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If someone wants to a) discuss what those alternative medical treatments actually are; and b) discuss what the other 83.2% of adult Americans do, then maybe it belongs. -- Calton 01:43, 13 Feb 2005 (UTC)
The reason so many use CAM is that conventional medicine is not very successful in providing symptom relief. On this page we should focus on conventional medicine in a systematic way. We should link to alternative forms of treatment as they are described.-- Mylesclough 05:57, 8 October 2005 (UTC)
I have been going through the list of orthopaedic conditions listed as stubs and suggesting this template for Orthopaedic Conditions (see
Talk:Orthopedic surgery)
Name
Definition
Synonyms
Incidence
Pathogenesis
Pathology
Stages
Classification
Natural History/Untreated Prognosis
Clinical Features
Investigation
Non-Operative Treatment
Risks of Non-Operative Treatment
Prognosis following Non-Operative Treatment
Operative Treatment (Note that each operations should have its own wiki entry)
Risks of Operative Treatment
Prognosis Post Operation
Complications
Management
Prevention
History
--
Mylesclough
05:57, 8 October 2005 (UTC)
As I sit here, I've got a cold-water bottle pressed up against my lower back. Wouldn't it be great if there were a section in this article on what do do, what not to do, if you've got lower back pain? Wadsworth 19:20, 28 October 2005 (UTC)
Seems the articles Back pain and low back pain need to be merged? Badgettrg 09:55, 2 February 2007 (UTC)
Personally, I think there is plenty to say on the topic of low back pain that it should stay as its own article, as opposed to upper back pain and mid back pain, etc. I will come back when I have more time and try to add more points to help people who have low back pain, such as a symptoms section. I think coccyx pain should be its own page and will see if there is an article already started on this topic. Am new to wikipedia, so please excuse (and advise) if I have missed one of the rules - I'm trying!
Two very important articles came out today in the New England Journal of Medicine about surgery for back pain. However, it is impossible to easily add this to WikiPedia - should the content go in low back pain, back pain, lumbago, or under lumbar disc herniation and spinal stenosis? Consequently, I aggregated the surgical content from low back pain and back pain and placed in the appropriate specific disease such as lumbar disc herniation and spinal stenosis. Now surgical information only needs to go in under the disease that is being treated.
Hope this is ok, feel free to revert if not, but better would be if you can find a better way to organize these sections. Badgettrg 15:52, 31 May 2007 (UTC)
I removed these two paragraphs as they seemed to go into a great deal of detail (out of balance with the rest of the page, which is an overview) in an area that has little to do with diagnosis of the cause of low back pain. Both hip and leg length differences are not among the common causes of lbp. Hope this helps make the article more useful.
Once again, this paragraph is deleted. If hip rotation is notable, it should have a Wikipedia article, with a reference on this page. Campingcar ( talk) 12:19, 5 November 2008 (UTC)
Are there honestly no medical articles to link to concerning the massive problems women have with back pain stemming from breast size and therefore bra heftiness? And you'd think there would be more to say about the curvature occuring in pregnant women, there's only a whisper of that on this page. —Preceding unsigned comment added by 71.7.244.18 ( talk) 20:32, 2 March 2008 (UTC)
The physiotherapy method developed by [ [2][Robin Anthony McKenzie]]: http://www.mckenziemdt.org/about.cfm —Preceding unsigned comment added by PeterKnaggs ( talk • contribs) 06:39, 22 July 2008 (UTC)
I have re-worded the lead from “Low back pain (sometimes referred to generally as lumbago) is a common musculoskeletal disorder causing back pain in the lumbar vertebrae” to “Low back pain (sometimes referred to generally as lumbago) is a common symptom of musculoskeletal disorders or of disorders involving the lumbar vertebrae.” The former says (literally) that pain causes itself; the latter is somewhat awkwardly-worded, so I recommend that it be rewritten again. 69.140.152.55 ( talk) 12:06, 10 October 2008 (UTC)
The article cites evidence in ClinicalEvidence.com (British Medical Journal). Unfortunately this is paid subscription only. Wouldn't the freely available Cochrane Collaboration cochrane.org be a better source? Campingcar ( talk) 13:28, 14 October 2008 (UTC)
Anthony ( talk) 09:11, 16 November 2008 (UTC)
Useful - perspective on incapacity caused by LBP and related pain conditions doi: 10.1093/bmb/ldl008 JFW | T@lk 00:43, 28 October 2008 (UTC)
It says there is disagreement but all the reviews say that it is equivalent to standard treatment. Doc James ( talk · contribs · email) 11:34, 19 November 2009 (UTC)
Doc- You reverted my edit showing significant studies that CHIROPRACTIC manipulation was significantly superior to the generic manipulative therapy provided in the studies that were quoted in the article under manipulation. Thus the fact that the apropos studies predated those in the article was irrelevant.
The article's paragraph is about generic, NOT chiropractic methods, and even they, did not really support the assertion that this part of the article made. Thus, I was not replacing the later "studies", only one of which reached any conclusion about efficacy at all; the other simply said they "could reach no valid conclusions". I was making a new statement to differentiate the results of CMT, not MT, by studies for CMT.
I feel this should be re-reverted, and at least discussed here. Also "Doc" Д-р СДжП,ДС 23:07, 18 December 2009 (UTC)
Cheers back to you, but you didn't get my point or choose not to. Nothing contradicory hre. Two different concepts! Please reconsider this. Д-р СДжП,ДС 23:18, 18 December 2009 (UTC)
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Additionally how is it being determined that the studies are "significant"? That sounds like original research to me to boost a particular WP:POV.-- Literaturegeek | T@1k? 22:55, 16 January 2010 (UTC)
Drsjpdc have you read WP:MEDRS? It gives guidance on sourcing.-- Literaturegeek | T@1k? 22:58, 16 January 2010 (UTC)
conservative treatment is undoubtedly the recommendation, but the statement that clinicial evidence has been reviewed and summarized into recommendations, followed by a teaser citation that requires log in to see any specific evidence or recommendations, is of little value. A better cite is needed.
Appears to be an ad for some kind of proprietary "source" of information.
Current cite is to:
Clinical Evidence: The international source of the best available evidence for effective health care |format= |work= |accessdate=}}(log-in required)</ref>:
— Preceding unsigned comment added by 68.165.11.243 ( talk • contribs) 14:18, 28 March 2010
perhaps the surgery section could use some more details along with the works cited, for individuals who are seeking all the various forms of surgical options to help deal with the pain.
It appears there are 3 methods of reaching the surgical site, or the actual spinal cord; the traditional surgical method which requires a large incision to the back, the endoscopic method which requires a small incision, and fiber option methods such as the new AccuraScopic procedure, which attempts to gain access to the spinal cord via a tiny tube and fiber optic camera. It appears the AccuraScopic proceudre uses the same methods to treat back pain (removal of unwanted tissue, etc.); but uses a better method to gain access to the site. Seems to be valuable information for those seeking relief. —Preceding unsigned comment added by 173.85.204.34 ( talk) 11:41, 29 March 2010 (UTC)
The systematic review of Machado et al suffers from the same problem as many other reviews in the field of musculosceletal medicine. They included in their review some studies that did not properly implement the McKenzie method. Considering e.g. the work of Browder et al 2007 Long et al 2004, a clear advantage is seen, when clinical subgroups are treated with sepcific interventions.I'll add some more references in the near future.-- Blueeye1967 ( talk) 11:05, 11 April 2011 (UTC)
Cause: Misaligned pelvis - pelvic obliquity, anteversion or retroversion - provide links to the anatomical movements, or pictures
Prevention: Exercise helps keep one’s back healthy and strong. - this statement is too vague and informal. Use more specific language, such as “Exercise can help maintain XYZ (what does ‘strong’ mean here?) and the health of the XYZ (what does healthy mean here?)” or similar.
What does ‘back strengthening’ - specify what motions, and what muscles?
“If one must stand for long periods of time, it is recommended to have something to rest one foot at a time on to alleviate back strain” This statement is informal. Also, it is unclear what “back strain” means. Stretching causes strain.. does it mean that the lumbar muscle can relax when resting one foot at a time? It does not make sense if the other side has to pick up the slack.
Ignoring this rule is a surefire way to an injury of one’s back : this is also informal. Needs formal language.
Eat a nutritious and healthy diet. => This should not be a command. Rewrite to say It is important to ..
There have been numbers of studies conducted about the relationship between the spine and nicotine. => Shorten this sentence or eliminate, as it is redundant.
Management:
The conventions of physical therapy => just say ‘Physical therapy’
Bed rest is discouraged as not being helpful => …as it is not helpful.
Epidemiology: Move the section to the beginning, right after “Classification” —Preceding unsigned comment added by Scholarchanter ( talk • contribs) 00:34, 1 June 2010 (UTC)
Under neoplasms, lymphoma should be added. An enlarged lymph node (pressing on a nerve) can cause excruciating back pain, as I know from bitter experience. My daughter, age 16 at the time, was finally diagnosed with Hodgkins Lymphoma (NSHD IVB). The backpain disappeared after only one cycle of MOPP/ABV! And since I have heard more cases of back pain in HD. Kind Regards. —Preceding unsigned comment added by Yospangsada ( talk • contribs) 20:15, 23 May 2011 (UTC)
From 2012 http://www.ncbi.nlm.nih.gov/pubmed/22335313 Doc James ( talk · contribs · email) 22:35, 7 June 2012 (UTC)
It should be noted that Cochrane review are independent studies, and they do systematic reviews. Not governed by commercial interests - such as those of chiropracters. 129.180.1.214 ( talk) —Preceding undated comment added 02:25, 8 November 2012 (UTC)
I reviewed the sourcing and have reassessed the article as C-class, there are some significant issues with the sourcing. I'm planning on working on this article to bring it up to GA over the next while.
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04:49, 26 February 2013 (UTC)
Hey Doc James, I have self-reverted this edit of mine because it changed what you had just previously done in that paragraph. Both our edits were adding the 2012 Cochrane review for acute LBP, but my edit also changed the order within the paragraph to be chronological. I don't really have much of a preference, but I usually default to chronology for ordering equally high-quality sources. Any preference on your part? If you prefer your version I will leave it, otherwise I will restore the chronological ordering that I applied here. Regards Puhlaa ( talk) 05:51, 3 March 2013 (UTC)
The prognosis section states that “most people with acute lower back pain recover completely over a few weeks” and uses this source. However, I think the text may not represent the source very well. The source says "Many cases are self-limited and resolve with little intervention. However, 31 percent of persons with low back pain will not fully recover within six months, although most will improve. Recurrent back pain occurs in 25 to 62 percent of patients within one to two years, with up to 33 percent having moderate pain and 15 percent having severe pain."
I should say that I am not a doctor, but are not such statements in danger of being tautological anyway? One could argue that, by definition, pain from which the patient does not largely recover over a few weeks would, because of this lack of recovery, retrospectively be classified as chronic rather than acute. The situation does not seem to me to be helped by the vague and muddled nature of some medical terminology - it often being unclear, when the term "acute" is used of a symptom, whether this term refers to the rapidity of onset, or rather to the short course up till recovery. (If the latter, then you do not know initially whether the current pain will ultimately be labelled acute or chronic, so what use is a pair of prognoses, one for acute and the other for chronic?) — Preceding unsigned comment added by 83.217.170.175 ( talk) 03:56, 3 June 2013 (UTC)
The text in the 'prognosis' section might benefit from a brief discussion of the growing consensus among experts that the very favourable prognosis for low back pain suggested by early research may be incorrect. For example, this synthesis by experts in the area of spine research indicates that "Several high quality studies reconfirmed the growing recognition that back pain is often intermittent, varies in presentation and severity, and persists in many primary care patients." It may be that the second sentence in the prognosis section "At 6 weeks complete recovery rates have been reported at between 40-90%" gives enough of a range to capture all of the different perspectives on prognosis and keeps the discussion simple? Thoughts? Puhlaa ( talk) 16:42, 16 April 2013 (UTC)
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16:53, 16 April 2013 (UTC)
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18:01, 16 April 2013 (UTC)
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18:33, 16 April 2013 (UTC)Checking back in here. Management now states, "The condition is normally not serious, most often resolves without significant intervention, and recovery is aided by attempting to resume normal activity as soon as possible within the limits of pain." sourced to Casazza 2012; regarding *acute* pain, Prognosis says "Pain and disability usually improve significantly in the first six weeks after onset of symptoms. After six weeks, improvement slows with only small gains up to one year. At one year after onset, pain and disability levels are low to minimal, on average." sourced to Menezes Costa 2021, and this had to be balanced a bit with other sources like Casazza that paint a rosier picture. Good?
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15:40, 1 August 2013 (UTC)
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20:35, 2 August 2013 (UTC)
An association has recently been found between chronic back pain and spinal disc infection with bacterium Propionibacterium acnes.
This research shows that 40% of chronic lower back pain could be caused by bacteria, and that a significant percentage of people with lower back pain following a herniated disc and swelling in the spine could find relief by taking an antibiotic.
It may be an idea to include this new research in this article. I know association does not automatically imply causation; nevertheless, this is an important discovery.
References:
Acne bacteria to blame for back pain
Low Back Pain Linked to Bacterial Infection
Drgao ( talk) 21:14, 13 May 2013 (UTC)
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15:42, 1 August 2013 (UTC)Hello, my employer has a patient guide to low back pain. It is written in simple English and these two pages contain most or all of what patients with this problem need to know if they have access to modern healthcare. In summary, it tells people to wait a few weeks before committing to diagnostics which is aligned with the content of this article. Something inappropriate about this is that it quotes some treatment prices in USA dollars and calls drugs by USA names. The content was written by Consumer Reports but came from a health suggestion by American College of Physicians and their journal, Annals of Internal Medicine, who both endorse this guide. This guide is part of a larger health campaign intended to have fewer procedures in cases when the procedure is unlikely to benefit them.
Is this suitable for inclusion as an external link?
Thoughts? Feedback? Blue Rasberry (talk) 20:52, 5 September 2013 (UTC)
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03:00, 6 September 2013 (UTC)The above condition causes lower back pain. See references of that page, but most are case reports, so might need a proper ref... Lesion ( talk) 17:13, 30 August 2013 (UTC)
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17:25, 30 August 2013 (UTC)
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18:40, 30 August 2013 (UTC)
Someone asked me why I put a citation needed tag on something that they knew that I could have fixed myself. I was not expecting anyone else to take action - I put that in the article to remind myself. In addition to being an encyclopedia Wikipedia is also my personal notebook. Thanks. I will fix the problem tomorrow. Blue Rasberry (talk) 02:48, 6 September 2013 (UTC)
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03:02, 6 September 2013 (UTC)
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15:30, 6 September 2013 (UTC)
No controversial points only need one or at most two refs. Not five. Clutters things IMO. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 14:52, 6 September 2013 (UTC)
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15:31, 6 September 2013 (UTC)
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15:37, 11 September 2013 (UTC)
Lately, there have been some edits around a couple articles labeled as reviews. I can't help but think that perhaps these reviews aren't as systematic/ideal MEDRS as one would hope. I'm thinking they could be too influenced by author opinion instead of being systematic. What about incorporating doi: 10.1097/AJP.0b013e31824909f9 to smooth things out? Biosthmors ( talk) 09:24, 13 September 2013 (UTC)
Not to say that's going to be an unbiased source either... doi: 10.1002/14651858.CD009265 appears like a promising proposal. I wonder when/if results are coming? Biosthmors ( talk) 09:35, 13 September 2013 (UTC)
Too bad doi: 10.1002/14651858.CD001351.pub2 says it was last assessed as up to date in 2003. Biosthmors ( talk) 09:39, 13 September 2013 (UTC)
Actually Furlan (first author on the Cochrane review and in the protocol) is the first author doi: 10.1155/2012/953139 there. I think that source would be probably the best for helping us here. Biosthmors ( talk) 09:42, 13 September 2013 (UTC)
Yeah it's a 2012 systematic review and it has been cited 12 times. Looks like Furlan decided to publish in a journal other than one under Cochrane. We should incorporate that source and weight it over either Marlowe or Casazza, in my opinion. Biosthmors ( talk) 09:48, 13 September 2013 (UTC)
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17:40, 13 September 2013 (UTC)There are issues with Marlowe. It states "the extract increased the number of patients reporting mild to no LBP over the course of 4 weeks from 1% to 24%, as well as decreasing the number of patients complaining of severe pain: 59% at week 1 and 35% at week"
The article says "The study was originally designed to measure Harpagophytum's effectiveness by measuring the use of supplementary pain-killer Tramadol over its final 3 weeks. However, this did not differ between the Harpagophytum and placebo groups nor was the consumption closely related to the amount of pain. Further analysis, though, revealed that 9 out of 51 patients who received the extract were pain free at the end of treatment compared to only 1 out of 54 patients who received placebo." Subgroup analysis or further analysis that was not set out ahead of time does not count. It is like doing a trial and looking at 20 separate different outcomes. Than if one of those outcomes hits 0.05 you claim that X was a success. If one has more than one primary outcome than they must change the p value to less than 0.05. And there are formulas for this. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 19:05, 13 September 2013 (UTC)
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19:13, 13 September 2013 (UTC)
Am going to store some comments here for whoever gets to them first.
Doc James ( talk · contribs · email) (if I write on your page reply on mine) 04:52, 11 September 2013 (UTC)
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12:52, 11 September 2013 (UTC) 2) fixed now, there were 2 Manchikanti's.
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15:54, 11 September 2013 (UTC)
Agree that this bit was overly complicated and thus moved here. It may do well on a subpage or the pain article. " Ingoing nerve fibers carry nerve impulses from sensory nerve cells in the lower back towards the central nervous system. Signals travel to the dorsal root ganglia (the connections between the peripheral nerves and the central spinal nerves) along three types of afferent nerve fibers: A beta fibers, A delta fibers, and C fibers. [1] The fibers of the A group are coated to differing degrees with myelin, [1] an electrical insulator that prevents signal loss and increases transmission speed. [2] The A beta fibers transmit light touch but not pain messages, and as they are heavily myelinated, they transfer their signals quickly. The A delta and C fibers handle pain messages, and as they are less myelinated, they transfer their signals more slowly. [1] These nerve cells release certain chemicals ( peptides) in response to painful event. [1] Common analgesics generally treat back pain by interfering with these neurochemical processes involved in the initiation and transmission of pain signals. [3]" Doc James ( talk · contribs · email) (if I write on your page reply on mine) 23:32, 13 September 2013 (UTC)
I just noticed this: "...following an episode of low back pain it is likely that a patient will have further episodes..." in this 2010 review: How do we define the condition ‘recurrent low back pain’? A systematic review. Worth mentioning?
I'm confused by the use of these terms in the literature, and by their use here. If they're generally interchangeable, can we stick to using just one of them? -- Anthonyhcole ( talk · contribs · email) 06:38, 11 September 2013 (UTC)
I have listed some possible issues I found while reading through the article, some may be to minor to consider? I am happy to help remedy anything that is similarly viewed by other editors as an issue.
Puhlaa ( talk) 03:43, 26 July 2013 (UTC)
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20:02, 26 July 2013 (UTC)
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21:02, 2 August 2013 (UTC)Good stuff, thanks for the notes.
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20:30, 1 August 2013 (UTC)
Yes, there's not much in the literature on prevention. The basic summary of the current state of the literature on that is Hoy 2012, which says "Further research is needed to identify risk factors and culturally appropriate interventions to prevent and treat low back pain." The NIH 2013 fact sheet mentions exercise and proper ergonomics/lifting techniques. Another review states exercise is helpful in preventing recurrence of LBP but not in preventing the initial onset of it. I can clarify that content in the article a bit. The only other things I found were that back belts and shoe insoles are not effective.
Regarding mattresses, I did not see anything in up-to-date literature about them so that's why I took it out. You mentioned Jacobsen 2010-- I did see it but as you noted it's a primary source. The only recent thing I have that does mention mattresses is Haldeman 2008 which simply lists "mattresses" as a "lifestyle therapy" available but otherwise does not talk about them at all. So overall I couldn't find sufficient coverage in up-to-date secondary sources to support content on mattresses. If you can find a good up-to-date secondary source on mattresses, it'd be great to have.
You're correct in that the sources available pay a lot more attention to things like acupuncture and chiropractic, so that's what the article content follows. In the overview sources I reviewed, heritability received almost zero mention. I looked at the meta-analysis implicating PARK2 you provided. As our article states, the large majority of LBP is considered to be caused by musculoskeletal sprain and strain, and also there's a lot of people walking around with disc problems that do not actually cause LBP. The conclusions of the PARK2 article are very tentative ("provides evidence of association ... suggests ... may influence"). And although it's a meta-analysis it comes across as a primary and not a secondary source: they're data-mining, not aggregating existing results. My thought is not to use it in this article but if you have a strong counter-argument I'm interested to hear.
Regarding the multifidus, Salzberg 2012's physiology overview does mention it, along with all of the other muscles and joints involved in the complex network of back structure, but does not call it out as a particular cause of LBP over all the other components. None of the other secondary sources I reviewed that cover cause or risks mention the multifidus in particular, they just talk about the network of back muscles and joints in general. I'd have WP:WEIGHT concerns if the article ends up covering the multifidus in detail but not the other components; likewise I'd be concerned about how big the pathophysiology section would end up being compared to the rest of the article if I tried to cover them all in detail.
Thanks for the careful review and feedback, it's very much appreciated.
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20:30, 1 August 2013 (UTC)
The first thing I want to mention is that I think we have to be careful to avoid letting our real-world experiences with these sorts of subjects drive the weight we give the topics in the article. It's great you found a particular mattress that you feel worked for your back pain, but we have to go by WP:DUEWEIGHT and let the reliable sources drive the weight.
It is kind of surprising how little there seems to be in the sourcing on the relationship between back pain and mattresses. To answer your question: Believe it or not, the word "mattress" does not appear at all in the full text of Kelly et al 2012 ( PMID 20842008). And I saw you added a bit to the article sources to Chou 2007 ( PMID 17909209). The addition of that content sourced to that source is not something I really agree with, honestly, as it's a bit old per WP:MEDDATE, and more importantly that's a guideline from only one medical organization. What's critical here is that we have a 2010 review of guidelines from many medical organizations worldwide (Koes 2010, PMID 20602122), and that source, surprisingly enough, does not mention mattresses at all either. I think it is a WP:WEIGHT problem to mention something from the 2007 guideline of only one medical organization when we have a 2010 review of guidelines worldwide that does not. I am not going to remove the content myself but I am pointing Biosthmors to it here for his review.
Regarding Manusov, that review is taken from this special series on LBP from 13 articles published together in The Clinics, a very well-respected publisher. I really like series like these, because they are organized by a single editing team to ensure complete and balanced coverage of a topic across all the articles. I think this is better than dipping a ladle into PubMed and seeing what you happen to pull up, because that way can get very unbalanced coverage: you might pull three review articles on some relatively obscure topic related to your subject just because three different journals by chance happened to publish on it recently, and it'll skew your article. So I've been using this series of The Clinics articles to drive the sourcing.
So I hope you understand here why I'm concerned about how you seem to be going about coming up with suggestions for what to weight in the article. You got benefit from focusing on your mattress and multifidus, but we don't want the experiences of one person to drive the weight. A better way to go about making sure we adhere to
WP:WEIGHT is to use a balanced, recent series of review articles.
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16:54, 6 September 2013 (UTC)
GA toolbox |
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Reviewing |
Reviewer: Biosthmors ( talk · contribs) 07:21, 5 August 2013 (UTC)
Be back later! Biosthmors ( talk) 07:21, 5 August 2013 (UTC)
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13:04, 5 August 2013 (UTC)
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02:32, 20 August 2013 (UTC)I'm caught up now on all your bullet points... looking forward to the next round of comments, hope we can finish this up soon. Thanks...
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19:59, 30 August 2013 (UTC)
Starting to look today...
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18:24, 2 September 2013 (UTC)
@
Biosthmors: caught up to you!
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04:10, 3 September 2013 (UTC)
@
Biosthmors: Agreed Furlan 2012 is better than Casazza for acupuncture, made the change. What else is left?
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17:42, 13 September 2013 (UTC)
Biosthmors and
Jmh649, I did a little final reviewing and copyediting and added a bit about multifidus from Menezes 2010 per ImperfectlyInformed's suggestion on the Talk page. I think the mattress mention is OK. I think I'm all caught up on all the outstanding items now, and am pretty happy with it. Anything else?
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04:23, 15 September 2013 (UTC)
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03:20, 27 August 2013 (UTC)
Also please do all you can to keep the language as simple as possible. Low back pain is one of our most important and most read articles. The translators will appreciated the easier English as we work to bring this content to other languages. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 18:34, 28 August 2013 (UTC)
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14:47, 12 September 2013 (UTC)The possible range often goes up to 80%. I suggest we change it to between 40 and 80% for lifetime prevalence [6]. The current ref mentions the issue of low income countries having a low rate. Data quality is often not as good in these areas. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 18:56, 28 August 2013 (UTC)
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03:04, 30 August 2013 (UTC)Hello, I have had a look at this article and would support its nomination to GA status, this article is structured very well, every sentence has a clear purpose, and overall I find it very easy to read and full of content. If I have one comment it's about the introduction:
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17:41, 1 September 2013 (UTC)
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01:33, 6 September 2013 (UTC)
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01:09, 8 September 2013 (UTC)
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17:07, 8 September 2013 (UTC)
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01:45, 8 September 2013 (UTC)
and this is cited to a 2011 Cochrane review, which I don't have, I'm using Guild's report on it. As we have a newer review which is pointing to a newer Cochrane review, I will age out the 2008 Cochrane review, which should resolve this.In a review of randomized controlled trials a total of 13,995 patients with lumbar supports, also known as corsets, were assessed for the effect on prevention of low back pain and treatment. Little to no evidence was found that lumbar support prevented back injury more than education on proper lifting technique. The review included 954 patients in a comparison of lumbar supports with no treatment for prevention of low back pain, with similar results. There was little to no evidence to support their use for prevention of low back injury.
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01:40, 8 September 2013 (UTC)
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01:57, 13 September 2013 (UTC)
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14:06, 13 September 2013 (UTC)
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17:44, 13 September 2013 (UTC)
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20:10, 8 September 2013 (UTC)
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20:05, 8 September 2013 (UTC)
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13:10, 9 September 2013 (UTC)
After all the recent edits/copyedits, I think we now have ourselves a good article. My thanks to all involved! Biosthmors ( talk) 09:05, 15 September 2013 (UTC)
ImperfectlyInformed after reviewing the sourcing again, I agree we can have the mattress mention you added. I also did a bit more reading on the multifidus and it does seem important. Salzberg gave it a whole paragraph and also devoted half a page to a diagram of them. That, plus the review you found, justifies a bit of specialized content on them. I added a new paragraph to Pathophysiology on it using Salzberg and Menezes that you found, please take a look and comment, if you would.
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04:16, 15 September 2013 (UTC)
Are there cultural variations, say? Or does all this info pertain worldwide, like Africa, India, Malaysia, etc? Soranoch ( talk) 21:42, 12 October 2013 (UTC)
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00:41, 13 October 2013 (UTC)This article could be improved by adequately represent the effectiveness of manual therapies and acupuncture. The evidence is of clear benefit for SM and c-LBP and mixed for acute. There also needs to be a discussion why osteopathic physicians, chiropractors and physical therapists manipulate the spine. That is is to help reduce pain, improve mobility to mechanical dysfunctions of the spinal segments. These mechanical dysfunctions are in the WHO and are most reliable with painful palpation of a spinal segments as this review suggest [7]. The JAMA has also recommended chiropractic care for LBP [8]. So, it seems like we may be minimizing the appropriateness of chiropractic management of low back pain. Massage has also been shown to be of short term benefit in this new review [9]. There is also good evidence of acupuncture for low back pain, maybe even moreso than medication, "The current evidence is encouraging in that acupuncture may be more effective than medication for symptom improvement or relieve pain better than sham acupuncture in acute LBP" [10] in this new review. The lede is rather ambiguous with spinal manipulation when the research is much more succinct, there is no mention of acupuncture whatsoever despite the evidence which suggests comparable effectiveness. Hoping we can have a good discussion and help make this article better by offering a complementary POV. Regards, DVMt ( talk) 03:49, 16 May 2014 (UTC)
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15:11, 16 May 2014 (UTC)
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20:01, 16 May 2014 (UTC)I have asked for wider input from the editors at
WT:MED
here.
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20:31, 16 May 2014 (UTC)
Low back is currently the leading cause of disability globally. -- Buchbinder R, Blyth FM, March LM, Brooks P, Woolf AD, Hoy DG. (2013). "Placing the global burden of low back pain in context". Best Pract Res Clin Rheumatol. 27 (5): 575–589. doi: 10.1016/j.berh.2013.10.007.
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A new edit citing Buchbinder says that according to the 2012 Global Burden of Disease study that LBP is now the #1 cause of disability. However, the WHO's site here:
http://www.who.int/features/factfiles/global_burden/facts/en/index7.html which is tagged as updated 2013 says that "Hearing loss, vision problems and mental disorders are the most common causes of disability". I am not sure how to reconcile the two.
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15:28, 16 May 2014 (UTC)
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20:04, 16 May 2014 (UTC)
It is definitely a top cause of disability globally. Let me look at the GBD report. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 03:57, 17 May 2014 (UTC)
salzberg_2012
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help page).![]() | This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page. |
Archive 1 | Archive 2 |
If someone wants to a) discuss what those alternative medical treatments actually are; and b) discuss what the other 83.2% of adult Americans do, then maybe it belongs. -- Calton 01:43, 13 Feb 2005 (UTC)
The reason so many use CAM is that conventional medicine is not very successful in providing symptom relief. On this page we should focus on conventional medicine in a systematic way. We should link to alternative forms of treatment as they are described.-- Mylesclough 05:57, 8 October 2005 (UTC)
I have been going through the list of orthopaedic conditions listed as stubs and suggesting this template for Orthopaedic Conditions (see
Talk:Orthopedic surgery)
Name
Definition
Synonyms
Incidence
Pathogenesis
Pathology
Stages
Classification
Natural History/Untreated Prognosis
Clinical Features
Investigation
Non-Operative Treatment
Risks of Non-Operative Treatment
Prognosis following Non-Operative Treatment
Operative Treatment (Note that each operations should have its own wiki entry)
Risks of Operative Treatment
Prognosis Post Operation
Complications
Management
Prevention
History
--
Mylesclough
05:57, 8 October 2005 (UTC)
As I sit here, I've got a cold-water bottle pressed up against my lower back. Wouldn't it be great if there were a section in this article on what do do, what not to do, if you've got lower back pain? Wadsworth 19:20, 28 October 2005 (UTC)
Seems the articles Back pain and low back pain need to be merged? Badgettrg 09:55, 2 February 2007 (UTC)
Personally, I think there is plenty to say on the topic of low back pain that it should stay as its own article, as opposed to upper back pain and mid back pain, etc. I will come back when I have more time and try to add more points to help people who have low back pain, such as a symptoms section. I think coccyx pain should be its own page and will see if there is an article already started on this topic. Am new to wikipedia, so please excuse (and advise) if I have missed one of the rules - I'm trying!
Two very important articles came out today in the New England Journal of Medicine about surgery for back pain. However, it is impossible to easily add this to WikiPedia - should the content go in low back pain, back pain, lumbago, or under lumbar disc herniation and spinal stenosis? Consequently, I aggregated the surgical content from low back pain and back pain and placed in the appropriate specific disease such as lumbar disc herniation and spinal stenosis. Now surgical information only needs to go in under the disease that is being treated.
Hope this is ok, feel free to revert if not, but better would be if you can find a better way to organize these sections. Badgettrg 15:52, 31 May 2007 (UTC)
I removed these two paragraphs as they seemed to go into a great deal of detail (out of balance with the rest of the page, which is an overview) in an area that has little to do with diagnosis of the cause of low back pain. Both hip and leg length differences are not among the common causes of lbp. Hope this helps make the article more useful.
Once again, this paragraph is deleted. If hip rotation is notable, it should have a Wikipedia article, with a reference on this page. Campingcar ( talk) 12:19, 5 November 2008 (UTC)
Are there honestly no medical articles to link to concerning the massive problems women have with back pain stemming from breast size and therefore bra heftiness? And you'd think there would be more to say about the curvature occuring in pregnant women, there's only a whisper of that on this page. —Preceding unsigned comment added by 71.7.244.18 ( talk) 20:32, 2 March 2008 (UTC)
The physiotherapy method developed by [ [2][Robin Anthony McKenzie]]: http://www.mckenziemdt.org/about.cfm —Preceding unsigned comment added by PeterKnaggs ( talk • contribs) 06:39, 22 July 2008 (UTC)
I have re-worded the lead from “Low back pain (sometimes referred to generally as lumbago) is a common musculoskeletal disorder causing back pain in the lumbar vertebrae” to “Low back pain (sometimes referred to generally as lumbago) is a common symptom of musculoskeletal disorders or of disorders involving the lumbar vertebrae.” The former says (literally) that pain causes itself; the latter is somewhat awkwardly-worded, so I recommend that it be rewritten again. 69.140.152.55 ( talk) 12:06, 10 October 2008 (UTC)
The article cites evidence in ClinicalEvidence.com (British Medical Journal). Unfortunately this is paid subscription only. Wouldn't the freely available Cochrane Collaboration cochrane.org be a better source? Campingcar ( talk) 13:28, 14 October 2008 (UTC)
Anthony ( talk) 09:11, 16 November 2008 (UTC)
Useful - perspective on incapacity caused by LBP and related pain conditions doi: 10.1093/bmb/ldl008 JFW | T@lk 00:43, 28 October 2008 (UTC)
It says there is disagreement but all the reviews say that it is equivalent to standard treatment. Doc James ( talk · contribs · email) 11:34, 19 November 2009 (UTC)
Doc- You reverted my edit showing significant studies that CHIROPRACTIC manipulation was significantly superior to the generic manipulative therapy provided in the studies that were quoted in the article under manipulation. Thus the fact that the apropos studies predated those in the article was irrelevant.
The article's paragraph is about generic, NOT chiropractic methods, and even they, did not really support the assertion that this part of the article made. Thus, I was not replacing the later "studies", only one of which reached any conclusion about efficacy at all; the other simply said they "could reach no valid conclusions". I was making a new statement to differentiate the results of CMT, not MT, by studies for CMT.
I feel this should be re-reverted, and at least discussed here. Also "Doc" Д-р СДжП,ДС 23:07, 18 December 2009 (UTC)
Cheers back to you, but you didn't get my point or choose not to. Nothing contradicory hre. Two different concepts! Please reconsider this. Д-р СДжП,ДС 23:18, 18 December 2009 (UTC)
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Additionally how is it being determined that the studies are "significant"? That sounds like original research to me to boost a particular WP:POV.-- Literaturegeek | T@1k? 22:55, 16 January 2010 (UTC)
Drsjpdc have you read WP:MEDRS? It gives guidance on sourcing.-- Literaturegeek | T@1k? 22:58, 16 January 2010 (UTC)
conservative treatment is undoubtedly the recommendation, but the statement that clinicial evidence has been reviewed and summarized into recommendations, followed by a teaser citation that requires log in to see any specific evidence or recommendations, is of little value. A better cite is needed.
Appears to be an ad for some kind of proprietary "source" of information.
Current cite is to:
Clinical Evidence: The international source of the best available evidence for effective health care |format= |work= |accessdate=}}(log-in required)</ref>:
— Preceding unsigned comment added by 68.165.11.243 ( talk • contribs) 14:18, 28 March 2010
perhaps the surgery section could use some more details along with the works cited, for individuals who are seeking all the various forms of surgical options to help deal with the pain.
It appears there are 3 methods of reaching the surgical site, or the actual spinal cord; the traditional surgical method which requires a large incision to the back, the endoscopic method which requires a small incision, and fiber option methods such as the new AccuraScopic procedure, which attempts to gain access to the spinal cord via a tiny tube and fiber optic camera. It appears the AccuraScopic proceudre uses the same methods to treat back pain (removal of unwanted tissue, etc.); but uses a better method to gain access to the site. Seems to be valuable information for those seeking relief. —Preceding unsigned comment added by 173.85.204.34 ( talk) 11:41, 29 March 2010 (UTC)
The systematic review of Machado et al suffers from the same problem as many other reviews in the field of musculosceletal medicine. They included in their review some studies that did not properly implement the McKenzie method. Considering e.g. the work of Browder et al 2007 Long et al 2004, a clear advantage is seen, when clinical subgroups are treated with sepcific interventions.I'll add some more references in the near future.-- Blueeye1967 ( talk) 11:05, 11 April 2011 (UTC)
Cause: Misaligned pelvis - pelvic obliquity, anteversion or retroversion - provide links to the anatomical movements, or pictures
Prevention: Exercise helps keep one’s back healthy and strong. - this statement is too vague and informal. Use more specific language, such as “Exercise can help maintain XYZ (what does ‘strong’ mean here?) and the health of the XYZ (what does healthy mean here?)” or similar.
What does ‘back strengthening’ - specify what motions, and what muscles?
“If one must stand for long periods of time, it is recommended to have something to rest one foot at a time on to alleviate back strain” This statement is informal. Also, it is unclear what “back strain” means. Stretching causes strain.. does it mean that the lumbar muscle can relax when resting one foot at a time? It does not make sense if the other side has to pick up the slack.
Ignoring this rule is a surefire way to an injury of one’s back : this is also informal. Needs formal language.
Eat a nutritious and healthy diet. => This should not be a command. Rewrite to say It is important to ..
There have been numbers of studies conducted about the relationship between the spine and nicotine. => Shorten this sentence or eliminate, as it is redundant.
Management:
The conventions of physical therapy => just say ‘Physical therapy’
Bed rest is discouraged as not being helpful => …as it is not helpful.
Epidemiology: Move the section to the beginning, right after “Classification” —Preceding unsigned comment added by Scholarchanter ( talk • contribs) 00:34, 1 June 2010 (UTC)
Under neoplasms, lymphoma should be added. An enlarged lymph node (pressing on a nerve) can cause excruciating back pain, as I know from bitter experience. My daughter, age 16 at the time, was finally diagnosed with Hodgkins Lymphoma (NSHD IVB). The backpain disappeared after only one cycle of MOPP/ABV! And since I have heard more cases of back pain in HD. Kind Regards. —Preceding unsigned comment added by Yospangsada ( talk • contribs) 20:15, 23 May 2011 (UTC)
From 2012 http://www.ncbi.nlm.nih.gov/pubmed/22335313 Doc James ( talk · contribs · email) 22:35, 7 June 2012 (UTC)
It should be noted that Cochrane review are independent studies, and they do systematic reviews. Not governed by commercial interests - such as those of chiropracters. 129.180.1.214 ( talk) —Preceding undated comment added 02:25, 8 November 2012 (UTC)
I reviewed the sourcing and have reassessed the article as C-class, there are some significant issues with the sourcing. I'm planning on working on this article to bring it up to GA over the next while.
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04:49, 26 February 2013 (UTC)
Hey Doc James, I have self-reverted this edit of mine because it changed what you had just previously done in that paragraph. Both our edits were adding the 2012 Cochrane review for acute LBP, but my edit also changed the order within the paragraph to be chronological. I don't really have much of a preference, but I usually default to chronology for ordering equally high-quality sources. Any preference on your part? If you prefer your version I will leave it, otherwise I will restore the chronological ordering that I applied here. Regards Puhlaa ( talk) 05:51, 3 March 2013 (UTC)
The prognosis section states that “most people with acute lower back pain recover completely over a few weeks” and uses this source. However, I think the text may not represent the source very well. The source says "Many cases are self-limited and resolve with little intervention. However, 31 percent of persons with low back pain will not fully recover within six months, although most will improve. Recurrent back pain occurs in 25 to 62 percent of patients within one to two years, with up to 33 percent having moderate pain and 15 percent having severe pain."
I should say that I am not a doctor, but are not such statements in danger of being tautological anyway? One could argue that, by definition, pain from which the patient does not largely recover over a few weeks would, because of this lack of recovery, retrospectively be classified as chronic rather than acute. The situation does not seem to me to be helped by the vague and muddled nature of some medical terminology - it often being unclear, when the term "acute" is used of a symptom, whether this term refers to the rapidity of onset, or rather to the short course up till recovery. (If the latter, then you do not know initially whether the current pain will ultimately be labelled acute or chronic, so what use is a pair of prognoses, one for acute and the other for chronic?) — Preceding unsigned comment added by 83.217.170.175 ( talk) 03:56, 3 June 2013 (UTC)
The text in the 'prognosis' section might benefit from a brief discussion of the growing consensus among experts that the very favourable prognosis for low back pain suggested by early research may be incorrect. For example, this synthesis by experts in the area of spine research indicates that "Several high quality studies reconfirmed the growing recognition that back pain is often intermittent, varies in presentation and severity, and persists in many primary care patients." It may be that the second sentence in the prognosis section "At 6 weeks complete recovery rates have been reported at between 40-90%" gives enough of a range to capture all of the different perspectives on prognosis and keeps the discussion simple? Thoughts? Puhlaa ( talk) 16:42, 16 April 2013 (UTC)
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16:53, 16 April 2013 (UTC)
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18:01, 16 April 2013 (UTC)
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18:33, 16 April 2013 (UTC)Checking back in here. Management now states, "The condition is normally not serious, most often resolves without significant intervention, and recovery is aided by attempting to resume normal activity as soon as possible within the limits of pain." sourced to Casazza 2012; regarding *acute* pain, Prognosis says "Pain and disability usually improve significantly in the first six weeks after onset of symptoms. After six weeks, improvement slows with only small gains up to one year. At one year after onset, pain and disability levels are low to minimal, on average." sourced to Menezes Costa 2021, and this had to be balanced a bit with other sources like Casazza that paint a rosier picture. Good?
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15:40, 1 August 2013 (UTC)
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20:35, 2 August 2013 (UTC)
An association has recently been found between chronic back pain and spinal disc infection with bacterium Propionibacterium acnes.
This research shows that 40% of chronic lower back pain could be caused by bacteria, and that a significant percentage of people with lower back pain following a herniated disc and swelling in the spine could find relief by taking an antibiotic.
It may be an idea to include this new research in this article. I know association does not automatically imply causation; nevertheless, this is an important discovery.
References:
Acne bacteria to blame for back pain
Low Back Pain Linked to Bacterial Infection
Drgao ( talk) 21:14, 13 May 2013 (UTC)
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15:42, 1 August 2013 (UTC)Hello, my employer has a patient guide to low back pain. It is written in simple English and these two pages contain most or all of what patients with this problem need to know if they have access to modern healthcare. In summary, it tells people to wait a few weeks before committing to diagnostics which is aligned with the content of this article. Something inappropriate about this is that it quotes some treatment prices in USA dollars and calls drugs by USA names. The content was written by Consumer Reports but came from a health suggestion by American College of Physicians and their journal, Annals of Internal Medicine, who both endorse this guide. This guide is part of a larger health campaign intended to have fewer procedures in cases when the procedure is unlikely to benefit them.
Is this suitable for inclusion as an external link?
Thoughts? Feedback? Blue Rasberry (talk) 20:52, 5 September 2013 (UTC)
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03:00, 6 September 2013 (UTC)The above condition causes lower back pain. See references of that page, but most are case reports, so might need a proper ref... Lesion ( talk) 17:13, 30 August 2013 (UTC)
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17:25, 30 August 2013 (UTC)
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18:40, 30 August 2013 (UTC)
Someone asked me why I put a citation needed tag on something that they knew that I could have fixed myself. I was not expecting anyone else to take action - I put that in the article to remind myself. In addition to being an encyclopedia Wikipedia is also my personal notebook. Thanks. I will fix the problem tomorrow. Blue Rasberry (talk) 02:48, 6 September 2013 (UTC)
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03:02, 6 September 2013 (UTC)
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15:30, 6 September 2013 (UTC)
No controversial points only need one or at most two refs. Not five. Clutters things IMO. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 14:52, 6 September 2013 (UTC)
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15:31, 6 September 2013 (UTC)
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15:37, 11 September 2013 (UTC)
Lately, there have been some edits around a couple articles labeled as reviews. I can't help but think that perhaps these reviews aren't as systematic/ideal MEDRS as one would hope. I'm thinking they could be too influenced by author opinion instead of being systematic. What about incorporating doi: 10.1097/AJP.0b013e31824909f9 to smooth things out? Biosthmors ( talk) 09:24, 13 September 2013 (UTC)
Not to say that's going to be an unbiased source either... doi: 10.1002/14651858.CD009265 appears like a promising proposal. I wonder when/if results are coming? Biosthmors ( talk) 09:35, 13 September 2013 (UTC)
Too bad doi: 10.1002/14651858.CD001351.pub2 says it was last assessed as up to date in 2003. Biosthmors ( talk) 09:39, 13 September 2013 (UTC)
Actually Furlan (first author on the Cochrane review and in the protocol) is the first author doi: 10.1155/2012/953139 there. I think that source would be probably the best for helping us here. Biosthmors ( talk) 09:42, 13 September 2013 (UTC)
Yeah it's a 2012 systematic review and it has been cited 12 times. Looks like Furlan decided to publish in a journal other than one under Cochrane. We should incorporate that source and weight it over either Marlowe or Casazza, in my opinion. Biosthmors ( talk) 09:48, 13 September 2013 (UTC)
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17:40, 13 September 2013 (UTC)There are issues with Marlowe. It states "the extract increased the number of patients reporting mild to no LBP over the course of 4 weeks from 1% to 24%, as well as decreasing the number of patients complaining of severe pain: 59% at week 1 and 35% at week"
The article says "The study was originally designed to measure Harpagophytum's effectiveness by measuring the use of supplementary pain-killer Tramadol over its final 3 weeks. However, this did not differ between the Harpagophytum and placebo groups nor was the consumption closely related to the amount of pain. Further analysis, though, revealed that 9 out of 51 patients who received the extract were pain free at the end of treatment compared to only 1 out of 54 patients who received placebo." Subgroup analysis or further analysis that was not set out ahead of time does not count. It is like doing a trial and looking at 20 separate different outcomes. Than if one of those outcomes hits 0.05 you claim that X was a success. If one has more than one primary outcome than they must change the p value to less than 0.05. And there are formulas for this. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 19:05, 13 September 2013 (UTC)
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19:13, 13 September 2013 (UTC)
Am going to store some comments here for whoever gets to them first.
Doc James ( talk · contribs · email) (if I write on your page reply on mine) 04:52, 11 September 2013 (UTC)
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12:52, 11 September 2013 (UTC) 2) fixed now, there were 2 Manchikanti's.
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15:54, 11 September 2013 (UTC)
Agree that this bit was overly complicated and thus moved here. It may do well on a subpage or the pain article. " Ingoing nerve fibers carry nerve impulses from sensory nerve cells in the lower back towards the central nervous system. Signals travel to the dorsal root ganglia (the connections between the peripheral nerves and the central spinal nerves) along three types of afferent nerve fibers: A beta fibers, A delta fibers, and C fibers. [1] The fibers of the A group are coated to differing degrees with myelin, [1] an electrical insulator that prevents signal loss and increases transmission speed. [2] The A beta fibers transmit light touch but not pain messages, and as they are heavily myelinated, they transfer their signals quickly. The A delta and C fibers handle pain messages, and as they are less myelinated, they transfer their signals more slowly. [1] These nerve cells release certain chemicals ( peptides) in response to painful event. [1] Common analgesics generally treat back pain by interfering with these neurochemical processes involved in the initiation and transmission of pain signals. [3]" Doc James ( talk · contribs · email) (if I write on your page reply on mine) 23:32, 13 September 2013 (UTC)
I just noticed this: "...following an episode of low back pain it is likely that a patient will have further episodes..." in this 2010 review: How do we define the condition ‘recurrent low back pain’? A systematic review. Worth mentioning?
I'm confused by the use of these terms in the literature, and by their use here. If they're generally interchangeable, can we stick to using just one of them? -- Anthonyhcole ( talk · contribs · email) 06:38, 11 September 2013 (UTC)
I have listed some possible issues I found while reading through the article, some may be to minor to consider? I am happy to help remedy anything that is similarly viewed by other editors as an issue.
Puhlaa ( talk) 03:43, 26 July 2013 (UTC)
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20:02, 26 July 2013 (UTC)
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21:02, 2 August 2013 (UTC)Good stuff, thanks for the notes.
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20:30, 1 August 2013 (UTC)
Yes, there's not much in the literature on prevention. The basic summary of the current state of the literature on that is Hoy 2012, which says "Further research is needed to identify risk factors and culturally appropriate interventions to prevent and treat low back pain." The NIH 2013 fact sheet mentions exercise and proper ergonomics/lifting techniques. Another review states exercise is helpful in preventing recurrence of LBP but not in preventing the initial onset of it. I can clarify that content in the article a bit. The only other things I found were that back belts and shoe insoles are not effective.
Regarding mattresses, I did not see anything in up-to-date literature about them so that's why I took it out. You mentioned Jacobsen 2010-- I did see it but as you noted it's a primary source. The only recent thing I have that does mention mattresses is Haldeman 2008 which simply lists "mattresses" as a "lifestyle therapy" available but otherwise does not talk about them at all. So overall I couldn't find sufficient coverage in up-to-date secondary sources to support content on mattresses. If you can find a good up-to-date secondary source on mattresses, it'd be great to have.
You're correct in that the sources available pay a lot more attention to things like acupuncture and chiropractic, so that's what the article content follows. In the overview sources I reviewed, heritability received almost zero mention. I looked at the meta-analysis implicating PARK2 you provided. As our article states, the large majority of LBP is considered to be caused by musculoskeletal sprain and strain, and also there's a lot of people walking around with disc problems that do not actually cause LBP. The conclusions of the PARK2 article are very tentative ("provides evidence of association ... suggests ... may influence"). And although it's a meta-analysis it comes across as a primary and not a secondary source: they're data-mining, not aggregating existing results. My thought is not to use it in this article but if you have a strong counter-argument I'm interested to hear.
Regarding the multifidus, Salzberg 2012's physiology overview does mention it, along with all of the other muscles and joints involved in the complex network of back structure, but does not call it out as a particular cause of LBP over all the other components. None of the other secondary sources I reviewed that cover cause or risks mention the multifidus in particular, they just talk about the network of back muscles and joints in general. I'd have WP:WEIGHT concerns if the article ends up covering the multifidus in detail but not the other components; likewise I'd be concerned about how big the pathophysiology section would end up being compared to the rest of the article if I tried to cover them all in detail.
Thanks for the careful review and feedback, it's very much appreciated.
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20:30, 1 August 2013 (UTC)
The first thing I want to mention is that I think we have to be careful to avoid letting our real-world experiences with these sorts of subjects drive the weight we give the topics in the article. It's great you found a particular mattress that you feel worked for your back pain, but we have to go by WP:DUEWEIGHT and let the reliable sources drive the weight.
It is kind of surprising how little there seems to be in the sourcing on the relationship between back pain and mattresses. To answer your question: Believe it or not, the word "mattress" does not appear at all in the full text of Kelly et al 2012 ( PMID 20842008). And I saw you added a bit to the article sources to Chou 2007 ( PMID 17909209). The addition of that content sourced to that source is not something I really agree with, honestly, as it's a bit old per WP:MEDDATE, and more importantly that's a guideline from only one medical organization. What's critical here is that we have a 2010 review of guidelines from many medical organizations worldwide (Koes 2010, PMID 20602122), and that source, surprisingly enough, does not mention mattresses at all either. I think it is a WP:WEIGHT problem to mention something from the 2007 guideline of only one medical organization when we have a 2010 review of guidelines worldwide that does not. I am not going to remove the content myself but I am pointing Biosthmors to it here for his review.
Regarding Manusov, that review is taken from this special series on LBP from 13 articles published together in The Clinics, a very well-respected publisher. I really like series like these, because they are organized by a single editing team to ensure complete and balanced coverage of a topic across all the articles. I think this is better than dipping a ladle into PubMed and seeing what you happen to pull up, because that way can get very unbalanced coverage: you might pull three review articles on some relatively obscure topic related to your subject just because three different journals by chance happened to publish on it recently, and it'll skew your article. So I've been using this series of The Clinics articles to drive the sourcing.
So I hope you understand here why I'm concerned about how you seem to be going about coming up with suggestions for what to weight in the article. You got benefit from focusing on your mattress and multifidus, but we don't want the experiences of one person to drive the weight. A better way to go about making sure we adhere to
WP:WEIGHT is to use a balanced, recent series of review articles.
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16:54, 6 September 2013 (UTC)
GA toolbox |
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Reviewing |
Reviewer: Biosthmors ( talk · contribs) 07:21, 5 August 2013 (UTC)
Be back later! Biosthmors ( talk) 07:21, 5 August 2013 (UTC)
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13:04, 5 August 2013 (UTC)
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02:32, 20 August 2013 (UTC)I'm caught up now on all your bullet points... looking forward to the next round of comments, hope we can finish this up soon. Thanks...
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19:59, 30 August 2013 (UTC)
Starting to look today...
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18:24, 2 September 2013 (UTC)
@
Biosthmors: caught up to you!
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04:10, 3 September 2013 (UTC)
@
Biosthmors: Agreed Furlan 2012 is better than Casazza for acupuncture, made the change. What else is left?
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17:42, 13 September 2013 (UTC)
Biosthmors and
Jmh649, I did a little final reviewing and copyediting and added a bit about multifidus from Menezes 2010 per ImperfectlyInformed's suggestion on the Talk page. I think the mattress mention is OK. I think I'm all caught up on all the outstanding items now, and am pretty happy with it. Anything else?
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04:23, 15 September 2013 (UTC)
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03:20, 27 August 2013 (UTC)
Also please do all you can to keep the language as simple as possible. Low back pain is one of our most important and most read articles. The translators will appreciated the easier English as we work to bring this content to other languages. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 18:34, 28 August 2013 (UTC)
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14:47, 12 September 2013 (UTC)The possible range often goes up to 80%. I suggest we change it to between 40 and 80% for lifetime prevalence [6]. The current ref mentions the issue of low income countries having a low rate. Data quality is often not as good in these areas. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 18:56, 28 August 2013 (UTC)
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03:04, 30 August 2013 (UTC)Hello, I have had a look at this article and would support its nomination to GA status, this article is structured very well, every sentence has a clear purpose, and overall I find it very easy to read and full of content. If I have one comment it's about the introduction:
Zad
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17:41, 1 September 2013 (UTC)
Zad
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01:33, 6 September 2013 (UTC)
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01:09, 8 September 2013 (UTC)
Zad
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17:07, 8 September 2013 (UTC)
Zad
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02:13, 8 September 2013 (UTC)
Zad
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01:19, 8 September 2013 (UTC)
Zad
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02:07, 8 September 2013 (UTC)
Zad
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20:36, 8 September 2013 (UTC)
Zad
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15:11, 12 September 2013 (UTC)
Zad
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01:45, 8 September 2013 (UTC)
and this is cited to a 2011 Cochrane review, which I don't have, I'm using Guild's report on it. As we have a newer review which is pointing to a newer Cochrane review, I will age out the 2008 Cochrane review, which should resolve this.In a review of randomized controlled trials a total of 13,995 patients with lumbar supports, also known as corsets, were assessed for the effect on prevention of low back pain and treatment. Little to no evidence was found that lumbar support prevented back injury more than education on proper lifting technique. The review included 954 patients in a comparison of lumbar supports with no treatment for prevention of low back pain, with similar results. There was little to no evidence to support their use for prevention of low back injury.
Zad
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01:40, 8 September 2013 (UTC)
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02:37, 8 September 2013 (UTC)
Zad
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01:57, 13 September 2013 (UTC)
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14:06, 13 September 2013 (UTC)
Zad
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17:44, 13 September 2013 (UTC)
Zad
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20:10, 8 September 2013 (UTC)
Zad
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20:05, 8 September 2013 (UTC)
Zad
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13:10, 9 September 2013 (UTC)
After all the recent edits/copyedits, I think we now have ourselves a good article. My thanks to all involved! Biosthmors ( talk) 09:05, 15 September 2013 (UTC)
ImperfectlyInformed after reviewing the sourcing again, I agree we can have the mattress mention you added. I also did a bit more reading on the multifidus and it does seem important. Salzberg gave it a whole paragraph and also devoted half a page to a diagram of them. That, plus the review you found, justifies a bit of specialized content on them. I added a new paragraph to Pathophysiology on it using Salzberg and Menezes that you found, please take a look and comment, if you would.
Zad
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04:16, 15 September 2013 (UTC)
Are there cultural variations, say? Or does all this info pertain worldwide, like Africa, India, Malaysia, etc? Soranoch ( talk) 21:42, 12 October 2013 (UTC)
Zad
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00:41, 13 October 2013 (UTC)This article could be improved by adequately represent the effectiveness of manual therapies and acupuncture. The evidence is of clear benefit for SM and c-LBP and mixed for acute. There also needs to be a discussion why osteopathic physicians, chiropractors and physical therapists manipulate the spine. That is is to help reduce pain, improve mobility to mechanical dysfunctions of the spinal segments. These mechanical dysfunctions are in the WHO and are most reliable with painful palpation of a spinal segments as this review suggest [7]. The JAMA has also recommended chiropractic care for LBP [8]. So, it seems like we may be minimizing the appropriateness of chiropractic management of low back pain. Massage has also been shown to be of short term benefit in this new review [9]. There is also good evidence of acupuncture for low back pain, maybe even moreso than medication, "The current evidence is encouraging in that acupuncture may be more effective than medication for symptom improvement or relieve pain better than sham acupuncture in acute LBP" [10] in this new review. The lede is rather ambiguous with spinal manipulation when the research is much more succinct, there is no mention of acupuncture whatsoever despite the evidence which suggests comparable effectiveness. Hoping we can have a good discussion and help make this article better by offering a complementary POV. Regards, DVMt ( talk) 03:49, 16 May 2014 (UTC)
Zad
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15:11, 16 May 2014 (UTC)
Zad
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20:01, 16 May 2014 (UTC)I have asked for wider input from the editors at
WT:MED
here.
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20:31, 16 May 2014 (UTC)
Low back is currently the leading cause of disability globally. -- Buchbinder R, Blyth FM, March LM, Brooks P, Woolf AD, Hoy DG. (2013). "Placing the global burden of low back pain in context". Best Pract Res Clin Rheumatol. 27 (5): 575–589. doi: 10.1016/j.berh.2013.10.007.
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A new edit citing Buchbinder says that according to the 2012 Global Burden of Disease study that LBP is now the #1 cause of disability. However, the WHO's site here:
http://www.who.int/features/factfiles/global_burden/facts/en/index7.html which is tagged as updated 2013 says that "Hearing loss, vision problems and mental disorders are the most common causes of disability". I am not sure how to reconcile the two.
Zad
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15:28, 16 May 2014 (UTC)
Zad
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20:04, 16 May 2014 (UTC)
It is definitely a top cause of disability globally. Let me look at the GBD report. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 03:57, 17 May 2014 (UTC)
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