Back Pain

Koes BW, Sanders RJ, Tuut MK, Anonymous00238. · Erasmus Universiteit, afd. Huisartsgeneeskunde, Rotterdam. · Ned Tijdschr Geneeskd. · Pubmed #15015247 No free full text.

Abstract: Under the auspices of the Dutch Institute for Healthcare Improvement (CBO), a guideline has been developed for the diagnosis and treatment of aspecific low-back pain, based on the recent scientific literature. So-called 'red flags' are used to identify physical disorders. To obtain insight into psychosocial factors, 'yellow flags' are used. Acute low-back pain (0-12 weeks) is treated in a time-contingent manner. Staying active is better than bed rest. If chronicity threatens, exercise therapy can be advised. As part of an activating management, manipulation can be used. For pain relief, paracetamol is the drug of choice. The treatment of chronic low-back pain is aimed at the optimisation of the patients' functionality. Staying active is preferred here as well. Varied exercise therapy is advised. Back training may be considered. Manipulation can be used as part of an activating management. Paracetamol is preferred for pain relief. There is a limited role for percutaneous lumbar facet denervation. Behaviour therapy can be employed and there is a place for multidisciplinary programmes if other methods of treatment have proved insufficiently effective.

Lindena G, Diener HC, Hildebrandt J, Klinger R, Maier C, Schöps P, Tronnier V, Anonymous00098. · CLARA Clinical Analysis, Kleinmachnow, Germany. · Schmerz. · Pubmed #12077679 No free full text.

Abstract: The committee for quality assurance of the German IASP chapter (DGSS) evaluated all relevant guidelines concerning pain treatment. Quality of guidelines was analysed according to the checklist "Methodical quality of guidelines" by Ollenschläger and the user manual released by the German Medical Centre for Quality Assurance. The guideline for the treatment of back pain released by the German Medical Association was examined as well as the one released by the German Association for physical therapy and rehabilitation, the guideline on cervical and lumbal nerve root compression syndrome of the German Association of Neurosurgeons, the guideline for cancer pain of the Drug Committee of the German Medical Association was compared with the one of the German Interdisciplinary Association for Pain Treatment. The guideline for the treatment of chronic headache and facial pain of the Medical Association was evaluated and the guideline for the treatment of trigeminal neuralgia of the German Association of Neurosurgery and Neurology, also the guideline for the treatment of acute postoperative and posttraumatic pain. All guidelines show deficiencies in different aspects and of different severity. At first there are deficiencies in interdisciplinary formulation of the guidelines and identification and interpretation of evidence of multimodal pain treatment options. The most prominent deficiency is the lack of implementation and application trials or impulses by all author associations. This way all expenditure on releasing guidelines is given away without improving quality of pain treatment. The authors' recommendation is to adjust to guidelines and, if they are working or not, tell the authors and improve interdisciplinary in pain treatment guidelines.

Anonymous00171. · No affiliation provided · Phys Ther. · Pubmed #11589642 links to  free full text

Abstract: INTRODUCTION: A structured and rigorous methodology was developed for the formulation of evidence-based clinical practice guidelines (EBCPGs), then was used to develop EBCPGs for selected rehabilitation interventions for the management of low back pain. METHODS: Evidence from randomized controlled trials (RCTs) and observational studies was identified and synthesized using methods defined by the Cochrane Collaboration that minimize bias by using a systematic approach to literature search, study selection, data extraction, and data synthesis. Meta-analysis was conducted where possible. The strength of evidence was graded as level I for RCTs or level II for nonrandomized studies. DEVELOPING RECOMMENDATIONS: An expert panel was formed by inviting stakeholder professional organizations to nominate a representative. This panel developed a set of criteria for grading the strength of both the evidence and the recommendation. The panel decided that evidence of clinically important benefit (defined as 15% greater relative to a control based on panel expertise and empiric results) in patient-important outcomes was required for a recommendation. Statistical significance was also required, but was insufficient alone. Patient-important outcomes were decided by consensus as being pain, function, patient global assessment, quality of life, and return to work, providing that these outcomes were assessed with a scale for which measurement reliability and validity have been established. VALIDATING THE RECOMMENDATIONS: A feedback survey questionnaire was sent to 324 practitioners from 6 professional organizations. The response rate was 51%. RESULTS: Four positive recommendations of clinical benefit were developed. Therapeutic exercises were found to be beneficial for chronic, subacute, and postsurgery low back pain. Continuation of normal activities was the only intervention with beneficial effects for acute low back pain. These recommendations were mainly in agreement with previous EBCPGs, although some were not covered by other EBCPGs. There was wide agreement with these recommendations from practitioners (greater than 85%). For several interventions and indications (eg, thermotherapy, therapeutic ultrasound, massage, electrical stimulation), there was a lack of evidence regarding efficacy. CONCLUSIONS: This methodology of developing EBCPGs provides a structured approach to assessing the literature and developing guidelines that incorporates clinicians' feedback and is widely acceptable to practicing clinicians. Further well-designed RCTs are warranted regarding the use of several interventions for patients with low back pain where evidence was insufficient to make recommendations.

Anonymous61942. · No affiliation provided · J Radiol. · Pubmed #11104986 links to  free full text

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Abenhaim L, Rossignol M, Valat JP, Nordin M, Avouac B, Blotman F, Charlot J, Dreiser RL, Legrand E, Rozenberg S, Vautravers P. · Montreal Department of Public Health, Quebec, Canada. · Spine (Phila Pa 1976). · Pubmed #10707404 No free full text.

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Bland P. · No affiliation provided · Practitioner. · Pubmed #19606610 No free full text.

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Shulman ST. · No affiliation provided · Pediatr Ann. · Pubmed #19476293 No free full text.

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Tillisch K. · No affiliation provided · Pain. · Pubmed #19443121 No free full text.

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Bennett AN, Marzo-Ortega H, Emery P, McGonagle D, Anonymous00046. · No affiliation provided · Ann Rheum Dis. · Pubmed #19435721 No free full text.

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Sherman FT. · No affiliation provided · Geriatrics. · Pubmed #19435389 No free full text.

Abstract: There are many factors that can reduce the rates of rehospitalization, including transition or discharge coaches who work with the patient before, during, and after the discharge; better collaboration between hospitals and physicians to improve promptness and reliability of follow-up care; and earlier medical follow-up after surgical procedures.

Gabay C, So A. · No affiliation provided · Rev Med Suisse. · Pubmed #19405269 No free full text.

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Johnson J, Wang MY. · No affiliation provided · Neurosurgery. · Pubmed #19404133 No free full text.

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Hartrick CT. · No affiliation provided · Pain Pract. · Pubmed #19400818 No free full text.

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Snow GJ, Torda P. · No affiliation provided · J Manipulative Physiol Ther. · Pubmed #19362226 No free full text.

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Sloan PA, Grider JS. · No affiliation provided · J Opioid Manag. · Pubmed #19344043 No free full text.

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Artus M, van der Windt D. · No affiliation provided · Rheumatology (Oxford). · Pubmed #19297416 No free full text.

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Schiltenwolf M, Schneider S. · No affiliation provided · Pain. · Pubmed #19233563 No free full text.

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Jull G, Sterling M. · No affiliation provided · Man Ther. · Pubmed #19218070 No free full text.

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Lund I, Näslund J, Lundeberg T. · Foundation for Acupuncture and Alternative Biological Treatment Methods, Sabbatsbergs Hospital, Stockholm, Sweden. · Chin Med. · Pubmed #19183454 links to  free full text

Abstract: ABSTRACT: Placebo-control of acupuncture is used to evaluate and distinguish between the specific effects and the non-specific ones. During 'true' acupuncture treatment in general, the needles are inserted into acupoints and stimulated until deqi is evoked. In contrast, during placebo acupuncture, the needles are inserted into non-acupoints and/or superficially (so-called minimal acupuncture). A sham acupuncture needle with a blunt tip may be used in placebo acupuncture. Both minimal acupuncture and the placebo acupuncture with the sham acupuncture needle touching the skin would evoke activity in cutaneous afferent nerves. This afferent nerve activity has pronounced effects on the functional connectivity in the brain resulting in a 'limbic touch response'. Clinical studies showed that both acupuncture and minimal acupuncture procedures induced significant alleviation of migraine and that both procedures were equally effective. In other conditions such as low back pain and knee osteoarthritis, acupuncture was found to be more potent than minimal acupuncture and conventional non-acupuncture treatment. It is probable that the responses to 'true' acupuncture and minimal acupuncture are dependent on the aetiology of the pain. Furthermore, patients and healthy individuals may have different responses. In this paper, we argue that minimal acupuncture is not valid as an inert placebo-control despite its conceptual brilliance.

Devor M, Tal M. · No affiliation provided · Pain. · Pubmed #19181449 No free full text.

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Hodges P. · No affiliation provided · Br J Sports Med. · Pubmed #19096017 No free full text.

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Huntoon MA, Burgher AH. · No affiliation provided · Pain Physician. · Pubmed #19057623 links to  free full text

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Beaudreuil J, Orcel P. · No affiliation provided · Joint Bone Spine. · Pubmed #19022695 No free full text.

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Lundberg U. · No affiliation provided · Int J Behav Med. · Pubmed #19005924 No free full text.

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Cheung KM, Ito K. · No affiliation provided · Eur Spine J. · Pubmed #19005705 links to  free full text

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