How can chronic pain be prevented? Oh that I and the insurance companies knew the answer to that question!
The key is to identify those patients at risk for the development of chronic pain .
Musculoskeletal pain is a significant problem in this country: 85% of the population suffers from this affliction at some point during the employment years. Fortunately, the majority recover rather quickly from acute back pain . It is the 3% to 10% that develop long-term disability due to their chronic pain, which is a deceptively small percentage if one considers that this minority consumes significantly more than 50% of the health care dollars for this problem.
If the chronic pain group could be identified, perhaps an intervention could occur which might avoid the suffering and costs associated with pain and loss of income. Unfortunately, musculoskeletal pain is such a frequent occurrence, it would be prohibitively costly to attempt psychological interventions upon every ...
Spondylolisthesis (spaun-di-lo-lie-thee-sis) is a mouthful and is a common cause of low back pain (although it can exist anywhere in the spine, the lumbar spine is the most common area affected). The spinal column is a series of building blocks called vertebral bodies stacked on top of one another. Sometimes these blocks do not line up perfectly. This slight separation in the spinal column is called a spondylolisthesis .
"Doc says I have a spondy-something-or-other. Don't ask me what it is; all I know is that it hurts". Steve tries to explain his low back condition to his friend. But, he finds that he cannot explain what he does not understand. Steve has had back pain for a number of years. Every year the pain gets worse and has now become constant. His doctor sent him for x-rays recently. The x-rays showed a spondylolisthesis with disc degeneration at L5/S1. Steve could not understand his doctor's explanation of the condition. So, now he has pain and has confusion.
Last month, the American Pain Society added to its recommendations to health care providers regarding the diagnosis and treatment of low back pain .
In addition, the Society decided to discuss openly procedures that could be risky to sufferers of low back pain, including recommendations on surgery and other invasive therapies.
Unfortunately, there is not a significant body of good evidence to justify unquestioningly embracing these new recommendations. It is difficult to find well-done clinical studies which support the use of a number of the more invasive treatments used for chronic low back pain.
The initial set of guidelines for the management of chronic low back pain were published in "Annals of Internal Medicine" last October. However, these recommendations dealt more with the initial evaluation of a low back pain patient, and included thoughts on what type of x-rays to order in addition to more conservative treatments such as massage/manipulation and exerci...
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