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Low Back Pain (low + back_pain)
Kinds of Low Back Pain Selected AbstractsHypothalamic,Pituitary,Adrenocortical Axis Dysregulation in Acute Temporomandibular Disorder and Low Back Pain: A Marker for Chronicity?,JOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH, Issue 3-4 2006John P. Garofalo Dysregulation of the hypothalamic,pituitary,adrenocortical (HPA) axis is believed to be a valid biological marker of stress. This study evaluating changes in patients with temporomandibular disorders (TMD) and low back pain (LBP) to determine whether dysregulation of this system represents a marker for chronicity. Salivary cortisol samples were collected from 78 patients (TMD = 41, LBP = 37) upon waking up and 20 minutes later daily for 2 weeks. High-risk patients for chronic pain had different overall cortisol levels versus low-risk patients. High-risk patients exhibited greater variability in terms of cortisol secretion compared with low-risk patients, F(1, 1,243) = 17.73, p < .000. These results provide evidence of a neuroendocrine mechanism underlying a constellation of psychosocial risk factors for chronic pain. [source] Peripheral Nerve Stimulation: A Treatment for Chronic Low Back Pain and Failed Back Surgery Syndrome?NEUROMODULATION, Issue 1 2009Paul Verrills MD ABSTRACT Objective., This study aims to evaluate the usefulness of peripheral nerve stimulation as a treatment option for patients with chronic low back pain. Materials and Methods., More than 12 months, we collected data on consecutive patients who had successful trials and were subsequently implanted with octrode percutaneous leads placed subcutaneously within the major area of pain. Eleven patients met diagnostic criteria for failed back surgery syndrome. A questionnaire assessed outcomes including: pain, analgesic use, and patient satisfaction. The response rate was 93% (13/14): average follow-up time was seven months. Results., There was a significant decrease in pain levels: an average reduction of 3.77 visual analog scale points. Eleven patients (85%) reported successful outcomes and an average pain reduction of 4.18 points but two reported a poor response. Pain relief was highly correlated with reduced analgesia and patient satisfaction. No complications were reported. Conclusion., This study demonstrates a treatment option that is safe, nonpharmacologic, reversible, and effective for patients with chronic low back pain that have exhausted other treatment options. [source] Long-Term Adjustment to Work-Related Low Back Pain: Associations with Socio-demographics, Claim Processes, and Post-Settlement AdjustmentPAIN MEDICINE, Issue 8 2009John T. Chibnall PhD ABSTRACT Objective., Predict long-term adjustment (pain intensity, pain-related catastrophizing, and pain-related disability) from socio-demographic, claim process, and post-settlement adjustment variables in a cohort of 374 Workers' Compensation low back claimants. Methods., Age- and gender-matched subsamples of African Americans and Caucasians were randomly selected for long-term follow-up (6 years post-settlement) from a larger, existing cohort of Workers' Compensation low back claimants in Missouri. Computer-assisted telephone interviews were used to assess pain, catastrophizing, and disability. Path analysis and logistic regression analysis were used to predict long-term adjustment from socio-demographic variables (race, gender, age, and socioeconomic status), Workers' Compensation claim process variables (surgery, diagnosis, claim duration, treatment costs, settlement awards, and disability rating), and adjustment at baseline. Results., Poorer long-term adjustment (higher levels of pain, catastrophizing, and pain-related disability) was significantly predicted by relatively poorer adjustment at baseline, lower socioeconomic status, and African American race. African American race associations were also mediated through lower socioeconomic status. Higher levels of occupational disability, as measured by long-term rates of unemployment and social security disability, were also predicted by African American race (in addition to age and claim process factors). Conclusion., Long-term adjustment to low back pain in this cohort of Workers' Compensation claimants was stable, relative to short-term adjustment soon after settlement. Long-term adjustment was worse for people of lower socioeconomic status, particularly for economically disadvantaged African Americans, suggesting the possibility of race- and class-based disparities in the Workers' Compensation system. [source] Impact of Chronic Musculoskeletal Pathology on Older Adults: A Study of Differences between Knee OA and Low Back PainPAIN MEDICINE, Issue 4 2009Natalia E. Morone MD ABSTRACT Objectives., The study aimed to compare the psychological and physical characteristics of older adults with knee osteoarthritis (OA) vs those of adults with chronic low back pain (CLBP) and to identify psychological and physical predictors of function as measured by gait speed. Design., Secondary data analysis. Method and Patients., Eighty-eight older adults with advanced knee OA and 200 with CLBP who had participated in separate randomized controlled trials were selected for this study. Measures., Inclusion criteria for both trials included age ,65 and pain of at least moderate intensity that occurred daily or almost every day for at least the previous 3 months. Psychological constructs (catastrophizing, fear avoidance, self-efficacy, depression, affective distress) and physical measures (comorbid medical conditions, pain duration, pain severity, pain related interference, self-rated health) were obtained. Results., Subjects with CLBP had slower gait (0.88 m/s vs 0.96 m/s, P = 0.002) and more comorbid conditions than subjects with knee pain (mean 3.36 vs 1.97, P < 0.001). All the psychological measures were significantly worse in the CLBP group except the Multidimensional Pain Inventory,Affective Distress score. Self-efficacy, pain severity, and medical comorbidity burden were associated with slower gait regardless of the location of the pain. Conclusions., Older adults with chronic pain may have distinct psychological and physical profiles that differentially impact gait speed. These findings suggest that not all pain conditions are the same in their psychological and physical characteristics and may need to be taken into consideration when developing treatment plans. [source] Psychometric Properties of Commonly Used Low Back Disability Questionnaires: Are They Useful for Older Adults with Low Back Pain?PAIN MEDICINE, Issue 1 2009Gregory E. Hicks PT ABSTRACT Objectives., To evaluate the psychometric properties of two commonly used low back pain (LBP) disability questionnaires in a sample solely comprising community-dwelling older adults. Design., Single-group repeated measures design. Setting., Four continuing care retirement communities in Maryland and in Virginia. Participants., Convenience sample of 107 community-dwelling men and women (71.9%) aged 62 years or older with current LBP. Outcome Measures., All participants completed modified Oswestry Disability (mOSW) and Quebec Back Pain Disability (QUE) questionnaires, as well as the Medical Outcomes Survey Short-Form 36 questionnaire at baseline. At follow-up, 56 participants completed the mOSW and the QUE for reliability assessment. Results., Test,retest reliability of the mOSW and QUE were excellent with intraclass correlation coefficients of 0.92 (95% confidence interval [CI]: 0.86, 0.95) and 0.94 (95% CI: 0.90, 0.97), respectively. Participants with high pain severity and high levels of functional limitation had higher scores on the mOSW (P < 0.0001) and QUE (P < 0.001) scales than other participants, which represents good construct validity for both scales. The threshold for minimum detectable change is 10.66 points for the mOSW and 11.04 points for the QUE. Both questionnaires had sufficient scale width to accurately measure changes in patient status. Conclusions., It appears that both questionnaires have excellent test,retest reliability and good construct validity when used to evaluate LBP-related disability for older adults with varying degrees of LBP. Neither questionnaire appears to have superior psychometric properties; therefore, both the Oswestry and Quebec can be recommended for use among geriatric patients with LBP. [source] What Is the Relationship of Low Back Pain to Signs of Abnormal Skeletal Metabolism Detected by Bone Scans?PAIN MEDICINE, Issue 2 2008Brenda Breuer PhD ABSTRACT Background., In approximately 80,85% of patients with chronic nonspecific low back pain (NSLBP), a precise pathoanatomical diagnosis cannot be identified. Mechanisms of bone nociception may contribute to NSLBP. Objective., To determine whether findings on bone scans, which provide a pathophysiological picture of functional activity, are associated with self-reports of NSLBP intensity. Design., A cross-sectional study of the relationship of self-reported chronic NSLBP intensity to the uptake of radiolabeled technetium-99m-methylene diphosphonate in the lumbosacral area. Study Participants., Patients referred for bone scans who were at least 18 years old. Outcome Measures., Subject reports of pain intensity and intensity of uptake of radiolabeled technetium-99m-methylene diphosphonate in the lumbosacral area. Results., Among subjects who were 65 years or younger, the age-adjusted worst pain intensity accounted for 45% of the variability in the amount of tracer uptake (r = 0.67, P = 0.0006). The association was not significant for those older than 65 years. Conclusion., Further studies should be conducted on possible mechanisms relating bone nociception to chronic NSLBP in individuals who are 65 years or younger. [source] Treatment of Refractory, Chronic Low Back Pain with Botulinum Neurotoxin A: An Open-Label, Pilot StudyPAIN MEDICINE, Issue 3 2006Bahman Jabbari MD ABSTRACT Objective., To study the short- and long-term effects of botulinum neurotoxin A (BoNT-A, Botox®, Allergan Inc.) on refractory chronic low back pain. Design., The effect of botulinum neurotoxin A on chronic low back pain was prospectively studied in 75 patients with repeated treatments over a period of 14 months. Pain intensity (visual analog scale [VAS]), pain frequency (pain days), and perceived functional status (Oswestry scale) were assessed at baseline, 3 weeks, and at 2, 4, 6, 8, 10, 12, and 14 months. BoNT-A was injected into para-spinal muscles at 4,5 levels (between L1 and S1) unilaterally or bilaterally. The dose per site varied from 40 to 50 units. The total dose per session ranged from 200 to 500 units. Reinjections were performed at 4 months only when pain returned. Results., At 3 weeks, 40 patients (53%) and at 2 months, 39 patients (52%) reported significant pain relief. The change in VAS, Oswestry score, and pain days was significant compared with baseline at 2 months after each injection period (P < 0.005) and remained so over subsequent treatments. Among initial responders, 91% continued responsiveness over the length of the study. Three patients (4%), after the first treatment, had a mild flulike reaction that lasted 2,5 days. Conclusion., Botulinum neurotoxin A may be beneficial in patients with chronic low back pain. A favorable initial response predicts subsequent responsiveness. The treatment is well tolerated, and side effects are mild and transient. [source] Low Back Pain in Older Adults: Are We Utilizing Healthcare Resources Wisely?PAIN MEDICINE, Issue 2 2006Debra K. Weiner MD ABSTRACT Objectives., 1) To examine recent change in prevalence and Medicare-associated charges for non-invasive/minimally invasive evaluation and treatment of nonspecific low back pain (LBP); and 2) to examine magnetic resonance imaging (MRI) utilization appropriateness in older adults with chronic low back pain (CLBP). Design., Two cross-sectional surveys of 1) national (1991,2002) and Pennsylvania (2000,2002) Medicare data; and 2) patients aged ,,65 years with CLBP. Setting., Outpatient data. Participants., Patients aged , 65 years with LBP. Measurements., Study 1: Outpatient national and Pennsylvania Part A Medicare data were examined for number of patients and charges for all patients, and for those with nonspecific LBP. Total number of visits and charges for imaging studies, physical therapy (PT), and spinal injections was also examined for Pennsylvania. Study 2: 111 older adults with CLBP were interviewed regarding presence of red flags necessitating imaging and history of having a lumbar MRI, neurogenic claudication (NC), and back surgery. Results., Study 1: Between 1991 and 2002, there was a 42.5% increase in total Medicare patients, 131.7% increase in LBP patients, 310% increase in total charges, and 387.2% increase in LBP charges. In Pennsylvania (2000,2002), there was a 5.5% increase in LBP patients and 33.2% increase in charges (0.2% for PT, 59.4% for injections, 41.9% for MRI/CT, and 19.3% for X rays). Study 2: None of the 111 participants had red flags and 61% had undergone MRIs (29% with NC, 24% with failed back surgery syndrome). Conclusion., LBP documentation and diagnostic studies are increasing in Medicare beneficiaries, and evidence suggests that MRIs may often be ordered unnecessarily. Injection procedures appear to account for a significant proportion of LBP-associated costs. More studies are needed to examine the appropriateness with which imaging procedures and non-invasive/minimally invasive treatments are utilized, and their effect on patient outcomes. [source] Radiofrequency Neurotomy for Low Back Pain: Evidence-Based Procedural GuidelinesPAIN MEDICINE, Issue 2 2005W. Michael Hooten MD ABSTRACT Objective., This review was undertaken to outline the procedural limitations of the randomized controlled trials (RCTs) of radiofrequency (RF) neurotomy for low back pain. Second, the literature related to patient selection, diagnostic testing, and the technique of performing lumbar spine, RF neurotomy will be critically reviewed and analyzed. Based on these analyses, diagnostic and procedural guidelines will be proposed. Design., A Medline and EMBASE search identified three RCTs and two systematic reviews of RF neurotomy for low back pain. A similar search identified pertinent literature related to the method of patient selection for a diagnostic block, the medial branch and L5 dorsal ramus comparative block, and the anatomical and technical parameters of lumbar spine RF neurotomy. Results., Substantial procedural shortcomings were identified in all three RCTs. In the systematic reviews, these procedural limitations were not accounted for by the quality assessment of study design which resulted in an inaccurate estimate of clinical effectiveness. Analysis using likelihood ratios showed that screening criteria could increase the probability of zygapophysial joint pain before performing diagnostic blocks. Similar analysis showed that comparative medial branch blocks, rather than single blocks, must be used before RF neurotomy. Anatomical studies demonstrated that the shorter distal compared with the circumferential radius of the RF lesion necessitates placement of the electrode parallel to the course of the nerve along the base of the superior articular process. Conclusions., The evidence-based procedural guidelines provide consistent criteria for multisite studies that could enroll a sufficiently large homogenous study cohort. [source] Low Back Pain, Health Status, and Quality of Life in Older Adults: Challenge and OpportunityPAIN MEDICINE, Issue 4 2003Rollin M. Gallagher MD No abstract is available for this article. [source] Evidence For and Against the Use of Opioid Analgesics for Chronic Nonmalignant Low Back Pain: A ReviewPAIN MEDICINE, Issue 3 2002J. D. Bartleson MD Abstract Introduction., Opioid analgesics are very effective for treating pain, but their chronic use in nonmalignant conditions is controversial. Low back pain is a common condition, and chronic low back pain (CLBP) is the most frequent regional pain syndrome in the United States. This article reviews the evidence for and against the use of chronic opioid analgesic therapy (COAT) for patients with CLBP unrelated to cancer. Methods., A literature review was conducted looking for reports of oral or transdermal opioid analgesic therapy for CLBP. Results., There are very few randomized controlled trials of COAT for CLBP. The scant evidence that is available suggests that over the short-term, COAT is helpful with patients with CLBP. In the published reports, most of which are brief in duration, COAT is associated with moderate side effects but a low risk of abuse or drug addiction. COAT was not associated with adverse long-term sequelae. Longer-acting opioid analgesics may be preferable to shorter-acting agents. Patient selection and close follow-up are critical to good outcomes. Conclusions., There is a place for the use of chronic oral or transdermal opioid analgesics in the treatment of some patients with CLBP. [source] Low Back Pain: Best Evidence,Best ToolsPAIN PRACTICE, Issue 3 2005Craig T. Hartrick MD No abstract is available for this article. [source] Intradiscal Electrothermal Coagulation and Percutaneous Neuromodulation Therapy in the Treatment of Discogenic Low Back PainPAIN PRACTICE, Issue 3 2005Dima Rozen MD Abstract: Low back pain (LBP) is a major physical and socioeconomic entity. A significant percentage of LBP is attributable to internal disc disruption. The management of internal disc disruption has traditionally been limited to either conservative treatment or spinal fusion. Intradiscal electrothermal coagulation (IDET) and percutaneous neuromodulation therapy (PNT) are now being performed as an alternative to these therapies. Scientific data regarding the pathophysiology, biologic effects, and clinical results are relatively scarce. Early biomechanical and histologic investigations into the effects of IDET are conflicting. However, in early prospective human trials, IDET seems to provide some benefit with little risk. PNT represents a new less invasive technique for the treatment of discogenic pain, but limited research is available to determine long-term clinical efficacy. IDET and PNT are potentially beneficial treatments for internal disc disruption in carefully selected patients as an alternative to spinal fusion. More basic science and clinical research with long-term follow-up evaluation is necessary. [source] Cell Types Obtained from the Epidural Space of Patients with Low Back Pain/RadiculopathyPAIN PRACTICE, Issue 3 2009James E. Heavner PhD Abstract Background: We investigated if correlations exist between medical history, tissue abnormalities, and cell types retrieved from the epidural space of patients with chronic low back pain (LBP) and chronic radicular pain (RP). Methods: Approval was obtained from the Institutional Review Board for the Protection of Human Subjects to study 191 patients undergoing epiduroscopy. Visual inspection was performed and abnormal areas were identified. A specimen obtained from the area using a cytology brush was processed by the Thin Prep technique. Patients were divided into four groups based on the presence or absence and intensity of LBP and RP. The gender and age of the patients were recorded, as was any history of prior back surgery. Areas of tissue abnormalities were rated according to changes in vascularity and amount of fat, fibrosis, and inflammation. Stenosis was assessed from magnetic resonance imaging or computerized tomography scan images. Cytologic assessments included notations of the presence or absence of erythrocytes, leukocytes, cell groups, lipocytes, spindled cells, and large round cells. Results: There was a significant difference in the number of patients from whom big round cells were obtained who had a high degree of LBP compared with the number of patients who had a high degree of both LBP and RP. Conclusions: The findings provide a foundation for future studies of cells obtained from similar patients with the goal of furthering the understanding of the pathogenesis of LBP/RP. [source] Epidemiology of low back pain in the United Arab EmiratesINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 3 2004Abdulbari BENER Abstract Aims:, Low back pain (LBP), a common presenting problem in general practice in the United Arab Emirates (UAE), has received increasing attention in recent decades. We seek to investigate the prevalence of LBP and associated risk factors among people living in the typically hot, humid desert environment of the UAE. Methods:, A cross-sectional questionnaire survey was conducted. The setting was the Primary Health Care (PHC) Clinics in Al-Ain, UAE. The subjects were a multistage stratified sample of 1304 UAE nationals, 15,70 years of age, who attended PHC clinics for any reason. All subjects were invited to participate. The questionnaire used in the survey is a modified version of the Roland-Morris scale for evaluating low back pain. The questionnaires were administered during face-to-face interviews conducted in Arabic by qualified nurses. Results:, Of the total 1304 subject, 1103 (84.5%) living in both urban and rural areas agreed to participate and responded to the study; 586 (53.1%) were men and 517 (46.9%) women. The mean ages and SD of the subjects were 34.9 ± 13.4 years for the men and 33.5 ± 11.8 years for the women. The prevalence of LBP in the present study was 64.6% (95% CI = 60.7,68.5). The results revealed that there were statistically significant differences between men and women with respect to LBP and body mass index (BMI) (P < 0.001), marital status (P < 0.001), occupational status (P < 0.001), housing condition (P < 0.001), and smoking habits (P < 0.001). Back pain had a greater influence on the lifestyle habits of the women than men. Stepwise multiple regression analysis showed that only BMI (OR = 2.54, 95% CI = 2.30,281; P < 0.001), prolonged standing (OR = 6.22, 95% CI = 4.01,9.67; P < 0.0001), weakness in leg (OR = 2.11, 95% CI = 1.16,3.85; P = 0.0142), lifting heavy weights (OR = 6.34, 95% CI = 4.09,9.84; P = 0.019) regular exercise (OR = 12.47, 95% CI = 7.50,20.71; P < 0.001) and smoking habits (OR = 1.61, 95% CI = 1.08,2.38; P < 0.05) had a significant effect on the presence of LBP in these patients. Conclusions:, The study showed that the prevalence of back-related disability was higher among women than men in the UAE. Also, low socio-economic status and adverse lifestyle habits may constitute risk factors and predictors of LBP. [source] Evidence For and Against the Use of Opioid Analgesics for Chronic Nonmalignant Low Back Pain: A ReviewPAIN MEDICINE, Issue 3 2002J. D. Bartleson MD Abstract Introduction., Opioid analgesics are very effective for treating pain, but their chronic use in nonmalignant conditions is controversial. Low back pain is a common condition, and chronic low back pain (CLBP) is the most frequent regional pain syndrome in the United States. This article reviews the evidence for and against the use of chronic opioid analgesic therapy (COAT) for patients with CLBP unrelated to cancer. Methods., A literature review was conducted looking for reports of oral or transdermal opioid analgesic therapy for CLBP. Results., There are very few randomized controlled trials of COAT for CLBP. The scant evidence that is available suggests that over the short-term, COAT is helpful with patients with CLBP. In the published reports, most of which are brief in duration, COAT is associated with moderate side effects but a low risk of abuse or drug addiction. COAT was not associated with adverse long-term sequelae. Longer-acting opioid analgesics may be preferable to shorter-acting agents. Patient selection and close follow-up are critical to good outcomes. Conclusions., There is a place for the use of chronic oral or transdermal opioid analgesics in the treatment of some patients with CLBP. [source] Intradiscal Electrothermal Coagulation and Percutaneous Neuromodulation Therapy in the Treatment of Discogenic Low Back PainPAIN PRACTICE, Issue 3 2005Dima Rozen MD Abstract: Low back pain (LBP) is a major physical and socioeconomic entity. A significant percentage of LBP is attributable to internal disc disruption. The management of internal disc disruption has traditionally been limited to either conservative treatment or spinal fusion. Intradiscal electrothermal coagulation (IDET) and percutaneous neuromodulation therapy (PNT) are now being performed as an alternative to these therapies. Scientific data regarding the pathophysiology, biologic effects, and clinical results are relatively scarce. Early biomechanical and histologic investigations into the effects of IDET are conflicting. However, in early prospective human trials, IDET seems to provide some benefit with little risk. PNT represents a new less invasive technique for the treatment of discogenic pain, but limited research is available to determine long-term clinical efficacy. IDET and PNT are potentially beneficial treatments for internal disc disruption in carefully selected patients as an alternative to spinal fusion. More basic science and clinical research with long-term follow-up evaluation is necessary. [source] MULTIDISCIPLINARY PAIN ABSTRACTS: 39PAIN PRACTICE, Issue 1 2004Article first published online: 15 MAR 200 A literature review was conducted to review the anatomy, pathophysiology, diagnosis, procedure, and clinical results of intradiscal electrothermal therapy (IDET). Low back pain is a major physical and socioeconomic entity. A significant percentage of low back pain is attributable to internal disc disruption. The management of internal disc disruption has traditionally been limited to either conservative treatment or spinal fusion. IDET has been performed as an alternative to these therapies. The available literature was reviewed. Scientific data regarding the pathophysiology, biologic effects, and clinical results are relatively scarce. Early biomechanical and histologic investigations into the effects of IDET are conflicting. However, in early prospective human trials, IDET seems to provide some benefit with little risk. It was concluded that IDET is a potentially beneficial treatment for internal disc disruption in carefully selected patients as an alternative to spinal fusion. More basic science and clinical research with long-term follow-up evaluation is necessary. [source] Low back pain in individuals with chronic airflow limitation and their partners , A preliminary prevalence studyPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 4 2002Anneliese Synnot Abstract Background and Purpose The prevalence of low back pain in individuals with chronic airflow limitation, and their partners, is unknown. Individuals with chronic airflow limitation, and their respective partners, are likely to have several risk factors that may increase the predisposition for low back pain. The aim of the present study was to provide preliminary data on the prevalence of low back pain in individuals with chronic airflow limitation, and their partners. Method A cross-sectional observational study design was used. Individuals with chronic airflow limitation, and their partners, were approached at South Australian metropolitan Lung Support Group meetings and invited to participate in the study. Three commonly used questionnaires: the Medical Outcomes Survey Short-Form 36 (MOS SF-36); the St George's Respiratory Questionnaire (SGRQ); and the Nordic Low Back Pain Questionnaire (NLBPQ) were used to collect data on general health, respiratory health and low back pain prevalence, respectively. Odds ratios and independent Student's t -tests were used to analyse data by use of Epi Info Version 6.0 software. Results Sixty subjects participated in the study: 41 individuals with chronic airflow limitation and 19 partners of individuals with chronic airflow limitation. The lifetime, 12-month and seven-day prevalence of low back pain in individuals with chronic airflow limitation was 69%, 58% and 31%, respectively. The prevalence of low back pain in the partners of individuals with chronic airflow limitation was found to be higher, at 74%, 68% and 58 %, respectively. Four significant relationships between general and respiratory health, and low back pain were demonstrated for individuals with chronic airflow limitation. Conclusions The prevalence of low back pain in individuals with chronic airflow limitation was comparable to the lifetime prevalence for the general and older population, and greater than the 12-month prevalence reported for the older population. The prevalence of low back pain for the partners of individuals with chronic airflow limitation was consistently higher than the lifetime and 12-month prevalence reported for individuals with chronic airflow limitation, the older population and family care workers. These findings suggest a larger prevalence study of low back pain in individuals with chronic airflow limitation, and their partners, is warranted. Copyright © 2002 Whurr Publishers Ltd. [source] Systematic review on the safety of Harpagophytum preparations for osteoarthritic and Low back painPHYTOTHERAPY RESEARCH, Issue 2 2008J. Vlachojannis Abstract Harpagophytum products are a treatment option for osteoarthritic and low back pain. The aim of this study was to review the safety of treatment with Harpagophytum procumbens. The databases OVID(MEDLINE), PUBMED and COCHRANE COLLABORATION LIBRARY were searched back to 1985 for studies with Harpagophytum procumbens. Twenty-eight clinical trials were identified of which 20 stated adverse events. In none of the double-blind studies was the incidence of adverse events during treatment with Harpagophytum procumbens higher than during placebo treatment. Minor adverse events occurred in around 3% of the patients, mainly gastrointestinal adverse events. A few reports of acute toxicity were found but there were no reports on chronic toxicity. Since the dosage used in most of the studies is at the lower limit and since long-term treatment with Harpagophytum products is advisable, more safety data are urgently needed. Copyright © 2008 John Wiley & Sons, Ltd. [source] The impact of the evolution of invasive surgical procedures for low back pain: a population based study of patient outcomes and hospital utilizationANZ JOURNAL OF SURGERY, Issue 9 2009Rachael Elizabeth Moorin Abstract Background:, Low back pain (LBP) is a ubiquitous health problem in Western societies, and while clinical decision making for patients requiring hospitalization for LBP has changed significantly over the past two decades, knowledge of the net impact on patient outcomes and health care utilization is lacking. The aim of this study was to evaluate the effectiveness of changes in the medical control of lumbar back pain in Western Australia in terms of the rate of patient readmission and the total bed days associated with readmissions. Methods:, A record linkage population-based study of hospitalization for LBP from 1980,2003 in Western Australia was performed. The rate of admission for LBP, changes in re-admission rates and number of bed days accrued 1 and 3 years post-initial admission over time adjusted for potential confounders was evaluated. Results:, The annual rate of first-time hospitalization for LBP halved. The proportion of females admitted increased (+6%). The disease severity increased and the proportion of individuals having an invasive procedure also increased (+75%) over the study period. While rate of readmission for non-invasive procedures fell, readmission for invasive procedures increased over the study period. Overall, the number of bed days associated with readmission reduced over time. Conclusion:, Between 1980 and 2003, there has been a shift from non-invasive procedural treatments towards invasive techniques both at the time of initial hospitalization and upon subsequent readmission. While overall readmission rates were unaffected, there was a reduction in the number of bed days associated with readmissions. [source] Spinal manipulation provides better short and long-term reduction in pain and disability for patients with non-specific chronic low back painFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 2 2010Article first published online: 14 JUN 2010 [source] Acupuncture combined bee venom therapy for low back pain and disability: a pilot studyFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 2006YD Kwon [source] A pilot randomised controlled trial comparing different frequencies of acupuncture for chronic low back painFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 2006J Yuan [source] Osteopathic manipulative treatment significantly reduces low back pain: systematic review and meta-analysisFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 1 2006Article first published online: 14 JUN 2010 [source] Can a spinal manipulation clinical prediction rule improve decision making for patients with low back pain?FOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 4 2005Article first published online: 14 JUN 2010 [source] Reflexology in the treatment of low back pain: a pilot RCTFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 2005F Quinn [source] Acupuncture for non-specific low back pain: a systematic review of RCTsFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 2004J Yuan [source] Efficacy of acupuncture in patients with chronic low back pain , the Acupuncture Randomised Trials (ART)FOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 4 2003B Brinkhaus [source] A positive trial of homoeopathy for low back painFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 2 2003Article first published online: 14 JUN 2010 [source] | ||||||||||||||||||||||||||||||||||||||||