Journal of Back and Musculoskeletal Rehabilitation - Volume 5, issue 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: Literature evidence indicates that physicians have great difficulty in translating medical impairment into functional limitation and thereby establishing the work capacity or the residual functional capacity (RFC) of the injured worker. This is especially true for the chronic pain patient (CPP). Development of quantitative methods for the measurement of functional capacity (FC), have not improved the problems involved in the measurement of RFC and the translation of RFC into the demand minimum functional capacity (DMFC) of some job or jobs. The relationship between FC, RFC, work capacity and DMFC is reviewed. We have developed a method/battery for measuring RFC in…CPPs utilizing the Dictionary of Occupational Titles (DOT) which is readily translatable into DMFC of some job or jobs. Suggestions are made for future directions in the measurement of work capacity.
Abstract: The current paper provides specific guidelines for treating chronic non-malignant pain syndrome patients. The guidelines were developed from an extensive review of existing literature on practice guidelines, the research literature, and common clinical practice across major pain treatment facilities in the USA. They are intended for application to all chronic pain syndrome patients (other than cancer pain) regardless of specific site or etiology of pain. They advocate goal directed treatment to reduce medication misuse and invasive medical procedures, maximize and maintain physical activity, return to productive activity, increase the patient's ability to manage pain, reduce subjective pain intensity, reduce or…eliminate the use of healthcare services for primary pain complaint, provide useful information for case settlement, and minimize treatment cost without sacrificing quality. The guidelines recommend interdisciplinary integrated evaluation and treatment on a time limit basis with a focus on conservative medical, psychological behavioral, physical, and vocational interventions based upon the patient's needs. There is emphasis on increasing the patient's level of function and ability to manage pain and related problems. Outpatient care is strongly recommended, with specific upper limits regarding treatment intensity and the use of trigger point injections and nerve blocks delineated. The guidelines also recommend that the long term use of opioid or sedative-hypnotic medications, surgery, implantable spinal devices, or brain stimulation techniques be avoided with chronic pain syndrome patients. These guidelines are intended to serve as a starting point to effectively extend and complement those released by the Agency for Health Care Policy and Research for other types of pain problems such as cancer and acute low back pain.
Keywords: Chronic pain, Practice guidelines, Pain rehabilitation
Abstract: The etiology of low back pain can be complex and the specific etiologies are rarely separated for investigation. There continues to be no single clinically proven superior treatment for low back pain. This may explain the multiplicity of treatments available. The purpose of this article is to evaluate the different forms of treatment for low back pain, treatment outcome and effectiveness. Nine more common treatments for low back pain are described. The long term effectiveness of the procedures reviewed in this article for the treatment of low back pain remains doubtful. For the majority of patients with complaints of low…back surgery is not indicated. For those patients who have neurological deficits and a documented lesion, surgery can be an immediate and appropriate treatment. The conventional treatment for low back pain continues to be the triad of rest, analgesic medication and perhaps exercise after the acute phase of low back pain. None of the other treatment options evaluated in this review were consistently shown to be more effective than this traditional triad treatment course.
Keywords: Back pain, Treatment, Outcome, Procedure
Abstract: Longitudinal outcomes of 35 patients with chronic benign pain were studied following their participation in a 3-week multidisciplinary pain management program. Pretreatment status with respect to activity levels, health care utilization, medication use, and subjective pain intensity was compared statistically with post-treatment status at three follow-up assessments (discharge, 1.6 months, and 22.7 months post-discharge). Results suggest a positive impact of treatment on activity levels, health care utilization, and medication use post-discharge, with diminution of that impact over time. Pain management programs increasingly will need to demonstrate cost effectiveness, including finding ways to maximize program gains over time.
Abstract: Cervical disc herniation is divided into three types with respect to the intraspinal location of the herniated mass: median, paramedian and lateral herniations. Median herniation presses the spinal cord against the lamina and deforms it into a boomerang shape in a cross section, thereby giving rise to myelopathy of the central cord syndrome or transverse lesion syndrome, according to Crandall's classification. Paramedian herniation presses the spinal cord unilaterally and deforms it into a comma shape. The symptoms and signs produced are not always those of the Brown-Sequard syndrome. Radiculopathy is produced by compression of a root in patients with a…wide spinal canal in which the spinal cord is thereby able to avoid compression. Lateral herniation presses a nerve root at the anterolateral corner of the spinal canal to the inlet of the foramen, thereby giving rise to radiculopathy. Of our 202 patients with myelopathy, 36% had median herniation and 64% had paramedian herniation. Of our 24 patients with radiculopathy, 12% had paramedian herniation and 88% had lateral herniation. Other matters pertinent to the management of patients are described.
Abstract: Gas within the spinal canal is uncommon and has been associated with trauma, infection and disc degeneration and vacuum phenomenon. We report a 73-year-old man with a history of intermittent low back pain who developed sharp low back pain with radiation to the left calf and ankle when ambulating or standing. Relief was obtained with sitting or lying down, which led to the clinical impression of spinal stenosis. The neuromuscular exam was unremarkable and no sciatic nerve tension sign was present. Electrodiagnostic studies were consistent with an acute S1 radiculopathy, while a dermatomal somatosensory evoked potential was interpreted as essentially…normal. A CT scan showed gas in the left lateral spinal canal at L4–S1. After 2 weeks, spontaneous improvement occurred and the patient resumed normal activities. A repeat CT scan after 0.5 years showed the intraspinal gas was diminished while the L5-S1 disc vacuum phenomenon had worsened and a right disc extrusion occurred. The natural history of intraspinal gas, disc vacuum phenomenon and related complications are discussed.
Keywords: Vacuum phenomenon, Low back pain, Sciatica, Computed tomography, Electrodiagnosis
Abstract: Treating physicians frequently are called upon to offer expert testimony in litigation. Courts will usually require treating physicians to give testimony about the facts concerning-their treatment and care of the patient. Courts have reached varying conclusions as to the extent that a treating physician can be compelled to render opinions about the patient's condition and prognosis. Different jurisdictions have varying rules as to what compensation, if any, is required to be paid to a treating physician subpoenaed to testify in the absence of a contract between a physician and a party concerning such compensation. Testimony offered by treating physicians who…qualify as medical experts must be found to be trustworthy by the court prior to being admitted into evidence.
Keywords: Expert witness, Litigation and medical legal