ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Despite greater knowledge, expertise, and health care resources for spinal pathologies, chronic disability resulting from nonspecific low back pain is rising exponentially in western society. Medical care certainly has not solved the everyday symptom of low back pain and even may be reinforcing and exacerbating the problem. An historic review shows that there is no change in the pathology or prevalence of low back pain: What has changed is our understanding and management. There are striking differences in health care for low back pain in the United States and the United Kingdom, although neither delivers the kind of care recommended by recent evidence-based guidelines. Medical care for low back pain in the United States is specialist-oriented, of high technology, and of high cost, but 40% of American patients seek chiropractic care for low back pain instead. National Health Service care for low back pain in the United Kingdom is underfunded, too little and too late, and 55% of British patients pay for private therapy instead. Despite the different health care systems, treatment availability, and costs, there seems to be little difference in clinical outcomes or the social impact of low back pain in the two countries. There is growing dissatisfaction with health care for low back pain on both sides of the Atlantic. Future health care for patients with nonspecific low back pain should be designed to meet their specific needs.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Back pain is an important problem for primary care physicians; it is common, costly, and controversial. Back pain is the second leading symptom prompting all physician visits in the United States. There are wide geographic variations in medical care for this problem, and surgical rates in the United States are twice those of most developed countries. The treatment of back pain has followed a series of fads and fashions, and work disability resulting from back pain continues to rise. For all these reasons, primary care clinicians have an important role in improving the care of patients with low back pain.Primary care clinicians face unique problems in treating these patients. First, in primary care, most patients have uncomplicated low back pain, and identifying the rare patient with an underlying malignancy or neurologic deficit is like looking for a needle in a haystack. Second, these practitioners face two populations with nonspecific back pain: one that is likely to improve no matter what (who mostly need reassurance), and a smaller group (about 20%) who are prone to development of chronic back pain and who present complex psychosocial and occupational problems. Third, these problems must be dealt with in the typical setting of a 15-minute patient visit. Finally, lifestyle changes in exercise, weight loss, and smoking cessation may be major parts of patient treatment, and improving compliance with such interventions always is a major challenge.Primary care investigators studying back pain face at least three important challenges. One is to identify more efficient diagnostic strategies that will alleviate doctors' and patients' anxieties. Second is to develop a better theory to explain the large majority of episodes of nonspecific low back pain. At present, competing theories generate competing and conflicting treatments, generating frustration among patients and loss of credibility for clinicians. Third, we need better science, with greater methodologic rigor in the evaluation of the many nonsurgical treatments used for back pain in the primary care setting.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignReview paper of outcome studies among primary care back pain patients.ObjectivesTo determine the short-term and long-term pain and functional outcomes of patients with back pain who are seeking treatment in primary care settings.Summary of Background DataBack pain has been viewed as running either an acute or a chronic course, but most patients experience recurrent back pain. This review summarizes outcome studies in light of the episodic course of back pain.MethodsStudies reporting pain and functional outcome data for consecutive primary care patients with back pain were reviewed.ResultsBack pain among primary care patients typically is a recurrent condition for which definitions of acute and chronic pain based on a single episode are inadequate. Because a majority of patients experience recurrences, describing only the outcome of the initial back pain episode may convey a more favorable picture of long-term outcome than warranted. For the short-term follow-up evaluation, most patients improve considerably during the first 4 weeks after seeking treatment. Sixty-six percent to 75% continue to experience at least mild back pain 1 month after seeking care. At 1 month, approximately 33% report continuing pain of at least moderate intensity, whereas 20-25% report substantial activity limitations. For the long-term follow-up (1 year or more) period, approximately 33% report intermittent or persistent pain of at least moderate intensity, one in seven continue to report back pain of severe intensity, and one in five report substantial activity limitations.ConclusionResults from existing studies suggest that back pain among primary care patients typically runs a recurrent course characterized by variation and change, rather than an acute, self-limiting course.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignA brief review of current literature and issues on drug therapy for low back pain.ObjectivesTo identify current knowledge and future research needs related to drug therapy.Summary of Background DataDrug therapy is one of many possible treatment choices for symptom relief in patients with low back pain. The variety of drugs used suggests that there is no uniquely successful form of drug therapy. One reason for uncertainty and slow progress in this area is the limited quality of many clinical trials for back pain, with inadequate description of patients and outcomes being common deficits.MethodsA selective review of randomized trials and systematic literature syntheses on drug therapy is given.ResultsDespite limitations, there is good evidence to support the efficacy of nonsteroidal anti-inflammatory drugs for acute low back pain and fair evidence for the use of muscle relaxants. There is greater controversy about the use of corticosteroids, which have been administered orally, intramuscularly, and epidurally. There is conflicting evidence regarding epidural injection of corticosteroids, but one meta-analysis suggests they may provide a small symptomatic improvement for patients with radiculopathy. Trials of systemic steroids and antidepressant drugs for managing chronic pain are inconclusive. The only randomized trial of local anesthetic injection into trigger points suggested that this treatment was equivalent to that of saline injection, needling without injection, or vapo-coolant spray alone.ConclusionIt seems reasonable to recommend acetaminophen or nonsteroidal anti-inflammatory drugs for patients with acute back pain, with efforts to minimize costs and complications. Muscle relaxants and narcotic analgesics may be appropriate for some patients, but selection criteria are unclear, and these drugs should be prescribed for fixed periods. Drug treatment for chronic low back pain is less clear, and a current controversy centers on the use of chronic narcotic analgesics for such patients. Future research should include evaluating combinations of medications, combinations of medication and physical therapy, systemic corticosteroid therapy, trigger point injections, and narcotic use for patients with chronic pain. Spinal stenosis is common in the older population, and more drug trials are needed for this condition.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study Design and ObjectivesA review of the literature was undertaken to identify and summarize randomized trials of educational, cognitive, and behavioral interventions for people with chronic low back pain.Summary of Background DataStudies of back schools have varied widely in patient characteristics, back school length and content, and comparison treatment. The available evidence suggests that back schools do not affect long-term outcomes of people with back pain.MethodsMEDLINE and PsycLIT databases were searched to identify randomized trials of cognitive and behavioral treatments for chronic low back pain. Outcome data were extracted from articles that met the meta-analysis inclusion criteria.ResultsThe meta-analysis found that cognitive and behavioral treatments were superior to control conditions after treatment on measures of chronic low back pain, pain behavior, and disability. Follow-up comparisons of cognitive and behavioral treatmentsversuscontrol conditions were not available. This meta-analysis did not find cognitive and behavioral therapies to differ from other active treatments on specific outcome measures, although only a few studies were available for each measure.ConclusionIt may be useful to incorporate cognitive-behavioral interventions in primary care settings, but additional research is needed to evaluate their efficacy in improving specific outcomes.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID