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Low back pain - Some real answers (Paperback, Illustrated Ed)
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Low back pain - Some real answers (Paperback, Illustrated Ed)
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Back pain is the commonest form of rheumatism and it is estimated
to affect between 65% and 80% of populations sampled. The costs of
back pain-related medical care and disability compensation make it
one of society's most significant non-lethal medical conditions.
Whilst mortality is low, its morbidity is high, inconvenience
great, and economic burden massive. The actual symptom of back pain
is one of the commonest and most perplexing encountered in medical
practice. A proper understanding of what it means is crucial for
further medical advance. However, the field of back pain research
probably has more experts than any other. Anybody who has back pain
will, as often as not, expound views on all matters concerning
causation and expectations. Indeed, it is not for a lack of ideas
that this field of investigation has failed to make progress. A
respected senior investigator advised me early on that patients
could not even tell which side their pain was on. It was only many
years later that I discovered why. Though the initial incident or
accident would seem important to the patient and to the researcher,
it is remarkable how little it helps distinguish patterns of back
pain. Tests of inappropriate behaviour in the past have been widely
disseminated and yet even the originators have said that they
cannot be sure of the implications of positive non-organic test
findings. This book will show that these 'indicators' are not what
they seem to be. In many cases, it is difficult to tell which level
in the lumbar spine the pain comes from, and thus treatments such
as injections or operation, may be given at the wrong level, let
alone the wrong side. Though the various forms of back pain
treatment seem to help some patients, when these same treatments
are subjected to randomised controlled trials, the evidence for
efficacy seems to all but vanish. With all these difficulties and
uncertainties, it can be seen why low back pain presents one of the
most fallible fields of healthcare. This book indicates that there
are ways of dealing with the majority of these problems. Many of
the answers from the research conducted were most unexpected. The
reader is also advised that the scientific approach cannot deliver
hard and fast answers to all contemporary questions in such a wide
field and much has depended on the choice of problems to study.
Whilst the tests used to distinguish the patterns in this study
have their limitations, and whilst there is, as yet, only limited
evidence as to the underlying pathology for the patterns
recognised, it is felt that some of the other patterns identified
are descriptive of diagnoses that are generally accepted. If the
answers that are put forward appear to change the direction of
understanding, it is hoped that you, the reader, will be able to
carry the enquiry further when you see patients, advise treatment
or even experience back pain yourself!
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