Computed tomography, electrodiagnostic and clinical findings in chronic workers' compensation patients with back and leg pain

One hundred patients with complaints of low-back pain and leg pain, consistent with a diagnosis of sciatica, were evaluated. All patients had complaints for longer than 6 months and had recently undergone electrodiagnostic testing and computed tomography (CT). Correlation was made between symptoms, straight leg raising, clinical neurological deficits, electrodiagnostic and CT findings. The radiation of pain above or below the knee and pain on straight leg raising did not show a high correlation with each other or with neurological deficits or CT findings. Electrodiagnostic studies often defined a radiculopathy in patients with equivocal clinical signs. CT findings did not predict the nature of symptoms or clinical and electrodiagnostic findings. Electrodiagnostic abnormalities showed the greatest ability to predict CT abnormalities. It is concluded that in chronic sciatica patients, no single diagnostic parameter is conclusive and a combination of clinical and laboratory findings is necessary to reach a diagnosis. In addition, many assumptions, valid in patients with acute pain cannot be extrapolated to patients with chronic sciatica.     

Intraligamentous injection of sclerosing solutions (prolotherapy) for spinal pain: a critical review of the literature.

BACKGROUND CONTEXT: The injection of various solutions aimed at producing a sclerosing effect has been used to treat soft tissues injuries (eg, inguinal hernia) for more than 100 years. In the 1930s, this treatment approach was applied to injured joints in an attempt to stimulate connective tissue repair. Although several studies have been published about this method of treatment for various orthopedic and spinal indications (termed prolotherapy), its use remains controversial. PURPOSE: To conduct a critical review of the literature on prolotherapy for spinal pain. STUDY DESIGN/SETTING: Critical review of the literature. METHODS: Computerized medical literature databases (Medline, CINAHL, Mantis, Cochrane Central Register of Controlled Trials) were searched to uncover all published information about the use of sclerosing injections in humans with spinal pain disorders. Search results were reviewed for relevance, and information was abstracted from full-text articles. RESULTS: Our search uncovered almost 200 reference materials in various media related to prolotherapy, including 31 clinical studies related to spinal pain. There were 26 observational cohorts and 5 randomized clinical trials (RCTs). Indications in these studies were low back pain (22), neck pain (3), cervical headaches (3) and dorsal or thoracic pain (3). A total of 20 sclerosing solutions were used in these studies; the most common was a mixture of dextrose 12.5%, glycerin 12.5%, phenol 1.25% and lidocaine 0.25%. Wide variations were found in treatment protocols, such as dose, number of treatments and use of adjunct therapies. Most cohort studies were only of moderate quality and varied greatly in the substances injected and the use of co-interventions. Most clinical studies reported positive results such as decreased pain or disability, although differences between treatment and control groups did not always reach statistical significance. Commonly reported adverse reactions to this treatment include temporary postinjection pain and stiffness. A handful of more serious adverse events were reported in the 1950s and 1960s with stronger or unknown solutions. CONCLUSION: Prolotherapy describes a variety of treatment approaches rather than a specific protocol. Results from clinical studies published to date indicate that it may be effective at reducing spinal pain. Great variation was found in the injection and treatment protocols used in these studies that preclude definite conclusions. Future research should focus on those solutions and protocols that are most commonly used in clinical practice and have been used in trials reporting effectiveness to help determine which patients, if any, are most likely to benefit from this treatment.     

The evolution and importance of spinal and chiropractic research.

From its discovery in 1895 to its current status, in which the World Federation of Chiropractic Meeting may be considered a prestigious international scientific conference, the evaluation of chiropractic can be viewed as a compression of the phases which medical and scientific evolution have followed over a much longer period. Chiropractic theory started primarily as a vitalistic philosophy justifying its treatment while the medical scientific community was rejecting vitalism. Both chiropractic and medical spine specialists went through a period of speculative theory in the first half of this century based upon either perceived neurological or pathological observations. There was a period of single-theory preoccupation by chiropractors (the subluxation) and medical specialists (disc herniation) which brought these professions into conflict. The past decade has led to greater scientific exploration by both professions, with more national scientific discussion of the causes and treatment of spinal problems. The next decade, however, appears likely to require greater emphasis on social research into clinical effectiveness of treatments, prevention of back pain, patient satisfaction and quality assurance. This evolution should be considered the normal maturation of a health care profession.     

Course and Prognostic Factors for Neck Pain in the General Population

European Spine Journal - Best evidence synthesis. To undertake a best evidence synthesis on course and prognosis of neck pain and its associated disorders in the general population. Knowing the...     

The Burden and Determinants of Neck Pain in Workers

European Spine Journal - Systematic review and best evidence synthesis. To describe the prevalence and incidence of neck pain and disability in workers; to identify risk factors for neck pain in...     

Research Priorities and Methodological Implications

European Spine Journal - Best evidence synthesis. To report on gaps in the literature and make methodologic recommendations based on our review of the literature on frequency and risk factors,...     

The Empowerment of People With Neck Pain: Introduction

European Spine Journal -