EL-3-06-01
PAIN MANAGEMENT - LOW BACK PAIN
Alf L. Nachemson (Goeteborg University, Goeteborg, Sweden)
Presently too much unnecessary treatment by unproven methods is practised for the majority of our low back pain patients. It seems that "industries" are built to take care of the predicament of low back pain. In the future such clinical freedom will not be allowed. It could be considered both unethical and a waste of the patient's time and the society's resources. Governments are assembling groups of specialists to go through the literature in order to give a scientific basis for both non-operative and operative treatment of low back pain. Looking at the scientific evidence from randomized controlled trials (RCT) for patients within the first month of pain there is little evidence that physical therapy is of any help except when information, advice and simple exercises have been combined with manipulative treatment. Recent studies indicate that simple explanation, encouragement and less prescription of pain killers should be the treatment of choice for the primary care physician. At a later stage RCT have demonstrated positive results with behavior psychology based activation programs.
Seminar-3-02-01
SHORT AND LONG OF NERVE CONDUCTION STUDIES
Jun Kimura (Kyoto University, Kyoto, Japan)
Optimal application of the nerve conduction study depends on an understanding of the principles and a recognition of the pitfalls of the technique. In the evaluation of a focal lesion such as compressive neuropathy, inclusion of the unaffected segments in calculation dilutes the effect of slowing at the site of lesion and lowers the sensitivity of the test. Therefore, incremental stimulation across the shorter segment helps isolate a localized abnormality that may otherwise escape detection. Thus, the study of short segments provides better resolution of restricted lesions. In assessing a more diffuse or multi-segmental process as might be seen in polyneuropathies, the longer the segment under study, the more evident the conduction delay. In another word, this approach has an advantage in accumulating all the segmental abnormalities, which individually might not show a clear deviation from the normal range. Evaluating a longer segment also improves the accuracy for the same absolute error in measurement.
