Articles: chronic.
-
Drug abuse with illicit drugs and licit drugs has been increasing steadily over the past decade. A recent National Household Survey on Drug Abuse found statistically significant increases between 2000 and 2001 in the use of multiple drugs, including marijuana, cocaine, and non-medical use of pain relievers and tranquilizers. Prescription controlled substance abuse is a major issue in chronic pain management. ⋯ Only one patient tested positive for a combined use of both marijuana and cocaine. This study showed that, in an interventional pain management setting, there is significant use of illicit drugs (16%) with 13% use of marijuana and 3% use of cocaine in patients who are considered as non-abusers of prescription controlled substances and those who are adherent to controlled substance agreements. However, if cocaine is considered as a hardcore drug in contrast to marijuana, abuse of hardcore illicit drugs is only 3%.
-
It is widely believed that the extent of a patient's subjective complaints are often based on developmental, psychological, social, and cultural factors rather than structural or physical pathology. In patients presenting with chronic low back pain, underlying behavioral problems may not be immediately apparent. These behavioral or non-physiological issues may be secondary to a deliberate deception or may be associated with psychological distress. ⋯ Results showed that 27 patients (22%) presented with non-physiological symptoms, 34 patients (28%) with non-physiological signs, and 19 patients (16%) with combined presence of non-physiological signs and symptoms. Overall there was significant correlation of non-physiological signs with depression, anxiety, and somatization, both by diagnosis of depression, diagnosis of anxiety and elevated scores. However, correlation was present for non-physiological symptoms only with elevated scores of anxiety and somatization.
-
The precise cause of low back pain based on clinical history, physical examination, radiological imaging, and electrophysiological testing can be identified in only 15% of patients in the absence of disc herniation and neurological deficit. The prevalence of chronic lumbar zygapophysial (facet) joint pain ranges from 15% to 45% utilizing comparative local anesthetic blocks in controlled settings in accordance with the criteria established by the International Association for the Study of Pain. Currently, facet joint injection procedures are considered as the gold standard in the diagnosis of facet joint pain. ⋯ Since we are unable to apply reference standards of biopsy, surgery, or autopsy, and pain relief has been argued as an inconsistent feature, long-term follow-up has been considered as the best indicator. This study was undertaken to evaluate stability of the diagnosis of lumbar facet joint pain following comparative local anesthetic blocks at a follow-up after 2 years. The results showed that 85% of the patients available for follow-up withstood the diagnosis of facet joint pain at the end of 2 years, whereas this proportion decreased to 75%, if all the patients in the study were included in the analysis.
-
Evidence-based practice guidelines for interventional techniques in the management of chronic spinal pain are systematically developed and professionally derived statements and recommendations that assist both physicians and patients in making decisions about appropriate health care in the diagnosis and treatment of chronic or persistent pain. The guidelines were developed utilizing an evidence-based approach to increase patient access to treatment, to improve outcomes and appropriateness of care, and to optimize cost-effectiveness. All types of relevant and published evidence and consensus were utilized. ⋯ It is expected that a provider will establish a plan of care on a case-by-case basis, taking into account an individual patient's medical condition, personal needs, and preferences, and the physician's experience. Based on an individual patient's needs, treatment different from that outlined here could be warranted. These guidelines do not represent "standard of care."
-
This prospective, non-randomized clinical trial was designed to determine the clinical outcome of patients who underwent Intradiscal Electrotherapy (IDET) for the treatment of chronic discogenic low back pain. Twenty-seven consecutive patients undergoing IDET were prospectively evaluated. All patients, as determined by provocative discography and/or MRI, had discogenic disease with chronic low back pain and were non-responsive to conservative treatment for at least 6 months. ⋯ This did not translate into a significant improvement in the SF-36 survey scores. The risks are negligible, and recovery time is minimal. The procedure may be useful in selected patients who would otherwise undergo an interbody fusion procedure.