement. Flow served to describe harmonious and continuous movement, even when adapted around restrictions of pain. Movement behaviours associated with pain are better understood in terms of their particular function than aggregated without reference to function.
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Multicenter Study Observational Study
Cerebrospinal fluid lysophosphatidylcholine species for distinguishing narrowing of the lumbar spine.
Reoperation, sometimes multiple, is common with progressively worse outcomes in patients with degenerative lumbar spine diseases. Lysophosphatidylcholine (LPC), a precursor of lysophosphatidic acid, in the cerebrospinal fluid (CSF) is a possible biomarker for neuropathic pain and discriminating neuropathic pain caused by lumbar spinal canal stenosis (LSCS) from other etiologies. This study aimed to explore this possible use of LPC species in the CSF. ⋯ The existing diagnostic protocols combining physical examinations and morphological imaging studies for lumbar spinal pain have limited sensitivity. Measuring LPC species in the CSF is a promising objective laboratory test and could be suitable for detecting the presence of lumbar spinal stenosis and can help indications for surgery.
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Observational Study
Pulsed Radiofrequency Therapy at Different Voltages on Dorsal Root Ganglia Using Multifunctional Catheter to Treat Low Back Pain: A Comparative Retrospective Study.
Applying pulsed radiofrequency (PRF) to the dorsal root ganglion (DRG) is an electrical neuromodulation technique, a valid complementary therapeutic treatment for failed back surgery syndrome (FBBS). Peridurolysis, when applied to vertebral canal adhesions, can be performed with dedicated catheters, providing patients with the benefits of mechanical, electrical, and pharmacological techniques. ⋯ E-field technology is the only way to generate a constant 38°/42° PRF and 100 V level throughout surgical interventions (respecting the exposure times "set" by the operator). The patient will not feel any pain or electric current because the generated milliamperes will be greatly reduced.
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Chronic low back pain, defined as lumbar pain persisting for 12 weeks or more, occurs in about 13% of U. S. adults. Patients with chronic low back pain should have a history and physical examination to identify red flags that may indicate serious conditions that warrant immediate intervention or yellow flags (i.e., psychological, environmental, and social factors) that indicate risk of disability. ⋯ Most patients with chronic low back pain will not require surgery; evaluation for surgery may be considered in those with persistent functional disabilities and pain from progressive spinal stenosis, worsening spondylolisthesis, or herniated disk. Physicians should consider prevention of chronic low back pain when patients present with acute back pain. Screening tools are available to predict the progression from acute to chronic low back pain, and targeted treatment strategies are beneficial for preventing progression.
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The combined use of spinal cord stimulation (SCS) and muscle stimulation, in the treatment of chronic pain, using the same probe, could improve the clinical results. However, this technique has not been established as yet. It was our hypothesis that it is possible to generate muscle stimulation by using low frequencies with SCS electrodes and use it to additionally treat chronic back pain. ⋯ In this study, it has been shown that with low-frequency SCS stimulation, pleasant and pain-relieving muscle contractions of the lower and upper back can also be generated. This combined method has been coined by us as "MuscleSCS" technique. Clinical trials are necessary to establish the value of this combined technique and its subtypes.