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There is low- to moderate-quality evidence that Pilates exercises taught by certified instructors improve pain and reduce disability in patients with chronic low back pain. It is unclear whether a Pilates regimen is superior to other exercise plans for the treatment of low back pain. Adverse effects are uncommon.
Naproxen alone is as effective as naproxen plus oxycodone/acetaminophen or naproxen plus cyclobenzaprine (Flexeril) in reducing pain and improving function in adults with acute musculoskeletal LBP without radicular symptoms. Adverse events were significantly more common in patients additionally trea...
It is hard to figure out what to do with these results. On the one hand, steroid injection did not provide a significant benefit compared with placebo injection in patients with radicular pain or spinal stenosis. However, part of the reason for this may be the significant and sustained improvement of pain scores seen with the placebo injection.
After controlling for the placebo effect that may accompany an epidural steroid injection, treatment with gabapentin is as effective as the injection in reducing radicular leg pain in the short term (three months). A placebo bump in response, if present, is likely to be transient.
Although acetaminophen was hoped to be a safer alternative to nonsteroidal anti-inflammatory drugs and opioids for the treatment of common musculoskeletal problems, on average it provides only minimal pain relief and improvement in function for patients with low back pain or osteoarthritis. Some per...
Among adults 65 years or older who present to primary care clinicians for a new episode of back pain, early imaging (before six weeks) resulted in no improved outcomes at one year, but increased overall health care costs by almost 30%.
Giving patients a pedometer, a walking diary, and instructions to walk at least four days per week, then gradually increase the walk's duration and intensity (see synopsis) results in improvement in pain and disability similar to usual physical therapy or a group exercise program.
What are the red flags of cauda equina syndrome? Which patients require imaging? Which treatments are most effective? When should surgery be considered? Get the answers to these questions, and more, on chronic low back pain.
Surgical diskectomy can be offered to patients with refractory sciatica, but there is only modest, short-term improvement in leg pain and disability scores. Epidural steroid injections may be offered to patients with sciatica of more than six months' duration.
Overall, in patients with chronic low-back pain, opioids are moderately more effective than placebo in the short term for pain relief and slightly more effective in the short term for improving function. However, data for long-term use are virtually nonexistent. The long-term use of opioids for pati...