Journal of Back and Musculoskeletal Rehabilitation - Volume 14, issue 1-2
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Journal of Back and Musculoskeletal Rehabilitation is a journal whose main focus is to present relevant information about the interdisciplinary approach to musculoskeletal rehabilitation for clinicians who treat patients with back and musculoskeletal pain complaints. It will provide readers with both 1) a general fund of knowledge on the assessment and management of specific problems and 2) new information considered to be state-of-the-art in the field. The intended audience is multidisciplinary as well as multi-specialty.
In each issue clinicians can find information which they can use in their patient setting the very next day. Manuscripts are provided from a range of health care providers including those in physical medicine, orthopedic surgery, rheumatology, neurosurgery, physical therapy, radiology, osteopathy, chiropractic and nursing on topics ranging from chronic pain to sports medicine. Diagnostic decision trees and treatment algorithms are encouraged in each manuscript. Controversial topics are discussed in commentaries and rebuttals. Associated areas such as medical-legal, worker's compensation and practice guidelines are included.
The journal publishes original research papers, review articles, programme descriptions and cast studies. Letters to the editors, commentaries, and editorials are also welcomed. Manuscripts are peer reviewed. Constructive critiques are given to each author. Suggestions for thematic issues and proposed manuscripts are welcomed.
Abstract: Chronic pain is a significant concern for many individuals with spinal cord injury (SCI). However, few effective treatments have been found for SCI-related pain. The current study sought to explore whether persons with SCI-related pain would respond to hypnotic suggestion for pain relief, and to examine possible moderators of this response. Twenty-two individuals with SCI-related pain rated their 6-month average and least pain on 0–10 scales of pain intensity. They also rated their current pain intensity and pain unpleasantness on 0–10 scales at eight subsequent time points: immediately before a hypnotic induction, immediately after the induction, after each of five…hypnotic suggestions, and at the end of the entire session after awakening. Eighty-six percent of the participants reported decreases in pain intensity and pain unpleasantness from pre-induction to post-induction. Significant omnibus analyses of variance followed by pairwise comparisons indicated statistically significant decreases in pain intensity and unpleasantness from pre-to post induction for both pain intensity and pain unpleasantness, and an additional decrease in pain intensity following the analgesia suggestion. In addition, although not specifically suggested, the decrease in pain that subjects experienced during the hypnotic session persisted after they were instructed to awaken. The ability of the subjects to decrease pain intensity to levels lower than the least pain they had experienced during the past six months was associated with hypnotic responsiveness, while the decrease in pain intensity from pre-induction to post-analgesia suggestion was associated with 6-month average pain. These preliminary findings indicate that hypnotic interventions have the potential to benefit many individuals with SCI-related pain, and that controlled trials of hypnotic analgesia with this population are warranted.
Abstract: The advent of managed care and third party payers are demanding greater efficiency and cost containment among rehabilitation providers. In the field of work rehabilitation programs, success is often measured with the injured worker's returning to their previous functional level. The efficacy of active rehabilitation has proven successful in returning injured workers back to their previous level of employment. The purposes of this paper are to discuss how a rural work rehabilitation program incorporated evidence based practices into the treatment of their clientele and the resulting 1998 and 1999 outcomes. Discharged status revealed 71% work with an average time of…4.9 months between date of injury and therapeutic intervention. The average number of treatment days was 20 for 1998 and 15 for 1999. Average total cost per day was $345 dollars for 1998 and $356 dollars for 1999. Emphasis on treating work related injuries of either acute or chronic nature should focus on restoring clients' functional mobility, endurance, strength, stabilization and cardiovascular impairments.
Abstract: Central pain syndrome (CPS) is a common and disabling sequela in many patients with spinal cord injury. Such pain frequently impedes functional recovery and leads to significant physical and psychological disability. While the treatment of CPS with antidepressant or anticonvulsant medication has been investigated, the treatment with a combination of these two classes of medications has not been studied. We report four separate cases of patients with paralysis and associated burning dysesthesias who had substantial improvement following a short course of treatment with a combination of a tricyclic antidepressant (TCA) and carbamazepine. Each patient suffered significant discomfort resulting in loss…of sleep or interference with functional abilities. These patients were treated with a therapeutic dose of a TCA alone without subjective improvement in pain. Subsequently, carbamazepine was added without changing the TCA dose. Each patient responded favorably to this combination of medications and reported a minimum of 50% two to three days of adding the carbamazepine. Two patients had complete resolution of pain. When the antidepressant was later discontinued in two patients, the dysesthesias significantly increased in both patients. The combination of a TCA and carbamazepine may improve the functional status and quality of life for patients with CPS unresponsive to either medication alone.
Abstract: The purpose of this study was to investigate the relationship between clinical measures of pelvic tilt angle, range of pelvic movement, and the lumbar lordosis category observed in normal, healthy, asymptomatic volunteers. A total of 54 subjects, 38 females (average age 24.7 ± 3.24 years) and 14 males, (average age 25.77 ± 5.13 years) were tested. Using methods previously described in the literature, subjects were divided into three groups according to the type of lordosis they exhibited: 1) decreased lordosis, 2) normal lordosis, 3) increased lordosis. Angles of resting, maximal anterior, and maximal posterior pelvic tilt positions were measured using…a goniometric technique. A weak correlation was found between resting pelvic tilt position and lumbar category, with a significant difference in resting pelvic tilt between subjects with increased lordosis and those with decreased lordosis. No significant relationship was demonstrated between lumbar category and available total pelvic ROM or pelvic ROM in anterior or posterior direction.