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Back Pain HELP
Based on 15,973 articles published since 2008
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These are the 15973 published articles about Back Pain that originated from Worldwide during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
1 Guideline Optimizing the Management and Outcomes of Failed Back Surgery Syndrome: A Consensus Statement on Definition and Outlines for Patient Assessment. 2019

Rigoard, Philippe / Gatzinsky, Kliment / Deneuville, Jean-Philippe / Duyvendak, Wim / Naiditch, Nicolas / Van Buyten, Jean-Pierre / Eldabe, Sam. ·Spine & Neuromodulation Functional Unit, Poitiers University Hospital, Poitiers, France. · Institut Pprime UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, Poitiers, France. · PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France. · Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden. · Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium. · Department of Anesthesia and Pain Management, Hospital AZ Nikolaas, Sint-Niklaas, Belgium. · Department of Pain and Anaesthesia, The James Cook University Hospital, Middlesbrough, UK. ·Pain Res Manag · Pubmed #30911339.

ABSTRACT: Failed back surgery syndrome (FBSS) is a controversial term for identifying patients affected by new, recurrent, or persistent pain in the low back and/or legs following spinal surgery. The lack of a comprehensive standardized care pathway compromises the appropriate management of FBSS patients, which is associated with a heavy financial burden. An international panel of spine surgeons, neurosurgeons, and pain specialists with a particular interest in FBSS established the chronic back and leg pain (CBLP) network with the aim of addressing the challenges and barriers in the clinical management of FBSS patients by building a common transdisciplinary vision. Based on literature reviews, additional input from clinical expertise of multiple professional disciplines, and consensus among its members, the network attempted to provide recommendations on the management of patients with FBSS utilizing a multidisciplinary team (MDT) approach. The presentation of this work has been divided in two separate parts to enhance its clarity. This first paper, in favour of selecting appropriate validated tools to improve the FBSS patient assessment, focuses on FBSS taxonomy and its clinical implications for evaluation. Concise recommendations for assessment, treatment, and outcome evaluation using a MDT approach would be an important resource for specialists and nonspecialist clinicians who manage patients with FBSS, to improve decision-making, reduce variation in practice, and optimize treatment outcomes in this difficult-to-treat population.

2 Guideline Responsible, Safe, and Effective Use of Biologics in the Management of Low Back Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines. 2019

Navani, Annu / Manchikanti, Laxmaiah / Albers, Sheri L / Latchaw, Richard E / Sanapati, Jaya / Kaye, Alan D / Atluri, Sairam / Jordan, Sheldon / Gupta, Ashim / Cedeno, David / Vallejo, Alejandro / Fellows, Bert / Knezevic, Nebojsa Nick / Pappolla, Miguel / Diwan, Sudhir / Trescot, Andrea M / Soin, Amol / Kaye, Adam M / Aydin, Steve M / Calodney, Aaron K / Candido, Kenneth D / Bakshi, Sanjay / Benyamin, Ramsin M / Vallejo, Ricardo / Watanabe, Art / Beall, Douglas / Stitik, Todd P / Foye, Patrick M / Helander, Erik M / Hirsch, Joshua A. ·Comprehensive Pain Management Center, Campbell, CA. · Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY. · University Pain Medicine and Rehabilitation Center, Newark, NJ. · LSU Health Science Center, New Orleans. · Tri State Spine Care Institute. · Associate Director of Research at Millennium Pain Center, Bloomington, IL; Chief Science Officer at South Texas Orthopaedic Research Institute, Laredo, TX; and Adjunct Researcher at Illinois Wesleyan University, Bloomington, IL. · Millennium Pain Center, Bloomington, IL; Illinois Wesleyan University, Bloomington, Illinois. · Millennium Pain Center, Bloomington, Illinois; University of Illinois at Urbana-Champaign, Champaign, Illinois. · Vice Chair for Research and Education, Department of Anesthesiology and Pain Management, Advocate Illinois Masonic Medical Center, Clinical Associate Professor of Anesthesiology and Surgery at University of Illinois, Chicago, IL. · St. Michael's Pain and Spine Clinics, Houston, TX, and Univeristy of Texas Medical Branch, Galveston, TX. · Pain and Headache Center, Eagle River, Alaska. · Ohio Pain Clinic. · Manhattan Spine and Pain Medicine, New York, NY, and Hofstra-North Shore/LIJ School of Medicine, New York, NY. · Texas Spine and Joint Hospital, Tyler, TX. · SurgiCare of Manhattan and Lenox Hill Hospital. · Millennium Pain Center, Bloomington, IN. · Mt. Baker Pain Center, Bellingham, WA. · Clinical Radiology of Oklahoma, Edmond, OK. · Department of Anesthesiology, LSU School of Medicine, New Orleans, LA. · Massachusetts General Hospital and Harvard Medical School, Boston, MA. ·Pain Physician · Pubmed #30717500.

ABSTRACT: BACKGROUND: Regenerative medicine is a medical subspecialty that seeks to recruit and enhance the body's own inherent healing armamentarium in the treatment of patient pathology. This therapy's intention is to assist in the repair, and to potentially replace or restore damaged tissue through the use of autologous or allogenic biologics. This field is rising like a Phoenix from the ashes of underperforming conventional therapy midst the hopes and high expectations of patients and medical personnel alike. But, because this is a relatively new area of medicine that has yet to substantiate its outcomes, care must be taken in its public presentation and promises as well as in its use. OBJECTIVE: To provide guidance for the responsible, safe, and effective use of biologic therapy in the lumbar spine. To present a template on which to build standardized therapies using biologics. To ground potential administrators of biologics in the knowledge of the current outcome statistics and to stimulate those interested in providing biologic therapy to participate in high quality research that will ultimately promote and further advance this area of medicine. METHODS: The methodology used has included the development of objectives and key questions. A panel of experts from various medical specialties and subspecialties as well as differing regions collaborated in the formation of these guidelines and submitted (if any) their appropriate disclosures of conflicts of interest. Trustworthy standards were employed in the creation of these guidelines. The literature pertaining to regenerative medicine, its effectiveness, and adverse consequences was thoroughly reviewed using a best evidence synthesis of the available literature. The grading for recommendation was provided as described by the Agency for Healthcare Research and Quality (AHRQ). SUMMARY OF EVIDENCE: Lumbar Disc Injections: Based on the available evidence regarding the use of platelet-rich plasma (PRP), including one high-quality randomized controlled trial (RCT), multiple moderate-quality observational studies, a single-arm meta-analysis and evidence from a systematic review, the qualitative evidence has been assessed as Level III (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best-evidence synthesis. Based on the available evidence regarding the use of medicinal signaling/ mesenchymal stem cell (MSCs) with a high-quality RCT, multiple moderate-quality observational studies, a single-arm meta-analysis, and 2 systematic reviews, the qualitative evidence has been assessed as Level III (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. Lumbar Epidural Injections Based on one high-quality RCT, multiple relevant moderate-quality observational studies and a single-arm meta-analysis, the qualitative evidence has been assessed as Level IV (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. Lumbar Facet Joint Injections Based on one high-quality RCT and 2 moderate-quality observational studies, the qualitative evidence for facet joint injections with PRP has been assessed as Level IV (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. Sacroiliac Joint Injection Based on one high-quality RCT, one moderate-quality observational study, and one low-quality case report, the qualitative evidence has been assessed as Level IV (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. CONCLUSION: Based on the evidence synthesis summarized above, there is Level III evidence for intradiscal injections of PRP and MSCs, whereas the evidence is considered Level IV for lumbar facet joint, lumbar epidural, and sacroiliac joint injections of PRP, (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis.Regenerative therapy should be provided to patients following diagnostic evidence of a need for biologic therapy, following a thorough discussion of the patient's needs and expectations, after properly educating the patient on the use and administration of biologics and in full light of the patient's medical history. Regenerative therapy may be provided independently or in conjunction with other modalities of treatment including a structured exercise program, physical therapy, behavioral therapy, and along with the appropriate conventional medical therapy as necessary. Appropriate precautions should be taken into consideration and followed prior to performing biologic therapy. Multiple guidelines from the Food and Drug Administration (FDA), potential limitations in the use of biologic therapy and the appropriate requirements for compliance with the FDA have been detailed in these guidelines. KEY WORDS: Regenerative medicine, platelet-rich plasma, medicinal signaling cells, mesenchymal stem cells, stromal vascular fraction, bone marrow concentrate, chronic low back pain, discogenic pain, facet joint pain, Food and Drug Administration, minimal manipulation, evidence synthesis.

3 Guideline Lumbar herniated disc treatment with percutaneous hydrodiscectomy. 2018

Anonymous3681096 / Silvinato, Antonio / Simões, Ricardo S / Buzzini, Renata F / Bernardo, Wanderley M. ·. Member of the Guidelines Program of the Brazilian Medical Association, São Paulo, SP, Brasil. · . Lecturer Professor of School of Medicine of USP; São Paulo, SP, Brasil. · . Coordinator of the Brazilian Medical Association Guidelines Program, São Paulo, SP, Brasil. ·Rev Assoc Med Bras (1992) · Pubmed #30672996.

ABSTRACT: Lumbar herniated disc are common manifestations of degenerative spine diseases, the main cause of radiated lower back pain. This guideline followed standard of a systematic review with recovery of evidence based on the movement of evidence-based medicine. We used the structured method for formulating the question synthesized by the acronym p.I.C.O., In which the p corresponds to the lumbar herniated disc, i to the treatment intervention with percutaneous hydrodiscectomy, c comparing with other treatment modalities, o the outcome of clinical evolution and complications. From the structured question, we identify the descriptors which constituted the evidence search base in the medline-pubmed databases (636 papers) and therefore, after the eligibility criteria (inclusion and exclusion), eight papers were selected to answer to clinical question. The details of the methodology and the results of this guideline are exposed in annex i.

4 Guideline Société d'imagerie musculosquelettique (SIMS), Fédération de radiologie interventionnelle (FRI), and Société française de radiologie (SFR) recommendations for epidural and transforaminal corticosteroid injections. 2018

Cotten, A / Drapé, J-L / Sans, N / Feydy, A / Bartoli, J-M / Meder, J-F. ·Centre de consultation et d'imagerie de l'appareil locomoteur, CHRU de Lille, rue du professeur Emile-Laine, 59037 Lille cedex, France. Electronic address: anne.cotten@chru-lille.fr. · AP-HP, site Cochin, 27, rue du Faubourg St-Jacques, 75679 Paris, France. Electronic address: jean-luc.drape@aphp.fr. · CHU Purpan, hôpital Pierre-Paul-Riquet, TSA 40031, 31059 Toulouse cedex 9, France. Electronic address: sans.n@chu-toulouse.fr. · AP-HP, site Cochin, 27, rue du Faubourg St-Jacques, 75679 Paris, France. Electronic address: antoine.feydy@aphp.fr. · Université d'Aix-Marseille, rue Saint-Pierre, 13385 Marseille cedex 05, France. Electronic address: jean-michel.bartoli@ap-hm.fr. · Université Paris V, 1, rue Cabanis, 75674 Paris cedex 14, France. Electronic address: jf.meder@ch-sainte-anne.fr. ·Diagn Interv Imaging · Pubmed #29454550.

ABSTRACT: -- No abstract --

5 Guideline National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. 2018

Stochkendahl, Mette Jensen / Kjaer, Per / Hartvigsen, Jan / Kongsted, Alice / Aaboe, Jens / Andersen, Margrethe / Andersen, Mikkel Ø / Fournier, Gilles / Højgaard, Betina / Jensen, Martin Bach / Jensen, Lone Donbæk / Karbo, Ture / Kirkeskov, Lilli / Melbye, Martin / Morsel-Carlsen, Lone / Nordsteen, Jan / Palsson, Thorvaldur Skuli / Rasti, Zoreh / Silbye, Peter Frost / Steiness, Morten Zebitz / Tarp, Simon / Vaagholt, Morten. ·Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark. m.jensen@nikkb.dk. · Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark. m.jensen@nikkb.dk. · The Danish Health Authority, Islands Brygge 67, 2300, Copenhagen S, Denmark. m.jensen@nikkb.dk. · Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark. · The Danish Health Authority, Islands Brygge 67, 2300, Copenhagen S, Denmark. · Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark. · Frederiksberg Municipality, Smallegade 1, 2000, Frederiksberg, Denmark. · Center for Spine Surgery and Research, Lillebaelt Hospital, Østre Hougvej 55, 5500, Middelfart, Denmark. · Center for Rheumatology and Spine Diseases, Frederiksberg Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark. · KORA-the Danish Institute for Local and Regional Government Research, Købmagergade 22, 1150, Copenhagen K, Denmark. · Research Unit for General Practice, Department of Clinical Medicine, Aalborg University, Fyrkildevej 7, 1, 9220, Aalborg O, Denmark. · Department of Occupational Medicine, Danish Ramazzini Center, Aarhus University Hospital, Noerrebrogade 42, 8000, Aarhus C, Denmark. · Spine Unit, Department of Orthopaedic Surgery, The National University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark. · Unit of Social Medicine, Department of Occupational and Environmental Medicine, Frederiksberg Hospital, Ndr. Fasanvej 57, Vej 8, 2.2, 2000, Frederiksberg, Denmark. · Aalborg Spine Clinic, Vingaardsgade 9, 9000, Aalborg, Denmark. · Department of Radiology, Bispebjerg and Frederiksberg Hospital, Ndr. Fasanvej 57, 2000, Frederiksberg, Denmark. · Department of Radiology, Rigshospitalet-Glostrup, Ndr. Ringvej 57, 2600, Glostrup, Denmark. · Copenhagen Back and Rehabilitation Centre, Mimersgade 41, 2200, Copenhagen, Denmark. · Department of Health Science and Technology, SMI®, Aalborg University, Frederik Bajers Vej 7D, 9220, Aalborg, Denmark. · , Bondetinget 24-01, 4000, Roskilde, Denmark. · Spine Section, Department of Neurosurgery, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark. · Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000, Copenhagen, Denmark. · , Hvidkildevej 62, 2400, København NV, Denmark. ·Eur Spine J · Pubmed #28429142.

ABSTRACT: PURPOSE: To summarise recommendations about 20 non-surgical interventions for recent onset (<12 weeks) non-specific low back pain (LBP) and lumbar radiculopathy (LR) based on two guidelines from the Danish Health Authority. METHODS: Two multidisciplinary working groups formulated recommendations based on the GRADE approach. RESULTS: Sixteen recommendations were based on evidence, and four on consensus. Management of LBP and LR should include information about prognosis, warning signs, and advise to remain active. If treatment is needed, the guidelines suggest using patient education, different types of supervised exercise, and manual therapy. The guidelines recommend against acupuncture, routine use of imaging, targeted treatment, extraforaminal glucocorticoid injection, paracetamol, NSAIDs, and opioids. CONCLUSION: Recommendations are based on low to moderate quality evidence or on consensus, but are well aligned with recommendations from international guidelines. The guideline working groups recommend that research efforts in relation to all aspects of management of LBP and LR be intensified.

6 Guideline ACR Appropriateness Criteria 2017

Anonymous3930905 / Bernard, Stephanie A / Kransdorf, Mark J / Beaman, Francesca D / Adler, Ronald S / Amini, Behrang / Appel, Marc / Arnold, Erin / Cassidy, R Carter / Greenspan, Bennett S / Lee, Kenneth S / Tuite, Michael J / Walker, Eric A / Ward, Robert J / Wessell, Daniel E / Weissman, Barbara N. ·Principal Author, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania. Electronic address: sbernard@psu.edu. · Panel Chair, Mayo Clinic, Phoenix, Arizona. · Panel Vice-Chair, University of Kentucky, Lexington, Kentucky. · NYU Center for Musculoskeletal Care, New York, New York. · University of Texas MD Anderson Cancer Center, Houston, Texas. · James J. Peters VA Medical Center, Bronx, New York; American Academy of Orthopaedic Surgeons. · Orthopaedics and Rheumatology of the North Shore, Skokie, Illinois; American College of Rheumatology. · UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons. · Medical College of Georgia at Georgia Regents University, Augusta, Georgia. · University of Wisconsin Hospital & Clinics, Madison, Wisconsin. · Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania. · Tufts Medical Center, Boston, Massachusetts. · Mayo Clinic, Jacksonville, Florida. · Specialty Chair, Brigham & Women's Hospital, Boston, Massachusetts. ·J Am Coll Radiol · Pubmed #28473095.

ABSTRACT: Inflammatory sacroiliitis or the seronegative axial spondyloarthropathies often presents as back pain or sacroiliac joint pain of more than 3-month duration with inflammatory symptoms and typically in patients younger than 45 years of age. Imaging plays an important role in diagnosis and disease monitoring. This article addresses the appropriate sequence of initial imaging for evaluation of a suspected spondyloarthropathy, the imaging follow-up of treatment response and the special considerations for imaging of trauma in patients with ankylosis of the spine. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

7 Guideline ACR Appropriateness Criteria 2017

Anonymous3670905 / Booth, Timothy N / Iyer, Ramesh S / Falcone, Richard A / Hayes, Laura L / Jones, Jeremy Y / Kadom, Nadja / Kulkarni, Abhaya V / Myseros, John S / Partap, Sonia / Reitman, Charles / Robertson, Richard L / Ryan, Maura E / Saigal, Gaurav / Soares, Bruno P / Tekes-Brady, Aylin / Trout, Andrew T / Zumberge, Nicholas A / Coley, Brian D / Palasis, Susan. ·Principal Author, Children's Medical Center, Dallas, Texas. Electronic address: tim.booth@childrens.com. · Co-Author, Seattle Children's Hospital, Seattle, Washington. · Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; American Pediatric Surgical Association. · Children's Healthcare of Atlanta, Atlanta, Georgia. · Texas Children's Hospital, Houston, Texas. · Emory University and Children's of Atlanta (Egleston), Atlanta, Georgia. · Hospital for Sick Children, Toronto, Ontario, Canada, neurosurgical consultant. · Children's National Medical Center, Washington, District of Columbia, neurosurgical consultant. · Stanford University, Stanford, California; American Academy of Pediatrics. · Medical University of South Carolina, Charleston, South Carolina; North American Spine Society. · Boston Children's Hospital, Boston, Massachusetts. · Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. · Jackson Memorial Hospital, Miami, Florida. · Johns Hopkins University School of Medicine, Baltimore, Maryland. · Johns Hopkins Medical Institute, Baltimore, Maryland. · Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. · Nationwide Children's Hospital, Columbus, Ohio. · Specialty Chair, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. · Panel Chair, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia. ·J Am Coll Radiol · Pubmed #28473069.

ABSTRACT: It is now generally accepted that nontraumatic back pain in the pediatric population is common. The presence of isolated back pain in a child has previously been an indication for imaging; however, recently a more conservative approach has been suggested using clinical criteria. The presence of constant pain, night pain, and radicular pain, alone or in combination, lasting for 4 weeks or more, constitute clinical red flags that should prompt further imaging. Without these clinical red flags, imaging is likely not indicated. Exceptions include an abnormal neurologic examination or clinical and laboratory findings suggesting an infectious or neoplastic etiology, and when present should prompt immediate imaging. Initial imaging should consist of spine radiographs limited to area of interest, with spine MRI without contrast to evaluate further if needed. CT of the spine, limited to area of interest, and Tc-99m bone scan whole body with single-photon emission computed tomography may be useful in some patients. The addition of intravenous contrast is also recommended for evaluation of a potential neoplastic or infectious process. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

8 Guideline Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. 2017

Qaseem, Amir / Wilt, Timothy J / McLean, Robert M / Forciea, Mary Ann / Anonymous5750896. ·From the American College of Physicians and Penn Health System, Philadelphia, Pennsylvania; Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; and Yale School of Medicine, New Haven, Connecticut. ·Ann Intern Med · Pubmed #28192789.

ABSTRACT: Description: The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain. Methods: Using the ACP grading system, the committee based these recommendations on a systematic review of randomized, controlled trials and systematic reviews published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for low back pain. Updated searches were performed through November 2016. Clinical outcomes evaluated included reduction or elimination of low back pain, improvement in back-specific and overall function, improvement in health-related quality of life, reduction in work disability and return to work, global improvement, number of back pain episodes or time between episodes, patient satisfaction, and adverse effects. Target Audience and Patient Population: The target audience for this guideline includes all clinicians, and the target patient population includes adults with acute, subacute, or chronic low back pain. Recommendation 1: Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation). Recommendation 2: For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation). Recommendation 3: In patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy, clinicians and patients should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy. Clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients. (Grade: weak recommendation, moderate-quality evidence).

9 Guideline Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. 2017

Wong, J J / Côté, P / Sutton, D A / Randhawa, K / Yu, H / Varatharajan, S / Goldgrub, R / Nordin, M / Gross, D P / Shearer, H M / Carroll, L J / Stern, P J / Ameis, A / Southerst, D / Mior, S / Stupar, M / Varatharajan, T / Taylor-Vaisey, A. ·UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Oshawa, ON, Canada. · Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada. · Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, Oshawa, ON, Canada. · Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada. · Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada. · Masters Program, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada. · Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, USA. · Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada. · Rehabilitation Research Centre, University of Alberta, Edmonton, AB, Canada. · Injury Prevention Centre and School of Public Health, University of Alberta, Edmonton, AB, Canada. · Department of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, ON, Canada. · Certification Program in Insurance Medicine and Medico-legal Expertise, Faculty of Medicine, University of Montreal, QC, Canada. · Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, ON, Canada. · Masters Program, University of Saskatchewan, Saskatoon, SK, Canada. ·Eur J Pain · Pubmed #27712027.

ABSTRACT: We conducted a systematic review of guidelines on the management of low back pain (LBP) to assess their methodological quality and guide care. We synthesized guidelines on the management of LBP published from 2005 to 2014 following best evidence synthesis principles. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane, DARE, National Health Services Economic Evaluation Database, Health Technology Assessment Database, Index to Chiropractic Literature and grey literature. Independent reviewers critically appraised eligible guidelines using AGREE II criteria. We screened 2504 citations; 13 guidelines were eligible for critical appraisal, and 10 had a low risk of bias. According to high-quality guidelines: (1) all patients with acute or chronic LBP should receive education, reassurance and instruction on self-management options; (2) patients with acute LBP should be encouraged to return to activity and may benefit from paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), or spinal manipulation; (3) the management of chronic LBP may include exercise, paracetamol or NSAIDs, manual therapy, acupuncture, and multimodal rehabilitation (combined physical and psychological treatment); and (4) patients with lumbar disc herniation with radiculopathy may benefit from spinal manipulation. Ten guidelines were of high methodological quality, but updating and some methodological improvements are needed. Overall, most guidelines target nonspecific LBP and recommend education, staying active/exercise, manual therapy, and paracetamol or NSAIDs as first-line treatments. The recommendation to use paracetamol for acute LBP is challenged by recent evidence and needs to be revisited. SIGNIFICANCE: Most high-quality guidelines recommend education, staying active/exercise, manual therapy and paracetamol/NSAIDs as first-line treatments for LBP. Recommendation of paracetamol for acute LBP is challenged by recent evidence and needs updating.

10 Guideline ACR Appropriateness Criteria Low Back Pain. 2016

Patel, Nandini D / Broderick, Daniel F / Burns, Judah / Deshmukh, Tejaswini K / Fries, Ian Blair / Harvey, H Benjamin / Holly, Langston / Hunt, Christopher H / Jagadeesan, Bharathi D / Kennedy, Tabassum A / O'Toole, John E / Perlmutter, Joel S / Policeni, Bruno / Rosenow, Joshua M / Schroeder, Jason W / Whitehead, Matthew T / Cornelius, Rebecca S / Corey, Amanda S. ·Fairfax Radiology Consultants PC, Fairfax, Virginia. Electronic address: nandini416@gmail.com. · Mayo Clinic Jacksonville, Jacksonville, Florida. · Montefiore Medical Center, Bronx, New York. · Children's Hospital of Wisconsin, Milwaukee, Wisconsin. · Bone, Spine and Hand Surgery, Chartered, Brick, New Jersey, American Academy of Orthopaedic Surgeons. · Massachusetts General Hospital, Boston, Massachusetts. · UCLA Medical Center, Los Angeles, California, neurosurgical consultant. · Mayo Clinic, Rochester, Minnesota. · University of Minnesota, Minneapolis, Minnesota. · University of Wisconsin Hospital and Clinic, Madison, Wisconsin. · Rush University, Chicago, Illinois, neurosurgical consultant. · Washington University School of Medicine, St Louis, Missouri, American Academy of Neurologists. · University of Iowa Hospitals and Clinics, Iowa City, Iowa. · Northwestern University Feinberg School of Medicine, Chicago, Illinois, neurosurgical consultant. · Walter Reed National Military Medical Center, Bethesda, Maryland. · Children's National Medical Center, Washington, District of Columbia. · University of Cincinnati, Cincinnati, Ohio. · Emory University, Atlanta, Georgia. ·J Am Coll Radiol · Pubmed #27496288.

ABSTRACT: Most patients presenting with uncomplicated acute low back pain (LBP) and/or radiculopathy do not require imaging. Imaging is considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. It is also considered for those patients presenting with red flags raising suspicion for serious underlying conditions, such as cauda equina syndrome, malignancy, fracture, and infection. Many imaging modalities are available to clinicians and radiologists for evaluating LBP. Application of these modalities depends largely on the working diagnosis, the urgency of the clinical problem, and comorbidities of the patient. When there is concern for fracture of the lumbar spine, multidetector CT is recommended. Those deemed to be interventional candidates, with LBP lasting for > 6 weeks having completed conservative management with persistent radiculopathic symptoms, may seek MRI. Patients with severe or progressive neurologic deficit on presentation and red flags should be evaluated with MRI. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

11 Guideline PURLs: More isn't better with acute low back pain treatment. 2016

Frazer, Kevin / Stevermer, James J. ·Department of Family and Community Medicine, University of Missouri-Columbia, MO, USA. ·J Fam Pract · Pubmed #27474822.

ABSTRACT: Adding cyclobenzaprine or oxycodone/acetaminophen to naproxen for the treatment of acute low back pain does nothing more than increase adverse effects.

12 Guideline Clinical Practice Guideline: Chiropractic Care for Low Back Pain. 2016

Globe, Gary / Farabaugh, Ronald J / Hawk, Cheryl / Morris, Craig E / Baker, Greg / Whalen, Wayne M / Walters, Sheryl / Kaeser, Martha / Dehen, Mark / Augat, Thomas. ·Senior Manager, Global Health Economics, Amgen, Inc., Thousand Oaks, CA. Electronic address: gglobe@amgen.com. · Private Practice, Columbus, OH. · Executive Director, Northwest Center for Lifestyle and Functional Medicine, University of Western States, Portland, OR. · Private Practice, Torrance, CA. · Private Practice, Chatsworth, GA. Electronic address: drgregbaker@yahoo.com. · Private Practice, Santee, CA. · Reference Librarian, Logan University, Chesterfield, MO. · Director of Academic Assessment, Logan University, Chesterfield, MO. · Private Practice, Mankato, MN. · Private Practice, Brunswick, ME. ·J Manipulative Physiol Ther · Pubmed #26804581.

ABSTRACT: OBJECTIVE: The purpose of this article is to provide an update of a previously published evidence-based practice guideline on chiropractic management of low back pain. METHODS: This project updated and combined 3 previous guidelines. A systematic review of articles published between October 2009 through February 2014 was conducted to update the literature published since the previous Council on Chiropractic Guidelines and Practice Parameters (CCGPP) guideline was developed. Articles with new relevant information were summarized and provided to the Delphi panel as background information along with the previous CCGPP guidelines. Delphi panelists who served on previous consensus projects and represented a broad sampling of jurisdictions and practice experience related to low back pain management were invited to participate. Thirty-seven panelists participated; 33 were doctors of chiropractic (DCs). In addition, public comment was sought by posting the consensus statements on the CCGPP Web site. The RAND-UCLA methodology was used to reach formal consensus. RESULTS: Consensus was reached after 1 round of revisions, with an additional round conducted to reach consensus on the changes that resulted from the public comment period. Most recommendations made in the original guidelines were unchanged after going through the consensus process. CONCLUSIONS: The evidence supports that doctors of chiropractic are well suited to diagnose, treat, co-manage, and manage the treatment of patients with low back pain disorders.

13 Guideline Reccomendations for the detection, study and referral of inflammatory low-back pain in primary care. 2015

Juanola Roura, Xavier / Collantes Estévez, Eduardo / León Vázquez, Fernando / Torres Villamor, Antonio / García Yébenes, María Jesús / Queiro Silva, Rubén / Gratacós Masmitja, Jordi / García Criado, Emilio / Giménez, Sergio / Carmona, Loreto / Anonymous670807. ·Servicio de Reumatología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, España; Institut d'Investigació Biomédica de Bellvitge, Barcelona, España; Grupo de Estudio de las Espondiloartritis de la SER. · Instituto Maimónides de Investigación Biomédica de Córdoba,, Córdoba, España; Servicio de Reumatología, Hospital Universitario Reina Sofía, Córdoba, España; Universidad de Córdoba, Córdoba, España; Grupo de Estudio de las Espondiloartritis de la SER. · Centro de Salud Universitario San Juan de la Cruz, Pozuelo de Alarcón, Madrid, España. · Centro de Salud Arroyo de la Media Legua, Servicio Madrileño de Salud, Madrid, España. · Instituto de Salud Musculoesquelética, Madrid, España. · Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Grupo de Estudio de las Espondiloartritis de la SER. · Hospital Parc Taulí, Sabadell, Barcelona, España; Grupo de Estudio de las Espondiloartritis de la SER. · Unidad de Gestión Clínica Fuensanta, Córdoba, España; Sociedad Española de Médicos de Atención Primaria (SEMERGEN-AP). · Unidad de Gestión Clínica Limonar, Málaga, España; Sociedad Española de Médicos de Atención Primaria (SEMERGEN-AP). · Instituto de Salud Musculoesquelética, Madrid, España. Electronic address: loreto.carmona@inmusc.eu. ·Reumatol Clin · Pubmed #25241260.

ABSTRACT: OBJECTIVE: To design a strategy for the early detection and referral of patients with possible spondyloarthritis based on recommendations developed, agreed upon, and directed to primary care physicians. METHODS: We used a modified RAND/UCLA methodology plus a systematic literature review. The information was presented to a discussion group formed by rheumatologists and primary care physicians. The group studied the process map and proposed recommendations and algorithms that were subsequently submitted in two Delphi rounds to a larger group of rheumatologists and primary care physicians. The final set of recommendations was derived from the analysis of the second Delphi round. RESULTS: We present the recommendations, along with their mean level of agreement, on the early referral of patients with possible spondyloarthritis. The panel recommends that the study of chronic low back pain in patients under 45 years be performed in four phases 1) clinical: key questions, 2) clinical: extra questions, 3) physical examination, and 4) additional tests. CONCLUSIONS: The level of agreement with these simple recommendations is high. It is necessary to design strategies for the education and sensitization from rheumatology services to maintain an optimal collaboration with primary care and to facilitate referral to rheumatology departments.

14 Guideline [German Society for Rheumatology S3 guidelines on axial spondyloarthritis including Bechterew's disease and early forms: 3 Clinical symptoms]. 2014

Kiltz, U / Rudwaleit, M / Sieper, J / Krause, D / Chenot, J-F / Stallmach, A / Jaresch, S / Oberschelp, U / Schneider, E / Swoboda, B / Böhm, H / Heiligenhaus, A / Pleyer, U / Böhncke, W-H / Stemmer, M / Braun, J / Anonymous1880805. ·Deutsche Gesellschaft für Rheumatologie (DGRh), -, -, Uta.Kiltz@elisabethgruppe.de. ·Z Rheumatol · Pubmed #25181971.

ABSTRACT: -- No abstract --

15 Guideline Report of the National Institutes of Health task force on research standards for chronic low back pain. 2014

Deyo, Richard A / Dworkin, Samuel F / Amtmann, Dagmar / Andersson, Gunnar / Borenstein, David / Carragee, Eugene / Carrino, John / Chou, Roger / Cook, Karon / DeLitto, Anthony / Goertz, Christine / Khalsa, Partap / Loeser, John / Mackey, Sean / Panagis, James / Rainville, James / Tosteson, Tor / Turk, Dennis / Von Korff, Michael / Weiner, Debra K / Anonymous3600803. ·Professor, Department of Family Medicine, Oregon Health & Science University, Portland, OR; Professor, Department of Medicine, Oregon Health & Science University, Portland, OR; Professor, Department of Public Health & Community Medicine, Oregon Health & Science University, Portland, OR. Electronic address: deyor@ohsu.edu. · Professor, Department of Oral Medicine, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA. · Research Associate Professor, Department of Rehabilitation Medicine, University of Washington, Seattle, WA. · Professor, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL. · Clinical Professor, Department of Medicine, George Washington University Medical Center, Washington, DC. · Professor, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA. · Associate Professor, Department of Radiology, Johns Hopkins University, Baltimore, MD. · Professor, Department of Medicine, Oregon Health and Science University, Portland, OR; Professor, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR. · Research Associate Professor, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. · Professor, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA. · Vice Chancellor of Research & Health Policy, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA. · Deputy Director, National Institutes of Health, Division of Extramural Research, National Center for Complementary and Alternative Medicine, Bethesda, MD. · Professor Emeritus, Department of Neurological Surgery, University of Washington, Seattle, WA; Professor Emeritus, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA. · Professor, Department of Anesthesia and Pain Management, Stanford University, Stanford, CA. · Program Director, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Orthopaedics Research Program, Bethesda, MD. · Chief, Department of Physical Medicine and Rehabilitation, New England Baptist Hospital, Roxbury Crossing, MA. · Professor, Department of Community and Family Medicine and The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH. · Professor Emeritus, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA. · Senior Investigator, Group Health Research Institute, Seattle, WA. · Professor, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Professor, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA; Professor, Department of Anesthesiology; University of Pittsburgh, Pittsburgh, PA. Geriatric Research, Educational and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA. ·J Manipulative Physiol Ther · Pubmed #25127996.

ABSTRACT: OBJECTIVES: Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed nonspecific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. The purpose of this article is to disseminate the report of the National Institutes of Health (NIH) task force on research standards for cLBP. METHODS: The NIH Pain Consortium charged a research task force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel developed a 3-stage process, each with a 2-day meeting. RESULTS: The panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimal data set to describe research subjects (drawing heavily on the Patient Reported Outcomes Measurement Information System methodology); reporting "responder analyses" in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved these recommendations, which investigators should incorporate into NIH grant proposals. CONCLUSIONS: The RTF believes that these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of cLBP. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes. We expect the RTF recommendations will become a dynamic document and undergo continual improvement.

16 Guideline Chronic nonspecific low back pain: rehabilitation. 2013

Anonymous4810775. ·Projeto Diretrizes da Associação Médica Brasileira, São Paulo, SP, Brasil. ·Rev Assoc Med Bras (1992) · Pubmed #24239032.

ABSTRACT: -- No abstract --

17 Guideline Referral strategy for early recognition of axial spondyloarthritis: consensus recommendations from the Hong Kong Society of Rheumatology. 2013

Mok, C C / Tam, L S / Leung, M H / Ying, K Y / To, C H / Lee, K L / Ho, L Y / Yip, M L / Tsui, H S / Chan, T H / Lee, K W / Li, E K M / Anonymous3830773. ·Department of Medicine, Tuen Mun Hospital. ·Int J Rheum Dis · Pubmed #24164836.

ABSTRACT: Low back pain is one of commonest problems prompting a visit to the family physician. Up to 5% of patients with chronic low back pain in the primary care setting are diagnosed as having spondyloarthritis, which includes the prototype disease ankylosing spondylitis. Making a diagnosis of ankylosing spondylitis is often delayed for years, leading to significant pain, impairment of quality of life, disability and productivity loss. A recent breakthrough in the treatment of spondyloarthritis is the anti-tumor necrosis factor-alpha biologics, which lead to rapid relief of pain and inflammation, and improvement in all clinical parameters of the disease. Patients with early spondyloarthritis often respond better than those with late established disease. With proper recognition of inflammatory back pain, and the use of magnetic resonance imaging, spondyloarthritis can now be diagnosed much earlier before features are evident on plain radiographs. Referral to the rheumatologist based on onset of back pain (> 3 months) before the age of 45 years, and an inflammatory nature of the pain, or the presence of human leukocyte antigen-B27, or sacroiliitis by imaging, have been confirmed in multi-center international studies to be a pragmatic approach to enable early diagnosis of spondyloarthritis. This referral strategy has recently been adopted by the Hong Kong Society of Rheumatology for primary care physicians and non-rheumatology specialists.

18 Guideline Low back and radicular pain: a pathway for care developed by the British Pain Society. 2013

Lee, J / Gupta, S / Price, C / Baranowski, A P / Anonymous1180762. ·Pain Medicine, Cayman Islands Hospital, PO Box 915, Grand Cayman KY1-1103, Cayman Islands. john.lee@uclmail.net ·Br J Anaesth · Pubmed #23794653.

ABSTRACT: These consensus guidelines aim to provide an overview of best practice for managing chronic spinal pain reflecting the heterogeneity of low back pain. Most guidelines have covered only one aspect of spinal care and thus have been divisive and potentially worsened the quality of care. Additionally, some of the evidence base is subjective and of poor quality. The British Pain Society low back pain pathway has reached across all disciplines and involved input from patients. It is recognized, however, that there is an urgent need for further good-quality clinical research in this area to underpin future guidelines. Considerable work is still needed to clarify the evidence; however, foundations have been laid with this pathway. Key features include: risk stratification; clarification of intensity of psychological interventions; a logical progression for the management of sciatica; and decision points for considering structural interventions such as spinal injections and surgery.

19 Guideline [Diagnosis and conservative treatment of low back pain: review and guidelines of the Croatian Vertebrologic Society]. 2012

Grazio, Simeon / Curković, Bozidar / Vlak, Tonko / Kes, Vanja Basić / Jelić, Miroslav / Buljan, Danijel / Gnjidić, Zoja / Nemcić, Tomislav / Grubisić, Frane / Borić, Igor / Kauzlarić, Neven / Mustapić, Matej / Demarin, Vida / Anonymous5140762. ·Klinika za reumatologiju, fizikalnu medicinu i rehabilitaciju, KBC Sestre milosrdnice, Zagreb, Hrvatska. simeon.grazio@zg.t-com.hr ·Acta Med Croatica · Pubmed #23814971.

ABSTRACT: Low back pain (LBP) is a very common condition with high costs of patient care. Medical doctors of various specialties from Croatia have brought an up-to-date review and guidelines for diagnosis and conservative treatment of low back pain, which should result in the application of evidence-based care and eventually better outcomes. As LBP is a multifactorial disease, it is often not possible to identify which factors may be responsible for the onset of LBP and to what extent they aggravate the patient's symptoms. In the diagnostic algorithm, patient's history and clinical examination have the key role. Furthermore, most important is to classify patients into those with nonspecific back pain, LBP associated with radiculopathy (radicular syndrome) and LBP potentially associated with suspected or confirmed severe pathology. Not solely a physical problem, LBP should be considered through psychosocial factors too. In that case, early identification of patients who will develop chronic back pain will be helpful because it determines the choice of treatment. In order to make proper assessment of a patient with LBP (i.e. pain, function), we should use validated questionnaires. Useful approach to a patient with LBP is to apply the principles of content management. Generally, acute and chronic LBP cases are treated differently. Besides providing education, in patients with acute back pain, advice seems to be crucial (especially to remain active), along with the use of drugs (primarily in terms of pain control), while in some patients spinal manipulation (performed by educated professional) or/and short-term use of lumbosacral orthotic devices can also be considered. The main goal of treating patients with chronic LBP is renewal of function, even in case of persistent pain. For chronic LBP, along with education and medical treatment, therapeutic exercise, physical therapy and massage are recommended, while in patients with a high level of disability intensive multidisciplinary biopsychosocial approach has proved to be effective.

20 Guideline Clinical policy: critical issues in the prescribing of opioids for adult patients in the emergency department. 2012

Cantrill, Stephen V / Brown, Michael D / Carlisle, Russell J / Delaney, Kathleen A / Hays, Daniel P / Nelson, Lewis S / O'Connor, Robert E / Papa, Annmarie / Sporer, Karl A / Todd, Knox H / Whitson, Rhonda R / Anonymous6090737. · ·Ann Emerg Med · Pubmed #23010181.

ABSTRACT: -- No abstract --

21 Guideline Low back pain. 2012

Delitto, Anthony / George, Steven Z / Van Dillen, Linda / Whitman, Julie M / Sowa, Gwendolyn / Shekelle, Paul / Denninger, Thomas R / Godges, Joseph J / Anonymous1671168. ·School of Health & Rehabilitation Sciences, University of Pittsburgh, Pennsylvania, USA. delitto@pitt.edu ·J Orthop Sports Phys Ther · Pubmed #22466247.

ABSTRACT: The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF). The purpose of these low back pain clinical practice guidelines, in particular, is to describe the peer-reviewed literature and make recommendations related to (1) treatment matched to low back pain subgroup responder categories, (2) treatments that have evidence to prevent recurrence of low back pain, and (3) treatments that have evidence to influence the progression from acute to chronic low back pain and disability.

22 Guideline Practice guidelines for the management of low back pain. Consensus Group of Practice Parameters to Manage Low Back Pain. 2011

Guevara-López, Uría / Covarrubias-Gómez, Alfredo / Elías-Dib, Jorge / Reyes-Sánchez, Alejandro / Rodríguez-Reyna, Tatiana Sofía / Anonymous4360719. ·Dirección de Educación e Investigación en Salud, Unidad Médica de Alta Especialidad Dr. Victorio de la Fuente Narváez, Instituto Mexicano del Seguro Social, México, DF, Mexico. uriahguevara91@yahoo.com.mx ·Cir Cir · Pubmed #22381000.

ABSTRACT: It has been documented that pain in its diverse modalities is the most common cause of medical attention. In Mexico, an increase in its frequency has promoted its consideration in several health programs. On the other hand, inadequate pain management will cause severe physical, psychoaffective, and socioeconomic repercussions for patients, families, and public health services. Despite this panorama, there has not been an agreement to establish better diagnostic and therapeutic methods for the management of chronic pain. A consensus group was reunited and was integrated by medical experts from private and public institutions and from various states of the Mexican Republic. To assure the development of these practice guidelines, these experts had experience in the assessment and treatment of conditions causing pain. With the guidelines used by other consensus groups, meetings were held to analyze and discuss published literary evidence for the management of low back pain. The recommendations were classified according to their methodological strength. As a result of this meeting, consensus recommendations were based on evidence and operational conclusions of such proactive educational plans, institutional policies and diagnostic recommendations for pharmacological and nonpharmacological treatment in order for Mexican physicians to provide a better therapeutic approach to low back pain.

23 Guideline [Epidural spinal cord stimulation for therapy of chronic pain. Summary of the S3 guidelines]. 2011

Tronnier, V / Baron, R / Birklein, F / Eckert, S / Harke, H / Horstkotte, D / Hügler, P / Hüppe, M / Kniesel, B / Maier, C / Schütze, G / Thoma, R / Treede, R D / Vadokas, V / Anonymous40706. ·Neurochirurgische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Deutschland. volker.tronnier@uk-sh.de ·Schmerz · Pubmed #21938604.

ABSTRACT: Epidural spinal cord stimulation (SCS) is a reversible but invasive procedure which should be used for neuropathic pain, e.g. complex regional pain syndrome I (CRPS) and for mostly chronic radiculopathy in connection with failed back surgery syndrome following unsuccessful conservative therapy. Epidural SCS can also successfully be used after exclusion of curative procedures and conservative therapy attempts for vascular-linked pain, such as in peripheral arterial occlusive disease stages II and III according to Fontaine and refractory angina pectoris. Clinical practice has shown which clinical symptoms cannot be successfully treated by epidural SCS, e.g. pain in complete paraplegia syndrome or atrophy/injury of the sensory pathways of the spinal cord or cancer pain. A decisive factor is a critical patient selection as well as the diagnosis. Epidural SCS should always be used within an interdisciplinary multimodal therapy concept. Implementation should only be carried out in experienced therapy centers which are in a position to deal with potential complications.

24 Guideline Evidence-based risk assessment and recommendations for physical activity: arthritis, osteoporosis, and low back pain. 2011

Chilibeck, Philip D / Vatanparast, Hassanali / Cornish, Stephen M / Abeysekara, Saman / Charlesworth, Sarah. ·College of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, Canada. phil.chilibeck@usask.ca ·Appl Physiol Nutr Metab · Pubmed #21800948.

ABSTRACT: We systematically reviewed the safety of physical activity (PA) for people with arthritis, osteoporosis, and low back pain. We searched PubMed, MEDLINE, Sport Discus, and the Cochrane Central Register of Controlled Trials (1966 through March 2008) for relevant articles on PA and adverse events. A total of 111 articles met our inclusion criteria. The incidence for adverse events during PA was 3.4%-11% (0.06%-2.4% serious adverse events) and included increased joint pain, fracture, and back pain for those with arthritis, osteoporosis, and low back pain, respectively. Recommendations were based on the Appraisal of Guidelines for Research and Evaluation, which applies Levels of Evidence based on type of study ranging from high-quality randomized controlled trials (Level 1) to anecdotal evidence (Level 4) and Grades from A (strong) to C (weak). Our main recommendations are that (i) arthritic patients with highly progressed forms of disease should avoid heavy load-bearing activities, but should participate in non-weight-bearing activities (Level 2, Grade A); and (ii) patients with osteoporosis should avoid trunk flexion (Level 2, Grade A) and powerful twisting of the trunk (Level 3, Grade C); (iii) patients with acute low back pain can safely do preference-based PA (i.e., PA that does not induce pain), including low back extension and flexion (Level 2, Grade B); (iv) arthritic patients with stable disease without progressive joint damage and patients with stable osteoporosis or low back pain can safely perform a variety of progressive aerobic or resistance-training PAs (Level 2, Grades A and B). Overall, the adverse event incidence from reviewed studies was low. PA can safely be done by most individuals with musculoskeletal conditions.

25 Guideline American Osteopathic Association guidelines for osteopathic manipulative treatment (OMT) for patients with low back pain. 2010

Anonymous5760680 / Anonymous5770680. · ·J Am Osteopath Assoc · Pubmed #21135197.

ABSTRACT: BACKGROUND: Osteopathic manipulative treatment (OMT) is a distinctive modality commonly used by osteopathic physicians to complement conventional treatment of musculoskeletal disorders, including those that cause low back pain. Osteopathic manipulative treatment is defined in the Glossary of Osteopathic Terminology as: "The therapeutic application of manually guided forces by an osteopathic physician (US Usage) to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction. OMT employs a variety of techniques." Somatic dysfunction is defined as: "Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial and myofascial structures, and their related vascular, lymphatic, and neural elements. Somatic dysfunction is treatable using osteopathic manipulative treatment." Previous published guidelines have been based on literature reviews and meta-analyses of spinal manipulation for low back pain. They have not specifically addressed OMT and generally have focused on spinal manipulation as an alternative to conventional treatment. The purpose of this study was to assess the efficacy of OMT for somatic dysfunction associated with low back pain by osteopathic physicians and osteopathic practitioners trained in osteopathic palpatory diagnosis and manipulative treatment. METHODS: Computerized bibliographic searches of MEDLINE, OLDMEDLINE, EMBASE, AMED, MANTIS, OSTMED (OSTMED.DR), and the Cochrane Central Register of Controlled Trials were supplemented with additional database and manual searches of the literature. Six trials, involving eight OMT vs control treatment comparisons, were included because they were randomized controlled trials of OMT that involved blinded assessment of low back pain in ambulatory settings. Data on trial methodology, OMT and control treatments, and low back pain outcomes were abstracted by two independent reviewers. Effect sizes were computed using Cohen d statistic, and meta-analysis results were weighted by the inverse variance of individual comparisons. In addition to the overall meta-analysis, subgroup meta-analyses were performed according to control treatment, country where the trial was conducted, and duration of follow-up. Sensitivity analyses were performed for both the overall and subgroup meta-analyses. RESULTS: Osteopathic manipulative treatment significantly reduced low back pain (effect size, -0.30; 95% confidence interval, -0.47 to -0.13; P=.001). Subgroup analyses demonstrated significant pain reductions in trials of OMT vs active treatment or placebo control and OMT vs no treatment control. There were significant pain reductions with OMT regardless of whether trials were performed in the United Kingdom or the United States. Significant pain reductions were also observed during short-, inter mediate-, and long-term follow-up. CONCLUSIONS: Osteopathic manipulative treatment significantly reduces low back pain. The level of pain reduction is clinically important, greater than expected from placebo effects alone, and may persist through the first year of treatment. Additional research is warranted to elucidate mechanistically how OMT exerts its effects, to determine if OMT benefits extend beyond the first year of treatment, and to assess the cost-effectiveness of OMT as a complementary treatment for low back pain.

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