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...
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 ...
I never much cared for anatomy class. Dead bodies, the cold, and the smell were just not the way I liked to spend an afternoon. Every first year medical student spends hours in the anatomy room because learning the parts is important, but even more important is knowing what those parts do and how they work—functional anatomy. Thankfully, studying functional anatomy requires warm, live people who don’t usually smell. Let’s learn some parts without the smell because if you understand the parts, then you will understand the treatment. Getting down to the framework of your body is the skeleton which holds you upright, otherwise you would be a blob of gooey mush. As part of the skeleton, the spine is your backbone that bridges the span between your head and your butt. Because it is a bridge, the spine has passive, stationary structures (bones, ligaments, and discs) which don’t “do” anything except provide support for the whole body. However, these parts o...
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