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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Low back pain, in its acute and chronic forms, is one of the most common health problems and is frequently evaluated by rheumatologists. The multiple possible diagnoses associated with this symptom make correctly attributing back pain to a specific disease difficult. This dilemma necessitates an organized approach to separate patients with mechanical disorders from those with rare systemic disorders. The most common forms of back pain are mechanical. Gradual modifications in the axial skeletal structures over time result in pathological disorders that generally occur later in an individual's lifespan. The diagnostic process that identifies these mechanical disorders is straightforward and does not require expensive radiological or laboratory tests in the early phases of the evaluation. Most low back pain resolves without intervention, but some reports suggest that episodes of back pain are persistent or recurring for a substantial minority of patients. Therapies for back pain can be nonpharmacological, pharmacological or surgical. All interventions have limited capacity to resolve low back pain. Nonsurgical therapies are preferred for muscle injuries and osteoarthritis of the lumbar spine. Surgical interventions can resolve the pain and dysfunction of disc herniation and spinal stenosis more rapidly than conventional therapy, but surgical benefit wanes over time.
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PMID:Mechanical low back pain--a rheumatologist's view. 2401 49

Low back pain (LBP) is a worldwide phenomenon. The UK studies place LBP as the largest single cause of absence from work; up to 80% of the population will experience LBP at least once in their lifetime. Most individuals do not seek medical care and are not disabled by their pain once it is managed by nonoperative measures. However, around 10% of patients go on to develop chronic pain. This review outlines the basics of the traditional approach to spinal surgery for chronic LBP secondary to osteoarthritis of the lumbar spine as well as explains the novel concepts and terminology of back pain surgery. Traditionally, the stepwise approach to surgery starts with local anaesthetic and steroid injection followed by spinal fusion. Fusion aims to alleviate pain by preventing movement between affected spinal segments; this commonly involves open surgery, which requires large soft tissue dissection and there is a possibility of blood loss and prolonged recovery time. Established minimally invasive spine surgery techniques (MISS) aim to reduce all of these complications and they include laparoscopic anterior lumbar interbody fusion and MISS posterior instrumentation with pedicle screws and rods. Newer MISS techniques include extreme lateral interbody fusion and axial interbody fusion. The main problem of fusion is the disruption of the biomechanics of the rest of the spine; leading to adjacent level disease. Theoretically, this can be prevented by performing motion-preserving surgeries such as total disc replacement, facet arthroplasty, and non fusion stabilisation. We outline the basic concepts of the procedures mentioned above as well as explore some of the novel surgical therapies available for chronic LBP.
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PMID:Low Back Pain: Current Surgical Approaches. 2624 Jul 29

Intervertebral disc degeneration and facet joint osteoarthritis of the lumbar spine are, among others, well known as a cause of low back and lower extremity pain. Together with their secondary disorders they set a big burden on health care systems and economics worldwide. Despite modern imaging modalities, such as magnetic resonance imaging, for a large proportion of patients with low back pain (LBP) it remains difficult to provide a specific diagnosis. The fact that nearly all the lumbar structures are possible sources of LBP, may serve as a possible explanation. Furthermore, our clinical experience confirms, that imaging alone is not a sufficient approach explaining LBP. Here, the Oswestry Disability Index, as the most commonly used measure to quantify disability for LBP, may serve as an easy-to-apply questionnaire to evaluate the patient's ability to cope with everyday life. For therapeutic purposes, among the different options, the lumbar facet joint intra-articular injection of corticosteroids in combination with an anaesthetic solution is one of the most frequently performed interventional procedures. Although widely used the clinical benefit of intra-articular steroid injections remains controversial. Therefore, prior to therapy, standardized diagnostic algorithms for an accurate assessment, classification and correlation of degenerative changes of the lumbar spine are needed.
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PMID:Magnetic resonance imaging-based interpretation of degenerative changes in the lower lumbar segments and therapeutic consequences. 2633 62