Articles: low-back-pain.
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Comparative Study
The Value of Prognostic Screening for Patients With Low Back Pain in Secondary Care.
Prognostic screening in patients with low back pain (LBP) offers a practical approach to guiding clinical decisions. Whether screening is helpful in secondary care is unclear. This prospective cohort study in adults with LBP placed on outpatient clinic waiting lists, compared the performance of the short-form Orebro Musculoskeletal Pain Screening Questionnaire, the Predicting the Inception of Chronic Pain Tool, and the STarT Back Tool. ⋯ All instruments were miscalibrated and underestimated risk. The decision curve analysis indicated that, in this setting, prognostic screening does not add value over and above a treat-all approach. The potential for LBP patients to be misclassified using screening and the high incidence of nonrecovery indicate that care decisions should be made with the assumption that all patients are 'at risk.'
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To identify patient-reported outcome (PRO) instruments that assess chronic low back pain (cLBP) symptoms (specifically pain qualities) and/or impacts for potential use in cLBP clinical trials to demonstrate treatment benefit and support labeling claims. ⋯ There is an unmet need for a validated PRO instrument to evaluate cLBP-related symptoms and impacts for use in clinical trials.
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Quantitative sensory testing (QST) has been used to predict the outcome of epidural steroid injections in lumbosacral radicular pain and has the potential to be an important tool in the selection of appropriate treatment (such as epidural steroid injections vs surgery) for patients with chronic radicular pain. In addition, QST assists in identification of the pain pathways of peripheral and central sensitization in selected groups of patients. ⋯ The study demonstrates that patients with unilateral radicular low back pain who receive dorsal root ganglion interventions show changes in pressure pain thresholds and conditioned pain modulation that are consistent with a 'normalization' of peripheral and central sensitization.
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This study examined key functional outcomes following a 3-week interdisciplinary pediatric pain rehabilitation program for adolescents with chronic pain. Maintenance of gains was evaluated at 3-month follow-up. ⋯ This study adds to the available data supporting interdisciplinary pediatric pain rehabilitation as effective in improving functioning and psychological distress even when discontinuing opioids. Implications for future research and limitations of the study are discussed.
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A 26-year-old woman was referred to physical therapy with lower back pain extending into the right buttock. Palpation of the right buttock revealed a firm, immobile mass of considerable size, which the patient identified as her locus of symptoms. Due to the noted palpable mass, her pain, her inability to sit normally, and the longevity of symptoms, the physical therapist ordered radiographs, which identified multiple osteochondromas. J Orthop Sports Phys Ther 2017;47(6):442. doi:10.2519/jospt.2017.6877.