摘要:

Study Design.Physicians were surveyed regarding their beliefs about treatment efficacy for patients with low back pain.Objective.To document physician beliefs about the efficacy of specific treatmets and the extent to which these beliefs correspond to current knowledge.Summary of Background Data.Little is known about physician beliefs regarding the efficacy of specific back pain treatments.Methods.A national random sample of 2897 physicians were mailed questionnaires that asked about 1) the treatments they would order for hypothetical patients with low back pain and 2) the treatments they believed were effective for back pain. Responses were compared with guidelines suggested by the Quebec Task Force on Spinal Disorders.Results.Almost 1200 physicians responded. More than 80% of these physicians believed physical therapy is effective, but this consensus was lacking for other treatments. Fewer than half of the physicians believed that spinal manipulation is effective for acture or chronic back pain or that epidural steroid injections, traction, and corsets are effective for acute or chronic back painor that epidural steroid injections, traction, and corsets are effective for acute back pain. Bed rest and narcotic analgesics were recommended by substantial minorties of physicians for patients with chronic pain. The Quebec Task Force found little scientific support for the effectiveness of most of the treatments found to be in common use.Conclusions.The lack of consensus among physicians could be attributable to the absence of clear evidencebsed clinical guidelines, ignorance or rejection of existing scientific evidence, excessive commitment to a particular mode of therapy, or a tendency to discount the efficacy of competing treatments.

ISSN:0362-2436    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Study Design.This study is an analysis of national survey data from 5 sample years.Objectives.The authors characterized the frequency of office visits for low back pain, the content of ambulatory care, and how these vary by physician specialty.Summary of Background Data.Few recent data are available regarding ambulatory care for low back pain or how case mix and patient management vary by physician specialty.Methods.Data from the National Ambulatory Medical Care Survey were grouped into three time periods (1980–81, 1985, 1989–90). Frequency of visits for low back pain, referral status, tests, and treatments were tabulated by physician speciatly.Results.There were almost 15 million office visity for “mechanical” low back pain in 1990, ranking this problem fifth as a reason for all physician visits. Low back pain accounted for 2.8 percent of office visity in all three time periods. Nonspecific diagnostic lables were most common, and 56 percent of visits were to primary care physicians. Specialty variations were observed in caseload, diagnostic mix, and management.Conclusion.Back pain remains a major reason for all physician office visity. This study describes visit, referral, and management patterns among specialties providing the most care.

ISSN:0362-2436    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Study Design.A survey of the prevalence of cervical zygapophysial jooint pain was conducted.Objectives.To determine the prevalence of cervical zygapophysial joint pain in patients with chronic neck pain after whiplash.Summary of Backgound Data.In a significant porportion of patients with whiplash, chronic, refractory neck pain develops. Provisional data suggests many of these patients have zygapophysial joint pain, but the diagnosis has been established by single, uncontrolled diagnostic blocks.Methods.Fifty consecutive, referred patients with chronic neck pain after whiplash injury were studid using double-blind, controlled, diagnotic blocks of the cervical zygapophysial joints. On separate occasions, the joint was blocked with either lignocaine or bupivacaine in random order.Results.A positive diagnosis was made only if both blocks relieved the patient's pain and bupivacaine provided longer relief, Painful joints were identified in 54% of the patients (95% confidence interval, 40% to 68%).Conclusion.In this population, cervical zygapophysial joint pain was the most common source of chronic neck pain after whiplash.

ISSN:0362-2436    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Study Design.In a prospective, consecutive study, correlation between the straight leg raising and other pain-related symptoms in lumbar disc herniation was evaluated preoperatively and postoperatively.Objectives.All patients were interviewed and examined preoperatively and at follow-up investigations 4 and 12 months postoperatively.Summary of Background Data.One-hundred-and-fifty consecutive patients underwent lumbar disc surgery. Mean patient age was 42 years (range, 21–81 years). Eighty-nine patients were men and 61 were women. Two herniations occurred at L2-L3, seven at L3-L4, 61 at L4-L5, and 80 at L5-S1.Methods.Pain at rest, at night, and upon coughing was recorded. Consumption of analgesics was classified into three categories: 1) none, 2) intermittent, or 3) regular. Walking capacity was recorded as >5 km, 1–5 km, 0.5–1 km, or <0.5 km. The strainght leg raising test was graded pos O°-30°, pos 30°-60°, pos >60°, or negative. At surgery, the herniation was classified as focal protrusion, subligamentous herniation, or perforation. The patient's assessment of outcome was graded into one of four categories.Results.There was an almost linear correlation between a postive straight leg raising test and pain at rest, pain at night, pain upon coughing, and reduction of walking capacity. Regular consumption of analgesics was more common in patients who had a very restricted posttive stratight leg raising test (30o). A postive straight leg raising test early postoperatively correlated with inferior outcome of the surgical procedure.Conclusion.The straight leg raising test as performed in clinical practice has a strong correlation with various parameters that signify the pain level of the patient. A postitive straight leg raising test postoperatively correlates with inferior surgical outcome.

ISSN:0362-2436    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Study Design.This was a cross-sectional analytic study.Objectives.In relation to pain from the sacroiliac joint, this study sought to establish 1) its prevalence, 2) the validity of pain provocation, 3) whether any arthrographic abnormalities predict a response to joint block, and 4) whether certain pain patterns discriminate patients with this diagnosis.Summary of Backgound Data.The true prevalence of sacroiliac joint pain is unknown and despite a plethora of clinical tests, none of these tests has been validated against an established criterion standard. To our knowledge, arthrography of the sacroiliac joint had never been studied.Methods.Forty-three consecutive patients with chronic low back pain maximal below L5-S1 were investigated with sacroiliac joint blocks under image intensifier using radiographic contrast followed by 2% lignocaine, Information was obtained on pain provocation, analgesia, and image pattern.Results.Thirteen patients (30%) obtained gratifying relief of their pain. Nine of these also exhibited tears of their ventral capsule. Groin pain was the only pain referral pattern found to be associated with response to sacroiliac joint block.Conclusion.The sacroiliac joint is a significant source of pain in patients with chronic low back pain and warrants further study.

ISSN:0362-2436    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Study Design.A surface electromyographic procedure for evaluating back muscle impairment was studied in patients undergoing rehabilitation for low back pain.Objectives.The results were analyzed to determine whether the electromyographic procedure was able to: 1) distinguish muscle impairment between patints with low back pain and normal subjects, and 2) monitor changes in muscle function after low back pain rehabilitation.Methods.Patients with chronic low back pain (n = 85) were tested to measure the median frequency of the electromyographic signals from six lumbar electrode sites during sustained trunk extensions. A subset (n = 28) of these patients was re-tested after low back pain rehabilitation. A discriminant function for classifying subjects into “low back pain” and “normal” goups was formulated using the electromyographic data from a subset of the patients with low back pain (n = 28) and a normative sample (n = 42). Results for this “learning” sample were compared with results using the same function on the remaining “holdout” sample of patients (n = 57) and an additional normative sample (n = 6). Differences in electromyographic parameters before and after rehabilitation also were analyzed.Results.The discriminant function classified subjects into low back pain and normal groups, with 86% and 89% correct classification for the “learning” and “holdout” samples, respectively. These classification results were independent of trunk extensor strength. Changes in median frequency after the rehabilitation program were consistent with improvements in back muscle fatigability.Conclusion.These findings demonstrate how electromyographic spectral measurements may be used to identify and monitor back muscle impairment in patients undergoing rehabilitation for low back pain.

ISSN:0362-2436    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Sutdy Design.In this prospective study, the athors evaluated the atlanto-odontoid (AO) joint in 500 consecutive patients who underwent computed tomographies (CTs) of the brain or paranasal sinuses.Objectives.The objective of the study was to determine age specificity of various morphologic abnormalities related to osteoarthritis at the AO joint in patients referred for CT primarilly to exclude brain or sinus abnormalities.Summary of Background Data.In all patients, at least two axial slices though the AO joint were evaluated by two authors, and agreement was reacheed by consensus.Methods.Abnormal morphology was categorized into three groups: (1) osteophytosis; (2) obliteration of the joint space; and (3) transverse ligament calcification.Results.In a significant percentage of older individuals, some form of degenerative disease is present. These changes show a roughly linear progression with advancing age.Conclusion.Morphologic changes related to AO osteoarthritis are frequent coincidental findings in patients referred for CT examination of the brain or paranasal sinuses. Awareness of the appearance and prevalence of degenerative chages in the AO joint on CT is important because reports in the literature adn earlier findings of the authors indicate that these changes can be a source of suboccipital headache.

ISSN:0362-2436    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Study Design.An operator-blinded dual modality trial of measurement of lumbar multifidus muscle cross-sectional area was performed.Objective.To compare two imaging modalities used for measurement of the lumbar multifidus muscle.Methods.Ten normal female subjects aged 21–31 years were imaged on two separate days using magnetic resonance imaging and ultrasound imaging. Bilateral measurements were made at each vertebral level from L2-S1.Results.No significant differnce was demostrated between cross-sectional area measurements made with the two different modalities. measurements of multifidus were symmetrical between left and right sides of the spine. For both modalities, a significant difference was demostrated in the cross-sectional area of multifidus between each vertebral level from L2-S1.Conclusions.The present study indicated that if a strict protocol for ultrasound imaging is adhered to, real-time ultrasound imaging can be used to document muscle size in young adults. Further studies are required to validate the technique in older subjects and in different conditions.

ISSN:0362-2436    

出版商:OVID    

年代:1995

数据来源: OVID