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PubMed1989

[Backache--causes, diagnosis and therapy].

Low back pain is considered to be a symptom of a variety of changes and disorders affecting the lumbar spine, the sacrococcyx and pelvis, but it may also be a symptom of disorders affecting the neighboring organs. If these points are taken into account and an accurate diagnostic evaluation including such modern procedures as scintigraphy, CT and MR imaging, low back pain can now--in contrast to 50 years ago--be analysed, and often treated with considerable success. In many cases, conservative treatment proves possible. In the presence of relevant morphological findings, however, various surgical procedures, developed in particular in recent years, offer new possibilities.

Back Pain↗
PubMed1989

[Therapeutic local anesthesia in backache].

Low back pain for which operative therapy is not indicated, can prove resistant to treatment even with the aggressive application of conservative measures and the use of suitable drugs. Here, local anesthesia can often have a decisive influence on pain. On account of possible complications, particular consideration must be given to pharmacological aspects. Moreover, certain minimum demands must be met by the equipment and personnel staffing of a pain clinic, and also the possibilities for monitoring the patient. Within the framework of an interdisciplinary pain clinic, the various blockade techniques employed for therapeutic local anesthesia provide suitable possibilities for combatting this type of pain.

Analgesia, Epidural↗
PubMed1989

[Surgical therapy of backache].

Apart from disc prolapse, there is a range of other disorders associated with low back pain, for which, when all conservative efforts have failed, surgical treatment should be offered. It must be emphasized, however, that the indication for surgery needs to be rigorously applied, since the most common cause of failure of surgical therapy is an erroneous surgical indication. Here, the clarification of the cause of the pain and not the diagnosis per se is decisive. In particular in degenerative disorders of the lumbar spine in the elderly, the diagnoses established often have little pathological value. Unfortunately, in many cases the real cause of low back pain still cannot be clarified with certainty. Our experience to date, however, in particular with the use of modern implants, shows that, in cases of lumbar spinal stenosis especially, tumors and pronounced segmental instability, excellent results can be achieved with surgery.

Back Pain↗
PubMed1989

[Backache--risk of disability?].

Low back pain and lumbo-ischialgia are symptoms of degeneration of the intervertebral disc with protrusion. The possible invalidity in these patients is difficult to assess. Several factors do influence the outcome of conservative and/or neurosurgical treatment: Some patients are treated as out-patients only instead of the necessary in-patient treatment. Only in case of a paresis or disturbances of the urine bladder function, operation must be done without pretreatment. The quality of the postoperative treatment decides on the later result! The clinical assessment of a patient is not possible without examination and intensive questions about the circumstances of daily life, holiday activities, hobbies and so on. Discrepancies between the result of examination and the answers to these questions give a signal to a very critical evaluation of this patient.

Back Pain↗
PubMed1989

[What do the waiting lists cost? A study of patients with backache].

Waiting for treatment usually contributes to patients' psychological and financial problems. In this study we calculate and discuss the economic implications of these patients being on a waiting list for treatment. Our calculations show that the income lost in economic production is higher than the cost of treating patients with degenerative low back pain. This is mainly because these afflictions strike people of working age and render them invalids, whereas early adequate treatment usually allows the patients to take up their previous work.

Appointments and Schedules↗
PubMed1989

[Critical review of the epidemiology of backache].

High frequency occurrence of back pain and the magnitude of its impact on society explain the large number of epidemiologic studies. Most investigators have considered back pain as a whole, without reference to different etiological types of back pain, probably for lack of an available classification of these types. Prevalence of back pain in general populations varies between 14 and 45% and annual incidence around 6%. Risk factors for low back pain are often social or cultural factors: smoking, driving, psychological stress. These factors seem to be far from the starting point of the disease process. Vagueness of case descriptions may explain in part the disappointing results of analytic surveys. Indistinctness of risk factors, especially workplace factors, is the principal reason for the poor results of intervention epidemiology: very few primary prevention programs and no educational programs ("low back school") have been shown to be really effective.

Back Pain↗
PubMedDate not supplied

[Backache].

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Adult↗
PubMed1989

[Systemic pharmacotherapy in backache. Indications and practical applications].

The treatment of acute and chronic low back pain is a problem frequently encountered in the doctor's office. Selective drug therapy has a useful role to play within the framework of the overall therapeutic strategy. Indications and practical application of the major analgesic agents in various low back pain conditions are discussed.

Adrenal Cortex Hormones↗
PubMed1985

Backache.

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Back Pain↗