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Ann Intern Med 2002 Oct 15;137(8):701-2; discussion 701-2
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PMID: 12379084, UI: 22266740
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PMID: 12379082, UI: 22266738
PMID: 12379081, UI: 22266737
Br J Anaesth 2002 Nov;89(5):711-4
Department of Anaesthetics and Pain Management, University Hospital Lewisham, Lewisham High Street, London SE13 6LH, UK.
[Medline record in process]
BACKGROUND: Postherpetic neuralgia is a complication of acute herpes zoster characterized by severe pain and paraesthesia in the skin area affected by the initial infection. There is evidence that the N-methyl-D-aspartate receptor is involved in the development of hypersensitivity states and it is known that magnesium blocks the N-methyl-D-aspartate receptor. METHOD: A double-blind, placebo-controlled, cross-over study was conducted in which magnesium sulphate was administered as an i.v. infusion. Spontaneous pain was recorded and qualitative sensory testing with cotton wool was performed in seven patients with postherpetic neuralgia before and after the i.v. administration of either magnesium sulphate 30 mg kg(-1) or saline. RESULTS: During the administration, pain scores were significantly lower for magnesium compared with placebo at 20 and 30 min (P=0.016) but not at 10 min. I.V. magnesium sulphate was safe, well-tolerated and effective in patients with postherpetic neuralgia. CONCLUSION: The present study supports the concept that the N-methyl-D-aspartate receptor is involved in the control of postherpetic neuralgia. Br J Anaesth 2002; 89: 711-14
PMID: 12393768, UI: 22280469
Eur J Pharmacol 2002 Oct 25;453(2-3):203-8
Departamento de Farmacologia and Departamento de Qui;mica, Universidade Federal de Santa Catarina, Rua Ferreira Lima, 82, 88015-420, SC, Florianopolis, Brazil
Experiments were designed to address whether the pentacyclic triterpene tormentic acid isolated from the stem bark of the plant Vochysia divergens exerts oral anti-allodynic properties in two models of chronic pain in mice: neuropathic pain caused by partial ligation of the sciatic nerve and inflammatory pain produced by intraplantar injection of Complete Freund's Adjuvant. Oral administration of tormentic acid (30 mg/kg) twice a day for several consecutive days produced time-dependent and pronounced anti-allodynia effect in both ispsilateral and contralateral paws after plantar injection of Complete Freund's Adjuvant. The inhibition observed was 82+/-9% and 100+/-11%, respectively. Interestingly, tormentic acid did not inhibit paw oedema formation following Complete Freund's Adjuvant plantar injection. Tormentic acid (30 mg/kg, p.o.) and gabapentin (70 mg/kg, p.o.), given twice a day, inhibited markedly the neuropathic allodynia induced by partial ligation of the sciatic nerve, with inhibition of 91+/-19% and 71+/-16%, respectively. The anti-allodynic action of tormentic acid was not associated with impairment of the motor activity of the animals. Together, the present results indicate that tormentic acid or its derivatives might be of potential interest in the development of new clinically relevant drugs for the management of persistent neuropathic and inflammatory allodynia.
PMID: 12398905, UI: 22286300
Spine 2002 Oct 1;27(19):2159-65
*National Institute for Working Life, Solna, the dagger Department of Occupational Health, Stockholm County Council, Stockholm, the double dagger Section for Personal Injury Prevention, Karolinska Institutet, Stockholm, the.
STUDY DESIGN A 2-year follow-up study was conducted to investigate new patients who sought care for low back pain from all the caregivers in a specific region with a population of approximately 17,000 men and women ages 20 to 59 years.OBJECTIVES To describe care-seeking behavior for low back pain in a general population; to characterize pain, disability, and sick leave among the patients; and to study predictors of recovery. An additional aim was to find a simple way of classifying low back pain in epidemiologic studies.SUMMARY OF BACKGROUND DATA Low back pain is very common, but its natural history in a general population and predictors of recovery are not fully known.METHODS All the patients went through a clinical examination, and data on personal, medical, and occupational history were collected. Follow-up assessments were made during a 2-year period.RESULTS Whereas 50% of the patients went to physicians and physiotherapists for treatment, 50% went to other caregivers. Some improvements in pain and disability were reported after 3 months, but not many after that. Approximately 70% of the care seekers had not been on sick leave during the follow-up period. Care seeking during the follow-up period was not associated with reduced pain and disability. No predictive factors for recovery were found. A simple pain drawing made by the patient gave information about pain distribution similar to that found by clinical examination.CONCLUSIONS In a general working population in Sweden ages 20-59 years, approximately 5% sought care because of a new low back pain episode during a 3-year period. Few of the care seekers became pain-free during the follow-up period. This study strengthens the hypothesis that low back pain often becomes chronic even when sick leave is rare.
PMID: 12394932, UI: 22282316
Spine 2002 Oct 15;27(20):2291-7
School of Economics and Trent Institute for Health Services Research, University of Nottingham, Queens Medical Centre, Nottingham, United Kingdom.
STUDY DESIGN: Fifty-two practices in the East Midlands, United Kingdom, were included. OBJECTIVES: To test the hypothesis that referral for lumbar spine radiography is cost-effective in primary care patients with low back pain of at least 6 weeks' duration compared with usual care in which referral is not routine. SUMMARY OF BACKGROUND DATA: Lumbar spine radiography is commonly used in the management of low back pain, although the yield of findings that alter clinical management is low. Evidence is needed on the cost-effectiveness of lumbar spine radiographs in patients with low back pain. METHODS: A prospective economic analysis alongside a randomized controlled trial was used. Outcomes included the Roland disability score, pain, health status scale, EuroQol, satisfaction, direct health care costs (primary, secondary, and community care; prescribed and over-the-counter medicines; special equipment), and indirect costs (informal care, extra expenses, welfare benefits, loss of earnings and productivity). RESULTS A total of 210 participants were randomly assigned to lumbar spine radiography, and 211, to usual care. At 9 months' postrandomization, no difference between the groups was found in any health outcomes other than satisfaction. The intervention group had a higher overall satisfaction score (21 19, < 0.01). The intervention group had higher direct costs (150 pounds sterling vs 109 pounds sterling, < 0.01). Cost-effectiveness analysis shows that patient satisfaction can be increased using lumbar radiography but at an additional cost (point estimate 20 pounds sterling per point on satisfaction scale). The simulated distribution based on trial data shows that only when a 1-point increase in satisfaction is valued at more than 50 pounds sterling can it be claimed that radiography is cost-effective in these terms (incremental net monetary benefit mean = 116 pounds sterling, 95% CI pound 7, 225 pounds sterling). CONCLUSIONS: Radiography is likely to be cost-effective only when satisfaction is valued relatively highly. Strategies to enhance satisfaction for patients with low back pain without using lumbar radiography should be pursued.
PMID: 12394910, UI: 22282343
Spine 2002 Oct 15;27(20):2274-8
*Department of Diagnostic Radiology and the dagger Department of Physical Medicine and Rehabilitation, Oulu University Hospital, Kajaanintie, Finland.
STUDY DESIGN One hundred and three lumbar intervertebral discs (L3/4-L5/S1) of 36 patients with low back pain were examined with computed tomography (CT) diskography and magnetic resonance imaging (MRI).OBJECTIVES To determine whether lumbar endplate degeneration correlates with the degree of disc degeneration or disc rupture and to determine if there is an association between pain provocation during diskography and lumbar endplate degeneration.SUMMARY OF BACKGROUND DATA There have been numerous attempts to explain the pathogenesis of pain provocation during diskography, but the possibility of endplate degeneration as a source of pain has not been widely assessed.METHODS One hundred and three lumbar intervertebral discs (36 L3/4, 36 L4/5, and 31 L5/S1 intervertebral discs) of 36 patients were examined. On the basis of MRI, the intervertebral discs were divided into four categories based on the degree of endplate degeneration. Based on pain provocation on diskography, the intervertebral discs were divided into three categories: no pain, indifferent/untypical pain, and familiar/typical pain. Based on disc degeneration and disc rupture, the intervertebral discs were divided into four categories in accordance with the Dallas Discogram Description: Grades 0-3 of both degeneration and rupture.RESULTS There was a positive correlation between endplate degeneration and disc degeneration and a positive correlation between disc rupture and pain provocation, but there was no association between endplate degeneration and disc rupture and no correlation between endplate degeneration and pain provocation on diskography.CONCLUSIONS This study showed a stronger association between endplate degeneration and disc degeneration than between endplate degeneration and disc rupture. The results indicate that the contrast injection during diskography reflects mainly pain of discogenic origin, whereas the possible pain associated with endplate damage cannot be depicted by CT diskography.
PMID: 12394906, UI: 22282339
Spine 2002 Oct 15;27(20):2193-204
Department of Epidemiology, University of California-Los Angeles School of Public Health, Los Angeles, California 90095-1772, USA. ehurwitz@ucla.edu
STUDY DESIGN: A randomized clinical trial. OBJECTIVES: To compare the effectiveness of medical and chiropractic care for low back pain patients in managed care; to assess the effectiveness of physical therapy among medical patients; and to assess the effectiveness of physical modalities among chiropractic patients. SUMMARY OF BACKGROUND DATA: Despite the burden that low back pain places on patients, providers, and society, the relative effectiveness of common treatment strategies offered in managed care is unknown. METHODS: Low back pain patients presenting to a large managed care facility from October 30, 1995, through November 9, 1998, were randomly assigned in a balanced design to medical care with and without physical therapy and to chiropractic care with and without physical modalities. The primary outcome variables are average and most severe low back pain intensity in the past week, assessed with 0 to 10 numerical rating scales, and low back-related disability, assessed with the 24-item Roland-Morris Disability Questionnaire. RESULTS: Of 1,469 eligible patients, 681 were enrolled; 95.7% were followed through 6 months. The mean changes in low back pain intensity and disability of participants in the medical and chiropractic care-only groups were similar at each follow-up assessment (adjusted mean differences at 6 months for most severe pain, 0.27, 95% confidence interval, -0.32-0.86; average pain, 0.22, -0.25-0.69; and disability, 0.75, -0.29-1.79). Physical therapy yielded somewhat better 6-month disability outcomes than did medical care alone (1.26, 0.20-2.32). CONCLUSIONS: After 6 months of follow-up, chiropractic care and medical care for low back pain were comparable in their effectiveness. Physical therapy may be marginally more effective than medical care alone for reducing disability in some patients, but the possible benefit is small.
PMID: 12394892, UI: 22282325
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