Technology Review

Documentation Based Care

HEALTH TECHNOLOGY ASSESSMENT UNIT MEDICAL DEVELOPMENT DIVISION MINISTRY OF HEALTH

BACKGROUND
Neck and back pain is an extremely common problem. It is estimated that four out of five people suffer from neck and back pain sometimes in their lives. It is usually not caused by any serious illness or damage and can be prevented if proper care or treatment is taken. Most of these pains resolve quickly, at least enough to continue normal activity. If the pain recurs often, active rehabilitation through exercise is highly recommended to improve lost function and relieve pain.

The “de-conditioning syndrome” is a major factor in chronic neck and back pain. Inactivity and guarding of the painful area lead to de-conditioning in which the structures and functions of the spine deteriorate. In this process, coordination and motor control of the spine also become impaired. The result is chronic pain and reduced tolerance to loading and movement. Reduced muscular endurance and loss of protective mechanisms increase the risk of further injury.

There were number of treatment available for chronic low back pain (CLBP) such as cognitive therapy, exercise therapy, brief educational interventions, multi-disciplinary (bio-psycho-social) treatment can recommended for non –specific CLBP. Back school and short courses of manipulation can also be considered. However the use of physical therapy likes TENS, heat/cold, traction, laser, traction, ultrasound, short wave, interferential, massage, corsets were not recommended. Pharmacological treatment use noradrenergic or noradrenergic-serotoninergic antidepressant, weal opioids, and the short term use of NSAIDs, muscle relaxants and capsicum plasters can be recommended for pain relief, strong opioid can be considered in patients who do not respond to all other treatment modalities. Apart from these invasive treatments likes acupuncture, epidural, corticosteroids, intra-articular (facet) steroid injections, local facet nerve blocks, intradiscal injections, trigger point injections, botulinum toxin, prolotherapy, radiofrequency facet denervation, intradiscal radiofrequency lesioning, intradiscal electrothermal therapy, radiofrequecy lesioning of the dorsal root ganglion, and spinal cord stimulation are not recommended for CLBP, on the other hand, percutaneous electrical nerve stimulation (PENS) and neuroreflexotherapy can be considered where available. Surgery is not recommended for non specific CLBP unless patients have failed to all the recommended treatments after 2 year of treatment with carefully selected patients. There is no single intervention is likely to be effective in treating the overall problem of CLBP of longer duration and more substantial disability, owing to its multidimensional nature (Airaksinen , Hildebrandt, Mannion et al, 2004)

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