Articles: low-back-pain.
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Health Technol Assess · May 2017
Randomized Controlled Trial Multicenter StudyFacet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial.
The National Institute for Health and Care Excellence (NICE) 2009 guidelines for persistent low back pain (LBP) do not recommend the injection of therapeutic substances into the back as a treatment for LBP because of the absence of evidence for their effectiveness. This feasibility study aimed to provide a stable platform that could be used to evaluate a randomised controlled trial (RCT) on the clinical effectiveness and cost-effectiveness of intra-articular facet joint injections (FJIs) when added to normal care. ⋯ Further work is needed to test recruitment from alternative clinical situations.
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Cost utility or cost effective analysis continues to take center stage in the United States for defining and measuring the value of treatments in interventional pain management. Appropriate cost utility analysis has been performed for caudal epidural injections, percutaneous adhesiolysis, and spinal cord stimulation. However, the literature pertaining to lumbar interlaminar epidural injections is lacking, specifically in reference to cost utility analysis derived from randomized controlled trials (RCTs) with a pragmatic approach in a practical setting. ⋯ This cost utility analysis of lumbar interlaminar epidural injections in patients nonresponsive to conservative management in the treatment of disc herniation, central spinal stenosis, and axial or discogenic low back pain in the lumbar spine shows the clinical effectiveness and cost utility of these injections of $1,976.58 for direct costs with a total cost of $3,301 per QALY.
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Due to uncertain evidence, lumbar fusion for degenerative indications is associated with the greatest measured practice variation of any surgical procedure. ⋯ Positive clinical change was greatest in patients undergoing fusion for spondylolisthesis while complications and the risk of reoperation limited the benefit of fusion for spinal stenosis. The relative safety and efficacy of fusion for chronic low back pain suggests careful patient selection is required (PROSPERO International Prospective Register of Systematic Reviews number, CRD42015020153).
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Reg Anesth Pain Med · May 2017
Randomized Controlled Trial Comparative StudyA Randomized Comparison Between Ultrasound- and Fluoroscopy-Guided Sacral Lateral Branch Blocks.
This randomized trial compared ultrasound (US)- and fluoroscopy-guided sacral lateral branch (SLB) blocks. We hypothesized that US would require a shorter performance time. ⋯ Compared with their fluoroscopic counterparts, US-guided SLB blocks require a shorter performance time as well as fewer needle passes and carry a lower risk of vascular breach.
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J Orthop Sports Phys Ther · May 2017
ReviewRisk of Recurrence of Low Back Pain: A Systematic Review.
Study Design Systematic review. Background While most people with acute low back pain (LBP) recover quickly, recurrences are believed to be common. To our knowledge, no published high-quality systematic review has assessed the risk of recurrent LBP or the factors that would predict LBP recurrence. ⋯ Prospectively registered in PROSPERO on February 9, 2016 (CRD42016030220). J Orthop Sports Phys Ther 2017;47(5):305-313. Epub 29 Mar 2017. doi:10.2519/jospt.2017.7415.