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...
One of the most common problems seen in a primary care medical practice is low back pain. It accounts for more discomfort, lost work and productivity, and frustration for many patients than any other malady. Some think it is the price we, as humans, pay for walking upright. The lower back is a complex structure made of bone, muscles, connective tissue and nerves that, along with our legs, hold us erect, allow us to bend, run, twist, catch a football, or just lay down and rest. However, once a problem arises, the complexity of its structure makes pain in the lower back difficult to diagnose and treat. The lower back consists of a spinal column from the lumbar region of the mid-back down to the tail bone or coccyx. The spinal column consists of 5 lumbar vertebrae which are cylindrical bony structures with a ring like component behind the cylinder also made of bone. In between the vertebrae are disc shaped cushions filled with a gelatinous central core known as the nucleus pulposis
“Sciatica” is an old world term that refers to leg pain felt down the back of the thigh into the calf and foot. What about thigh pain? What about buttock pain? Unfortunately, “sciatica” has been wrongly applied to all types and locations of leg pain. In 1948, the use of the word “sciatica” was declared “unhelpful” by a leading orthopedic specialist because it is limited to a certain location and really does not address the origin of the pain. Over the years, many older medical terms like sciatica have become archaic as the newer research technologies give doctors clearer definitions and a better understanding of the human body. Leg pain that comes from the low back is most accurately categorized as referred pain or neurogenic pain. These terms apply to all locations and address the origin of the pain. With these newer terms, the antiquated word, “sciatica”, has no place in the modern world. Sally has been waking up with right ...
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