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Episode 95: Making the treatment of low back pain less of a pain in the derrière – part 1

In episode 95, Mike and James look at the issue of non-specific low back pain and deal with concepts around diagnosis and we find out that x-rays aren’t that useful but MRI’s in the right patient population can play a role. We then start to look at the available evidence for treatment (massage, acupuncture, spinal manipulation) and at the end Mike tries to give James a two-handed neck massage and in retaliation James does acupuncture on Mike with a harpoon.

Show notes

1) Guidelines on back pain

TOP Back Guideline

American College Guideline

Ann Intern Med 2007; 147:478-91

Ann Intern Med 2007;147:505-14 (meds)

Ann Intern Med 2007;147:492-504 (non-meds)

Summary of guidelines

BMJ 2006; 332:1430-4

Evidence-based Series (non-medication) on Back Pain

Spine 2009, 34:1066-77 and 1078-93 and 1094-1109

2) Imaging – x-ray, CT and MRI

BMJ 2001;322:400-5

Lancet 2009;373:463-72

JAMA 2003;289:2810–8

MRI likelihood ratios

Condition Positive Likelihood ratio Negative Likelihood ratio
Herniated Disc 1.1 – 33 0 – 0.93
Stenosis 3.2 – ? 0.1 – 0.14
Cancer 8.3 – 31 0.07 – 0.19
Infection 12 0.04

Ann Intern Med 2002;137:586-97

BMJ 2006;332:1430-4

Ann Intern Med 2007;147:478-91

4) Massage

Cochrane 2008; 4: CD001929

5) Acupuncture

Ann Intern Med. 2005 Apr 19;142(8):651-63

Cochrane 2005; 1:CD001351

6) Spinal manipulation

Cochrane 2004; 1: CD000447

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