Saturday, March 28, 2009


Back Pain
There's been a trend in medical to provide evidence that a particular treatment works for any given medical condition. Likewise, guidelines for the accurate diagnosis of conditions like low back pain are based on evidence when it's available. But no such guidelines exist for dealing with low back pain in children and teens.
Developing evidence-based diagnostic and treatment guidelines for adults is one thing. Providing the same for children is something else entirely. When there's a lack of evidence of back pain, then physicians rely on what's called consensus-based evidence.
Back pain can be caused by injury, inflammation, tension or spasm of the muscle, ligament, cartilage or bone. Arthritis, muscle strain, osteoporosis, sciatica and stress are common causes of back pain. the Treatment can include rest, exercise, medication and manipulation.
What have been these case series told us so far? First, back pain in children and teens is far more common than ever thought before. Second, there's very rare a known (pathologic) cause such as a tumor, fracture, or infection.
But please keep this in mind just because you have back pain doesn't mean you'll need serious medical attention or surgery. It does mean that you're in good company and that you have an arrange of treatment options to get you feeling good
Among people reporting ongoing, serious low back pain in 1993, about 75% said they had seen a physician, physical therapist or chiropractor at least once during the past year. In 2005, 85% said they had done so. However, the average number of health care visits remained the same, at just 17 a year.
In the United States, back pain is reported to occur at least once in 84% of adults below the age of 55. Nearly all of them will have at least one recurrence. It is the second most common illness-related reason given for a missed workday and the most common cause of disability.
The conventional medical treatment for back pain follows a predictable script. After the patient is interviewed and given a physical exam, he or she undergoes a series of diagnostic tests. his normally includes x-rays, CT scans, and Magnetic Resonace Imgae(MRI).
Disability followed the same pattern as pain (decreased at first then slowly increased again). Along the same lines, patients were satisfied with the treatment and treatment results for the first five months. Patients reported being able to work more hours with fewer days absent during the year of the study.
Compared to other studies done in this area, the patients in this study had a much greater reduction in pain/back pain intensity. Similar to other studies, the results didn't last. There were no complications, so it seems the procedure is safe and effective for short-term pain relief.
When looking for the cause of low back pain in children and teens, as the old saying goes think horses not zebras. Physicians should look for the obvious and not chase after serious pathology when there's no sign that any exists. Using a checklist of red flags to identify serious conditions is still advised so far.
The authors make several suggestions based on the results of this study. First, it may be possible to get more people back to work all-time (many returned part-time) if the treatment is followed by a formal occupational/vocational rehabilitation program. Second, patients may get benefit from a supervised low back pain fitness program.
There is general though not unanimous agreement that back pain is more common in people in heavy manual occupations who undertake heavy lifting. People in such jobs take significantly more time off thir duty with back pain.
The findings also raise questions as to the effectiveness of current back pain treatments, Carey said. For example, another recent study he participated in showed that exercise remains underutilized as a means of treating chronic back and include neck pain, though numerous studies show it can be effective.
Brookh Marthin, An University of Washington health services researcher who specializes in studying spinal services, agreed that a doubling of chronic back pain over 15 years raises serious issues about current treatment approaches.
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