Chronic pain is a costly and debilitating condition that has proven difficult to treat, solely with medical interventions, due to the complex interplay of biological, psychological, and social factors in its onset and persistence. Many studies have demonstrated the effectiveness of interdisciplinary treatment that includes psychosocial interventions for low back pain. Nevertheless, these interventions continue to be under-utilized due to concerns of cost and applicability. The present study utilized a cost utility analysis to evaluate effectiveness and associated costs of interdisciplinary early intervention for individuals with acute low back pain that was identified as high-risk for becoming chronic. Treatment effectiveness was evaluated using a standard pain measure and quality-adjusted life years, and associated medical and employment costs were gathered for 1 year. Results indicated that subjects improved significantly from pretreatment to 1-year follow-up, and that the early intervention group reported fewer health-care visits and missed workdays than the treatment as usual group. The majority of 1,000 bootstrapped samples demonstrated the dominance of the early intervention program as being both more effective and less costly from a societal perspective. The early intervention treatment was the preferred option in over 85% of samples within an established range of acceptable costs. These results are encouraging evidence for the cost-effectiveness of interdisciplinary intervention and the benefits of targeted early treatment.
NEE is an independent predictor of long-term pain relief after LESI for LSR. Abnormal NEE is predictive of better outcome than normal NEE. A regression equation including NEE and other independent predictors was predictive of pain and functional outcomes.
This study examined the effects of tobacco smoking and cigarette nicotine content on four dimensions of emotional behavior (peripheral autonomic, electrocortical, cognitive, and overt motor) during both the preparation for and the performance of a psychosocially stressful task (extemporaneous speaking). Three groups of experienced smokers either did not smoke, smoked a low-nicotine cigarette, or smoked a high-nicotine cigarette while they were preparing to perform the speaking task. All subjects reported prior to the experiment that they did experience smoking as relaxing and that they did experience a stronger desire to smoke under a variety of negative affective states compared to a variety of positive affective states. In spite of these verbal reports, however, neither the smoking ritual nor the nicotine content of the cigarette smoked had a significant effect on any of the four dimensions of the emotional behavior studied during either the preparation for or the performance of the task. These results were discussed in terms of previous psychophysiological studies utilizing different types of stressors and behavioral indices of emotion.
Patients with chronic low back pain suggestive of lumbar lumbar zygopophyseal joint arthropathy responded similarly to triamcinolone or hyaluronate injections. Synvisc-One group showed significant short- and long-term functional improvement and short-term pain improvement; KA group showed only significant short-term functional benefit and no significant short- or long-term pain improvement.
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