BACKACHE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Backache: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00120-9 1. Backache-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail:
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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on backache. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.
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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON BACKACHE ................................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Backache ........................................................................................ 5 The National Library of Medicine: PubMed ................................................................................ 45 CHAPTER 2. ALTERNATIVE MEDICINE AND BACKACHE ................................................................ 69 Overview...................................................................................................................................... 69 The Combined Health Information Database............................................................................... 69 National Center for Complementary and Alternative Medicine.................................................. 70 Additional Web Resources ........................................................................................................... 70 General References ....................................................................................................................... 73 CHAPTER 3. BOOKS ON BACKACHE ................................................................................................ 75 Overview...................................................................................................................................... 75 Book Summaries: Online Booksellers........................................................................................... 75 Chapters on Backache................................................................................................................... 76 CHAPTER 4. PERIODICALS AND NEWS ON BACKACHE .................................................................. 77 Overview...................................................................................................................................... 77 News Services and Press Releases................................................................................................ 77 Academic Periodicals covering Backache ..................................................................................... 78 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 83 Overview...................................................................................................................................... 83 NIH Guidelines............................................................................................................................ 83 NIH Databases............................................................................................................................. 85 Other Commercial Databases....................................................................................................... 87 APPENDIX B. PATIENT RESOURCES ................................................................................................. 89 Overview...................................................................................................................................... 89 Patient Guideline Sources............................................................................................................ 89 Finding Associations.................................................................................................................... 91 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 93 Overview...................................................................................................................................... 93 Preparation................................................................................................................................... 93 Finding a Local Medical Library.................................................................................................. 93 Medical Libraries in the U.S. and Canada ................................................................................... 93 ONLINE GLOSSARIES.................................................................................................................. 99 Online Dictionary Directories ................................................................................................... 100 BACKACHE DICTIONARY ........................................................................................................ 101 INDEX .............................................................................................................................................. 137
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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with backache is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about backache, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to backache, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on backache. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to backache, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on backache. The Editors
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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.
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CHAPTER 1. STUDIES ON BACKACHE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on backache.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and backache, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “backache” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •
Nonbladder Related Symptoms in Patients with Interstitial Cystitis Source: Journal of Urology. 166(2): 557-562. August 2001. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax: (301) 824-7290. Website: www.lippincott.com. Summary: Clinical experience and epidemiological studies suggest that patients with interstitial cystitis (IC) have multiple nonbladder related symptoms. This article reports on a study undertaken to test this hypothesis. The authors used the University of Wisconsin scale to compare the scores for patients with IC to those for control subjects. This validated questionnaire includes 7 bladder and 18 reference symptoms not related to the bladder. The study included a total of 35 female patients with IC and 35 age
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matched female controls. For the 7 bladder symptoms, the difference between IC and control groups was extremely significant. Patients with IC had higher scores than controls for 9 reference symptoms, including other pelvic discomfort, backache, dizziness, chest pain, aches in joints, abdominal cramps, nausea, heart pounding, and headache. However, they did not have higher scores for blind spots or blurred vision, numbness or tingling in fingers or toes, swollen ankles, feeling of suffocation, sore throat, cough, flu, nasal congestion, and ringing in ears (tinnitus). The majority of patients with IC had a 0 score for all but 2 of the reference symptoms (backache and aches in joints). Patients with IC had increased scores for 9 reference symptoms, but did not indiscriminately report high scores for generalized complaints. This result suggests that in some cases of IC, the pathophysiology may affect other organ systems besides the bladder. Alternatively, some of these symptoms may result from changes in sleep pattern or other factors associated with IC. An editorial commentary is appended to the article. 5 tables. 16 references. •
Peritoneal Dialysis: Its Indications and Contraindications Source: Dialysis and Transplantation. 29(2): 71-77. February 2000. Contact: Available from Dialysis and Transplantation, Attn.: Subscriptions. P.O. Box 10535, Riverton, NJ 08076. (800) 624-4196 or (609) 786-0871. Summary: Global utilization of peritoneal dialysis ranges from 6 to 91 percent of the people on dialysis in various parts of the world; in the United States, approximately 14 percent of the patients with end stage renal disease (ESRD) use peritoneal dialysis. This article reviews the indications and contraindications for chronic peritoneal dialysis (PD), provides evidence when available, and offers recommendations based on the experiences of the authors. Strong indications for PD include situations such as vascular access failure and intolerance to hemodialysis (HD); medical preferences such as congestive heart failure, prosthetic valvular disease, and children aged 0 to 5 years; and social situations such as patient preference and living far from a dialysis clinic. The situations where PD is preferred include bleeding tendencies, multiple myeloma (bone tumors), labile diabetes (hard to control), chronic infections, possibility of transplantation in the near future, age between 6 and 16 years, needle anxiety, and active lifestyle. Situations where PD is not preferred but is still possible with some special considerations include obesity, multiple hernias, severe backache, multiple abdominal surgeries, impaired manual dexterity, blindness, less than ideal home situation, and depression. Relative contraindications (reasons not to use the technique) for PD include patients with severe malnutrition, multiple abdominal adhesions, ostomies, proteinuria greater than 10 grams per day, advanced COPD (chronic pulmonary disease, usually attributed to smoking), ascites (fluid accumulation), upper limb amputation with no help at home, poor hygiene, dementia, and homelessness. PD is contraindicated in patients with documented Type II ultrafiltration failure, severe inflammatory bowel disease (IBD), active acute diverticulitis, abdominal abscess, active ischemic bowel disease, severe active psychotic disorder, marked intellectual disability, and the third trimester of pregnancy. In most of the remaining situations, either HD or PD is equally preferred. The authors conclude that in order to take full advantage of the advances that have occurred over the past decade, successful PD requires committed and knowledgeable physicians and nurses, and a center with at least 20 to 25 patients on this modality. 1 table. 30 references.
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Primary Care Approach to Low Back Pain: The Good, the Bad, and the Ugly Source: Physician Assistant. 24(11): 31-42. November 2000.
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Summary: This journal article, part of the 'Physician Assistant' recertification series, provides health professionals with information on the differential diagnosis, risk factors, evaluation, and management of low back pain in adults. Acute low back pain is among the most common complaints presented to primary care practitioners; however, the etiologic pathology is often elusive. Etiologies of low back pain range from muscle strain to metastatic cancer. Clinically, low back pain can be divided into mechanical and nonmechanical pain. Mechanical low back pain is aggravated by activity and relieved by rest, whereas nonmechanical back pain is constant and persistent. The differential diagnosis of low back pain is extensive, and, although the vast majority of back pain is benign, primary care clinicians should not treat all back pain in the same way. The serious pathology in the differential diagnosis, if missed, can cause permanent neurologic deficit or death. Clinicians should triage for neurologic compromise, especially progression deficit, and the red flags that suggest serious pathology. Once these have been ruled out, initial treatment can be prescribed with relative confidence. Nonsteroidal antiinflammatory drugs are the first line of medical treatment for simple backache. There is no general consensus on the use of muscle relaxants for treating simple backache. Physical therapy is an important treatment option. During the acute phase, chiropractic manipulation can accelerate pain relief and return some patients to normal activity levels. Surgery may be required for more serious causes of backache such as ruptured disks, spinal stenosis, and cauda equina syndrome. For the majority of patients presenting with low back pain, pain is a symptom, not a disease, and the primary goal is to reduce pain and restore function. A continuing medical education test follows the article. 6 figures, 5 tables, and 17 references. (AA-M).
Federally Funded Research on Backache The U.S. Government supports a variety of research studies relating to backache. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to backache. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore backache. The following is typical of the type of information found when searching the CRISP database for backache: •
Project Title: 3-D DYNAMIC MOTION SEGMENT BEHAVIOR Principal Investigator & Institution: Krag, Martin H.; Orthopedics and Rehabilitation; University of Vermont & St Agric College 340 Waterman Building Burlington, Vt 05405 Timing: Fiscal Year 2002; Project Start 22-SEP-2000; Project End 31-AUG-2005
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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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Summary: (adapted from Investigator's abstract) Mechanical dysfunction of the low back is widely considered to be an important component of the large problem of idiopathic low back pain (LBP) and to involve abnormalities of vertebral motion (motion segment kinematics) and vertebral muscle use and/or morphology. Much has been learned concerning the end-points of the range of spinal motion but there is still limited understanding and treatment of these kinematic and muscle abnormalities. Recent investigations of these topics by the applicants and others have shown that: (1) the details of the motion between pairs of vertebrae are very finely controlled and repeatable in normal subjects (2) the expected linkage between abnormal motion and abnormal local muscle activity appears to be present, and (3) localized muscle morphometric changes occur in a number of cases of idiopathic LBP. Building on these studies, the proposed work has as its specific aims: 1) for each of the lumbar motion segments, to measure kinematic, EMG, and muscle size parameters during various range of motion and lifting tasks in normal subjects and in idiopathic LBP subjects that are considered likely to have abnormalities detectable by these measurements; 2) to test for correlation of these measurements with those of clinically available parameters; and 3) to test whether subjects can voluntarily alter their motion segment kinematic or EMG behaviors during task performance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: A PILOT TRIAL OF IV PAMIDRONATE FOR LOW BACK PAIN Principal Investigator & Institution: Pappagallo, Marco; Beth Israel Medical Ctr (New York) 1St Ave at 16Th St New York, Ny 10003 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-JUL-2006 Summary: (provided by the applicant): We have been motivated to propose an openlabel, dose-escalation, clinical pilot trial of Pamidronate infusions for the relief of chronic low-back pain by: (1) human studies that have demonstrated the analgesic effect of Pamidronate for cancer and non-cancer bone pain; (2) animal studies that have demonstrated the analgesic effect of this drug for pain unrelated to bone pathology; and (3) the impressive relief of non-malignant, chronic low-back pain among our patients treated with Pamidronate. Chronic low-back pain affects large segments of populations throughout the world, and is responsible for large costs in the form of suffering, lost workdays, and medical treatment. While Pamidronate infusions relieve bone pain related to Metastatic cancer, Paget's Disease, Ankylosing Spondylitis, and inflammatory bone and articular conditions, there have been no clinical trials of Pamidronate for chronic, mechanical low-back pain. The study participants will be 40 patients who have not had back surgery, and who have chronic, mechanical low-back pain associated with disc degeneration. Consistent with the success we have observed in patients with and without Osteoporosis, study participants will include individuals with and without Osteoporosis. They will be equally divided among five treatment groups (N=8 per group), who will receive between one and five 90 mg. Pamidronate infusions, respectively. There will be a one-month interval between infusions, and a 24-week follow-up period after the last infusion. Nightly, participants will electronically complete the Brief Pain Inventory (BPI). In addition, the research coordinator will administer the BPI, weekly, via telephone. The primary objective of the pilot is to determine the optimal dose of Pamidronate for a Phase III trial by comparing the different doses with respect to their tolerability and safety profiles, including their effect on bone remodeling. Very little is known about the effects of Pamidronate in individuals with normal bone turnover. Secondary aims include the determination of the duration of follow-up for the Phase 111 trial, and the assessment of the relationships of (1) pain
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intensity changes to baseline bone scan results, (2) changes in performance on the Simmonds Physical Performance Battery for Patients with Low-Back Pain, to the number of Pamidronate infusions and to changes in pain intensity scores, and (3) patient satisfaction to treatment regimen. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ACADEMIC CAREER DEVELOPMET AWARD IN CAM Principal Investigator & Institution: Gay, Ralph E.; Mayo Clinic Coll of Medicine, Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2006 Summary: The purpose of this Academic Career Development Award is to enable the candidate, Ralph Edward Gay, MD, DC, an Instructor in Physical Medicine and Rehabilitation, to pursue formal, supervised training and skill development in clinical research, curriculum development, teaching and leadership. These skills are necessary for the candidate to become an effective teacher, researcher and leader with special expertise in the treatment of musculoskeletal disorders with complementary and alternative medicine (CAM) treatments. The candidate has a unique background as both a chiropractor and a board certified physiatrist , which enhances his ability to pursue these career goals. His Academic Career Plan will be implemented with guidance and counsel from a structured, three-member mentoring committee composed of accomplished academic researchers and educators. The Academic Career Award will provide 5 years of supervised training experience with the following specific aims: 1) Completion of the Mayo K30 NIH- supported Clinical Research Training Program leading to a Masters of Biomedical Science in Clinical Research, 2) Application of learned research competencies to complete a feasibility study of Flexion- Distraction manipulation treatment of low back pain, 3) Acquisition of grant writing and submission of grant applications for future studies in manual medicine, 4) Acquisition of teaching and curriculum development skills, 5) Development of two graduate level courses in CAM available at no cost to the approximately 4000 students, trainees, practitioners, physicians and researchers of the Mayo Clinic system, 6) Development of leadership competencies to aid in the achievement of short and long-term professional goals, including academic advancement, networking, and the formation of a Mayo CAM research. This Academic Career Award will provide Dr. Gray with the opportunities and resources necessary to achieve his goal of becoming a respected and recognized expert in CAM treatment of musculoskeletal disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ANGER, SYMPTOM SPECIFIC REACTIVITY AND CHRONIC PAIN Principal Investigator & Institution: Burns, John; Psychology; Rosalind Franklin Univ of Medicine & Sci North Chicago, Il 60064 Timing: Fiscal Year 2002; Project Start 01-SEP-1998; Project End 30-JUN-2004 Summary: Anger and anger management style (the tendency to suppress or express anger) are important emotional factors which contribute to the aggravation of chronic pain. Few mechanisms, however, have be examined which explain how anger variables affect chronic pain. A "symptom-specificity model" is advanced in which chronic low back pain (CLBP) patients can be distinguished from patients with chronic nonback pain and from normals on the basis of anger-induced tension in the musculature at the site of pain (lower paraspinals). The investigator proposes that exaggerated lower paraspinal (LP) reactivity during anger constitutes a physiological mechanism by which anger and
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anger management style affect CLBP. Three aims will be pursued. First, it will be determined whether anger provocation has unique effects on LP reactivity among CLBP patients. Study 1 will examine whether CLBP patients show: greater overall LP reactivity than nonback pain patients and normals; greater LP reactivity during angerinduction versus anxiety-induction; trapezius, bicep and cardiovascular reactivity equivalent to the other groups. Second, it will be determined whether anger expression or suppression have effects on LP reactivity. Study 2 will examine whether self-reported anger management style predicts the degree to which anger is expressed during provocation, which in turn predicts LP reactivity, but not trapezius nor bicep reactivity, only among CLBP patients. Third, it will be determined whether anger arousal can influence variables reflecting CLBP aggravation via LP reactivity. Study 3 will test whether anger-induced LP reactivity, but not trapezius nor bicep reactivity, is related to pain report and pain behavior among CLBP patients during a subsequent paininduction task. Findings will show whether LP reactivity constitutes a unique pathway by which anger, distinct from other emotions, exacerbates CLBP. Documenting a link between anger and LP reactivity will give empirical justification for targeting problematic anger among CLPB patients, and will provide principles on which to found new intervention strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ASSESS & IMPROVE THE QUALITY OF CARE FOR LOW BACK PAIN Principal Investigator & Institution: Birkmeyer, Nancy J.; Associate Professor; Community and Family Medicine; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, Nh 03755 Timing: Fiscal Year 2002; Project Start 15-SEP-2000; Project End 31-AUG-2005 Summary: As reflected in the-topic of this proposal, the applicant has two main career goals: (I) to evaluate the quality of surgical and non-surgical treatment for low back pain; and (2). to reduce variation in treatment practices and improve the outcomes of treatment for these conditions. This five-year project combines the use of outcomes research and continuous quality improvement techniques to close the gap between knowledge gained through outcomes research and clinical practices to improve outcomes for patients with low back pain. Despite its frequency and related costs, little is known about the quality of care for spinal disorders. The data and infrastructure provided by the recently initiated Spine Patient Outcomes Research Trials (SPORT) presents a unique opportunity to study, compare, and improve outcomes for patients undergoing treatment for three surgically treatable spine conditions: herniated disc, spinal stenosis, and degenerative spondylolisthesis. SPORT is a set of clinical trials to compare the effectiveness of surgical and non-surgical approaches to the treatment of these conditions that is being conducted at II U.S. medical centers and expects to enroll approximately 3000 patients. The overall goals of this proposal are to evaluate and improve the quality of care for low back pain through a comparative study of the structure, process, and outcomes of care at medical centers participating in SPORT. Specifically, this proposal has three research objectives: 1. To characterize clinical practices. We plan a detailed study of variability in structures and processes of care for patients with low back pain at the sites participating in SPORT. 2. To assess outcomes of care. After developing and validating methods for risk-adjustment, we will evaluate and compare quality of care for low back pain across the II sites participating in SPORT. Outcomes, to be assessed in both surgically and non-surgically treated patients, will include functional health status, clinical outcomes, patient satisfaction, and cost. 3. To
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link clinical practices and outcomes. Using statistical models to account for random variation in the setting of hierarchical data structures, we will examine associations between clinical structure, process, and outcomes to identify high-leverage areas for improvement. Improving clinical care can not occur in the vacuum of a research laboratory. At each step of this project, we will feedback data to clinicians at the participating medical centers and work with them to develop a focused quality improvement agenda that is designed to improve patient outcomes by reducing variability in clinical practices. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: BACK PAIN & WORK DISABILITY IN HEALTH CARE WORKERS Principal Investigator & Institution: Pompeii, Lisa A.; Community and Family Medicine; Duke University Durham, Nc 27710 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 29-SEP-2006 Summary: (provided by applicant): The purpose of the proposed study is to examine risk factors for occupational back pain (OBP), and to examine the impact of work disability on workers and their co-workers in a large population population (n = 12,500) of health care workers at Duke University Medical Center (DUMC). This study aims to examine organizational factors, such as downsizing efforts while considering other known and suspected risk factors of OBP, as possible predictors for back injury and disability in health care workers that have not been adequately addressed in prior studies. In addition, risk factors for back injury specific to nursing personnel whose jobs involve patient handling will be examined. Detailed analyses will be conducted to explore differences in back injuries that result in restricted and lost workdays across variable demographic, psychosocial, and occupational characteristics for the entire cohort of health care workers. Factors influencing the feasibility and effectiveness of modified work assignments specific to nursing units will also be addressed. The number of lost and restricted workdays, physical impairment, psychosocial demands, and the injured worker's perception of workplace accommodations will be considered in determining the overall effectiveness of modified work assignments. The feasibility of modified work assignments in nursing units will be examined by considering feedback from nurse managers, nursing personnel, occupational physicians, occupational health nurses, and workers' compensation administrators and case-managers who are integrally involved with implementing these workplace strategies. Data previously collected at DUMC will be used, as well as additional prospective surveillance data, and focus group information. This mix of quantitative and qualitative techniques will be utilized to address the National Occupational Research Agenda's Priority Research Area of low back disorders, in addition to addressing issues related to special populations at risk, surveillance efforts, and occupational health services research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CHRONIC LOW BACK PAIN AS A MODEL OF FIBROMYALGIA Principal Investigator & Institution: Clauw, Daniel J.; Associate Professor; Medicine; Georgetown University Washington, Dc 20057 Timing: Fiscal Year 2002; Project Start 15-JUN-1999; Project End 31-MAY-2004 Summary: Fibromyalgia (FM) is defined by a history of widespread pain, and the finding of tender points on examination. Arguably the two most discriminating features of FM are: 1) a generalized disturbance in pain perception, and 2) elevated levels of pronociceptive neuropeptides in the cerebrospinal fluid. The first feature, pain induced by a
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normally non-painful stimuli, is not surprising since this is a defining feature of FM. But it is not certain how tenderness relates to pain, since population based studies have demonstrated that not all persons who are tender have pain, and vice versa. And it has recently become clear that tender points are a poor measure of a person's inherent tenderness. The meaning of these elevated levels of CSF neuropeptides is likewise unclear. These findings may not be specific for FM, and may be the cause of pain and/or tenderness, or may be the result of pain, tenderness, or some other process. Chronic lower back pain (CLBP) is among the most common medical problems in industrial societies. Despite this, little is actually known about the precise cause for most cases of CLBP. Anatomic and psychosocial factors have been demonstrated to predict only a small portion of the variance in the degree of pain or disability in CLBP. In preliminary studies in CLBP, we have demonstrated that tenderness predicts a significant percentage of the variance in both functional status and pain, more than either the severity of path-anatomical abnormality (i.e., X-ray/MRI),or by psychosocial factors. In a small pilot study of a subset of these patients tenderness was correlated with CSF levels of pro-nociceptive neuropeptides. There are 3 specific aims in the proposed study: 1) To confirm in a cross-sectional study of 200 CLBP patients that pain sensitivity predicts more variance in clinical outcome (e.g. functional status, pain level, Roland index) than either anatomic or psychological factors. Furthermore, we will demonstrate that pain sensitivity is an independent trait, and not a surrogate for psychological factors such as depression, anxiety, or work-related stressors. 2) To demonstrate that an individual's global pain sensitivity is determined primarily by physiologic factors (e.g. neurotransmitters in cerebrospinal fluid) and modified by psychosocial factors (e.g. cognitive and behavior influences on pain perception). We will measure the CSF concentrations of pro-nociceptive peptides such as Substance P and Nerve Growth Factor, and hypothesize that the levels of these substances largely determine an individual's global pain sensitivity. This testing will be done in patients with CLBP and FM, as well as sedentary and non-healthcare-seeking controls. 3) To use alternative methods of pain assessment that are much less influenced by psychological factors (e.g., scaling methods, Multiple Random Staircase), using both pressure and thermal stimuli, to examine the true meaning of tender points, and the relationship between these results, and the results of the above noted physiologic and psychologic parameters in individuals with FM and CLBP. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CHRONIC PAIN IN THE 65+: EVALUATING FUNCTIONAL IMPACTS Principal Investigator & Institution: Rudy, Thomas E.; Professor and Director; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 15-SEP-2001; Project End 31-AUG-2005 Summary: Chronic pain plagues approximately 50 percent of community dwelling older adults, and may cause significant disruption of physical, psychosocial, and cognitive function. Despite the prevalence of this potentially devastating problem, well-controlled studies of chronic pain in older adults that use a comprehensive multidimensional model are lacking. Chronic low back pain (CLBP) is among the most common chronic pain conditions of older adults, affecting approximately 6 million individuals in the United States who are greater than or equal to age 65. CLBP offers a robust model with which to study the comprehensive functional effects of chronic pain in the older adult because of the reliable and valid measures of observed physical capacity, self-reported
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disability and pathology that have been developed specifically for patients with low back pain. The purpose of this investigation is to broaden our understanding of disability in the older adult with chronic pain. Specifically, we will explore (1) the magnitude of the effect of CLBP on physical, psychosocial, and cognitive functioning in 200 community dwelling older adults greater than or equal to age 65 as compared with 200 pain-free control subjects, (2) the impact of CLBP associated psychosocial and neuropsychological dysfunction on physical function, and (3) whether older adults with chronic pain can be classified using a multiaxial taxonomy that has been demonstrated in younger chronic pain patients. The laboratory-based physical capacities testing protocol is designed to assess body mechanics, endurance and coordination using ergonomically relevant tasks (e.g., lifting, reaching). Other comprehensive multidimensional assessment measures will include those that have particular relevance to older adults, such as pain intensity, clinical measures of physical performance, disability, sleep, mood, self- efficacy, detailed measures of neuropsychological function, and self perceptions of health and well-being. This study represents the first wellcontrolled, comprehensive examination of the effects of chronic pain on individuals who may be most threatened by the risk of functional decline, that is, community dwelling older adults. Once the effects of chronic pain have been comprehensively described, only then can effective treatment programs be developed to help ameliorate the suffering of these older Americans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CHRONIC PAIN MANAGEMENT IN PRIMARY CARE Principal Investigator & Institution: Von Korff, Michael R.; Senior Investigator; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002 Summary: This research seeks a more effective and cost-effective integration of medical care and self-care for chronic and recurrent pain in pr5imary care settings. Aim 1: Identify improved methods for analysis of automated health care and medicine use data for TMD pain, headache and back pain patients. Identify potentially modifiable determinants of long-term frequent use of health care and pain medications for these conditions. Study One: We will study determinants of health care and prescription medicine use for pain over a five-year time span. {{Methods for analysis of automated health care and medicine use data will be assessed to test more powerful and informative approaches. Using improved analytic methods,}} we will assess the ability of patient variables to predict and explain frequent use of health care, opioid medications and sedative- hypnotic medications for patients with TMD (n=391), back pain (n=833) and headache (n=869) over a five year time-span. Aim 2: Evaluate the effectiveness of Self-Care Group interventions guided by a stepped care model. Study Two: Data from two randomized controlled trials of Self- Care Groups (SCG) initiated in 1996-98) as part of the current Program Project will be used to identify factors influencing the long-term effectiveness of SCG (participation, baseline severity, self-care orientation, prognostic variables). Study Three: A new randomized controlled trial will evaluate Self-Care Groups fully integrated into primary care. This trial will evaluate the initial benefits and the long-term effectiveness of Self-Care Groups among actively recruited back pain patients (n=250). The intervention will target patients with enduring activity limitations and higher use of health care for back pain {{Patients with continuing activity limitations will receive more intensive intervention according to a stepped care protocol.}} Patients will be followed-up 2, 6, 12 and {{24}} months after randomization. The primary outcome will be activity limitations (Roland Disability Score with added
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items concerning occupational role disability). Aim 3: Assess the impact of Self-Care Groups (SCG) on long-term health care and prescription medication use. Determine the effect of SCG on health care costs. Study Four: Using automated health care and medicine use data and improved analytic methods, we will investigate the long-term effects of SCG on: (1) use of health care; (2) use of prescription pain medications; and (3) health care costs for back pain (total n from three SCG trials=731). Since the SCG interventions have been shown to reduce worry, enhance confidence in self-care, and reduce activity limitations, this research will provide an experimental test of whether modifying these factors reduces subsequent use of health care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CLINICAL DECISION MAKING IN LOW BACK PAIN Principal Investigator & Institution: Lurie, Jon D.; Medicine; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, Nh 03755 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): The applicant has the broad career goal of improving the diagnostic evaluation, treatment recommendations, and health outcomes for patients with low back pain. In this project he proposes to extend his prior training in outcomes research, technology assessment, medical decision-making, and biostatistics. These advanced quantitative skills will be used to identify optimal treatment strategies for subgroups of low back pain patients defined on the basis of clinical and radiologic features. Low back pain is one of the most prevalent and costly health problems in the industrial world. Back surgery is nearly always elective, yet the rates of spine surgery in the US have increased dramatically in the past 10 years and show marked geographic variation. Both the First and Second International Forums for Primary Care Research on Low Back Pain chose the identification of important clinical subgroups of low back pain patients based on characteristics, imaging studies and other factors as their number one research priority. The data and infrastructure provided by the recently initiated Spine Patient Outcomes Research Trial (SPORT) presents a unique opportunity to study the predictors of outcome for patients with herniated discs, spinal stenosis, and degenerative spondylolisthesis. SPORT is a set of clinical trials designed to compare the effectiveness of surgical and non-surgical approaches to the treatment of these conditions; it is being conducted at I I U.S. medical centers and expects to enroll approximately 3000 patients. Extensive clinical, functional status, quality of life, and imaging data will allow for an unprecedented ability to identify optimal treatment approaches for these patients. This five-year project combines the use of outcomes research and decision analytic techniques to better understand the predictors of outcome with surgery and non-surgical treatment. After a period of additional training in decision in mdeling and biostatistics, the applicant will work closely with the Principal Investigator and Co-Principal vestigators of SPORT to accomplish two specific research objectives: To identify patient subgroups, defined by clinical and radiographic features at baseline, that are predictive of good/bad outcome with surgical/nonsurgical treatment among patients with intervertebral disc herniation, spinal stenosis, or degenerative spondylolisthesis with associated stenosis. To develop decision analytic models for specific patient subgroups, which also accommodate individual patient preference and quality of life data, for the purpose of identifying optimal treatment strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CORTICAL PATHOPHYSIOLOGY OF PAIN Principal Investigator & Institution: Apkarian, Apkar Vania.; Associate Professor; Physiology; Northwestern University Office of Sponsored Research Chicago, Il 60611 Timing: Fiscal Year 2002; Project Start 01-MAY-1996; Project End 31-MAY-2003 Summary: (Adapted from the Investigator's Abstract) This proposal is in response to the BIOBEHAVIORAL PAIN RESEARCH RFA PA-99-021. It is a COMPETING CONTINUATION application for grant NS 35115 funded from 5-1-96 to 4-30-99. In the last funding period we developed a new functional brain imaging paradigm, using functional magnetic resonance imaging (fMRI), that enables us to parcel cortical activity associated with painful stimuli along a stimulus-suffering from chronic Reflex Sympathetic Dystrophy (RSD) pain show prefrontal hyperactivity. These abnormal activations are reversed to that seen in normal subjects after a sympathetic block. Given the new paradigm and our observations in chronic pain patients and normal volunteers we propose to extend the studies to extend the studies of the pathophysiology of chronic pain by testing specific hypotheses, designed to distinguish between two chronic pain states: Specific Aim 1 tests the hypothesis that chronic low back pain with radicular involvement can be differentiated from acute low back pain, and from normal subjects by functional brain imaging studies. These studies are designed to image brain activity directly related to the pain from which the patients suffer. The acute back pain patients are studied before and three months after spinal cord surgery. Specific Aim 2 tests the hypothesis that chronic RSD pain with allodynia is distinct from chronic RSD pain with only hyperalgesia, and that chronic RSD pain is distinguishable from chronic low back pain. The studies are done using fMRI and again are designed to directly study the pain from which the patients suffer. Specific Aim 3 tests the hypothesis that chronic pain states are associated with brain biochemistry abnormalities, and that different chronic pains may be differentiated by brain biochemistry. Hydrogen-Magnetic Resonance Spectroscopy (MRS) will be used to examine different brain regions and chemicals in RSD and low back pain patients and compared to normal subjects. Specific Aim 4 tests the hypothesis that chronic pain is correlated with cognitive abnormalities. RSD and back pain patients will be tested on a battery of cognitive tests: Stroop, WCST, and Bechara's Gambling test. The chosen tests examine different frontal abilities and may differentiate between types of chronic pain. Overall the studies are designed to examine chronic pain by functional imaging, brain biochemistry, and cognitive abilities. The results, if successful, have the potential of being used in the clinic as diagnostic or prognostic tools. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PROSTHESIS
DEVELOPMENT
OF
A
SPINAL
INTERVERTEBRAL
DISC
Principal Investigator & Institution: Buttermann, Glenn R.; Dynamic Spine, Llc 1725 Park Ave Mahtomedi, Mn 55115 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 31-DEC-2004 Summary: (provided by applicant): Chronic back pain is a common disability in which spinal fusion surgery is sometimes beneficial. Far more functional outcomes would be obtained with a successful intervertebral disc prosthesis If commercialized world-wide, it has been estimated that disc prostheses would be implanted at a rate of one million per year, after five years of marketing with potential sales of two billion dollars. This SBIR Phase I project will perform research to develop a spinal device that will restore function of the spine and relieve back pain for patients with intervertebral disc
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degeneration. Dynamic Spine is pursuing the development of an intervertebral disc replacement. Historically, severe knee and hip degeneration were treated with fusion of the joint which decreased pain but eliminated motion. Currently, hip and knee fusion have almost been entirely eliminated due to the enormous success of prosthetic hip and knee replacements. For back pain due to disc degeneration that has not responded to nonoperative treatment, spinal fusion is recommended. Spinal fusion improves pain but limits motion and hence function, and also increases stress on neighboring discs which over time predisposes to additional disc degeneration. A successful disc replacement is not yet available. Dynamic Spine is developing a prototype disc replacement which is unique from others currently in development and has characteristics which should overcome deficiencies of other disc prototypes. A US patent has been obtained and international patents are pending. The objective of Phase I is to demonstrate that the device restores normal spine biomechanics (range of motion and stiffness) and is durable in fatigue testing. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EARLY DETECTION AND PREVENTION OF CHRONIC PAIN DISABILIT Principal Investigator & Institution: Gatchel, Robert J.; Professor; Psychiatry; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2002; Project Start 01-AUG-1993; Project End 31-AUG-2004 Summary: This is a request for a competitive renewal of an NIMH Independent Scientist Award (K02). It will provide important continuity of my research program developed during an original K02 award (1993-98). The proposal presents 3 separate research projects that evaluate an early prediction-intervention approach to 2 costly chronic pain syndromes-low back pain (LBP) and temporomandibular disorder (TMD). Early detection to prevent such chronic disorders is now recognized as a high priority research area in the PHS Report of "Healthy People 2000." The goal of the first project is the assessment of a large cohort of acute LBP patients in order to screen out those patients who are at "high risk" for developing chronic disability. This screening will be accomplished by using a statistical algorithm developed in an earlier RO1 project that successfully identified such "high risk" patients. These "high risk" patients will then be randomly assigned to an early intervention or a nonintervention group. One-year follow-up evaluations will assess important socioeconomic outcomes such as return to work and health- care utilization rates. The second project parallels the earlier conducted study that successfully identified "high risk" acute LBP patients. This project will develop a specific algorithm for predicting the development of chronic TMD. Those acute patients who subsequently develop chronic problems will then participate in a second phase which evaluates the relative efficacy of 4 techniques, 3 of which are biobehovioral approaches. Finally, the third project will also assess an early assessment intervention model with TMD. It will parallel the methodology used in the first project. "High risk" patients, screened on the basis of a statistical algorithm, will be randomly assigned to either early intervention or nonintervention. Long term follow-up of these patients will assess important diagnostic, self-report and functional changes. Finally, interwoven within all 3 projects will be the evaluation of a potentially heuristic theory of the interaction between pain and stress. We are now at a point to identify early signs of chronicity, and then provide early intervention in order to prevent costly problems from developing. These 3 research projects will explore the efficacy of early identification of "high risk" acute patients in order to provide biobehavioral treatment intervention, while simultaneously evaluating cost-effectiveness.
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Project Title: EFFECTS OF BINAURAL BEATS ON PAIN, MOOD AND EEG IN LOW BACK PAIN PATIENTS Principal Investigator & Institution: Taylor, Ann G.; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ELECTROMECHANICAL PROPERTIES OF INTERVERTEBRAL DISC Principal Investigator & Institution: Gu, Weiyong; Biomedical Engineering; University of Miami Coral Gables Box 248293 Coral Gables, Fl 33134 Timing: Fiscal Year 2002; Project Start 01-JUN-2000; Project End 30-NOV-2003 Summary: Low-back pain is a major socio-economic concern in this country. Although the exact cause for low back pain is unclear, the degenerative changes of the intervertebral disc (IVD), a crucial component of the human spine, have been implicated as a possible primary etiologic factor. The long-term objectives of this project are: (1) to better understand the biomechanics of the IVD, (2) to delineate the biomechanical etiology of disc failure, (3) to elucidate the pathophysiology of low-back pain, and (4) to develop new, minimally invasive diagnostic tools for disc degeneration. The purpose of this pilot research is to develop new techniques and experimental protocols for the investigation of relations of material properties to tissue composition and structure. The specific aims are to (1) investigate effects of proteoglycan (PG) content and collagen matrix density on tissue hydration, (2) investigate electrical properties of normal and PG-extracted IVD tissues, and (3) investigate dynamic compressive behavior of normal and PG-extracted IVD tissues. Three experimental studies will be developed and performed in this project. They are: (1) measurements of water content and true density of solid matrix, (2) measurement of electrical conductivity, and (3) dynamic compression testing of normal and PG-extracted animal IVD tissues. The experimental data will also be analyzed using a mechano-electrochemical theory to elucidate the relations of material properties to tissue composition and structure. These studies will help to understand the mechanism for regulating tissue hydration, the effect of disc degeneration on material properties and biomechanical behavior, and the biomechanical etiology of disc failure in human IVDs. The results will be useful for the future development of theoretical modeling as well as minimally invasive diagnostic tools for disc degeneration. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ERGONOMIC INTERVENTIONS FOR GARMENT WORK Principal Investigator & Institution: Ritz, Beate R.; Associate Professor; Epidemiology; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2005 Summary: The center of apparel manufacturing in the United States is California with approximately 7,500 apparel firms and the Los Angeles basin accounting for 80% (115,000 jobs) of California's apparel and textile industry. Nearly 40% of the industries with the highest reported incidence rates of injuries and illnesses from repetitive motion
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in the United States are in apparel manufacturing. Thus, we are proposing to conduct a randomized trial of a newly developed ergonomic intervention applied to sewing machine operators working in LA garment shops; we tested these interventions previously for acceptance by workers in Northern California. The proposed ergonomic intervention package includes changes in work station design such as 1) tilting the sewing machine table to decrease neck and trunk flexion; 2) seating improvements such as adding sitting wedges to existing chairs and/or providing highly adjustable chairs appropriate selected for work at a sewing machine; 3) installing table extension on the left side of the sewing machine table to decrease awkward arm postures and pinch forces; and 4) providing support for the left foot with a simple block of wood or extending the foot pedals so that both feet are well supported, or activate, the control. In addition to equipment changes, we will train all employees in how to perform work tasks more safely, and/or suggest improvements in the work procedures (e.g., redesign of the work flow, rest breaks, enhanced variety in tasks to reduce repetitive strain). We will examine whether interventions implemented at 150 sewing work station and expected to have benefits can reduce rates of upper extremity, neck (and lower back) musculoskeletal disorders, severity of pain and impairment, and lost-time compared to 150 'placebo' (control) interventions. Secondary purposes include (1) determining the effect of the intervention on body postures and work practices, (2) identifying the characteristics of employees, who benefit from the intervention, (3) estimating the effects of the intervention on productivity, and (4) estimating the cost of the intervention. The long-term objectives of this line of research are to determine to what extent ergonomic and some work organizational changes (for sewing machine operators in garment shops can prevent upper extremity, neck and low back musculoskeletal impairment, disorders, and disability. This study will provide employers, employees and public agencies with evidence of the effectiveness of ergonomic interventions in order to guide health and safety policy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EVALUATING YOGA FOR CHRONIC LOW BACK PAIN Principal Investigator & Institution: Sherman, Karen J.; Associate Scientific Investigator; Center for Health Studies Seattle, Wa 98101 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-APR-2004 Summary: Back problems are among the moist prevalent conditions afflicting adults and are a leading reason for using complementary or alternative medical (CAM therapies). Despite the common use of CAM therapies for back pain, little is known about how they compare with conventional treatments. Although there have been numerous randomized trials evaluating the effectiveness of spinal manipulation and acupuncture for back pain, no trials could be identified that evaluated yoga. This study will lay the groundwork for a full-scale trial that compares yoga with conventional exercise and usual care for chronic low back pain. During Phase I of this project, we will develop, test, and refine individual components of such a randomized clinical trial. This will include specification of protocols in the yoga and exercise groups, subject selection criteria, and recruitment and retention strategies. During Phase II, we will use the study components developed during Phase I to conduct a pilot trial of these interventions. We will randomized 30 persons with chronic low back pain to each of the following groups: yoga, a conventional therapeutic exercise program, and usual care. We will measure each treatment's impact on symptoms, function, quality of live, and back pain-related utilization and costs of care after 6 weeks, 122 weeks, and 6 months. The pilot study will permit us to identify and resolve unanticipated problems, to estimate the samples
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required for an adequately powered full-scale trial, and to obtain preliminary estimates of the effectiveness and safety of yoga and the therapeutic exercise program. At the conclusion of this project, we will be well-positioned to prepare a competitive grant proposal to evaluate the effectiveness of yoga as a treatment for persons with chronic low back pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: FLOOR SLOPE EFFECTS ON LIFTING KINEMATICS AND KINETICS Principal Investigator & Institution: Reiser, Raoul F.; Health and Exercise Science; Colorado State University-Fort Collins Fort Collins, Co 80523 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 29-MAR-2004 Summary: (provided by applicant): This is a revision of a previously submitted R03 proposal. The long-term objective of this research program is to develop guidelines for the Manual Materials Handling task of lifting an object from an inclined floor surface in order to reduce the risk of low-back pain and injury at the workplace. Specific aims include determining lifting capacities while facing up an incline, down an incline, and compare them to lifting the same object from a level floor surface. Additional efforts will be made to quantify the kinematics of lifting as well as the loading on the low back in order to understand how the different lifting conditions affect the lifter, and if one lifting condition places a person at an increased risk of injury compared to other conditions, Efforts will also be made to examine how different lifting techniques (altered foot placement) may reduce the likelihood of low-back pain or injury caused from lifting on an inclined surface. Two separate experimental protocols will be utilized in order to realize the long-term objectives of this two-year research program. The first protocol will determine lifting capacities under three distinctly different lifting situations with the feet placed in the same position relative to the lifted object: facing up an incline, facing down an incline, and on a level surface. The psychophysical method will be used to determine lifting capacities in each condition. This method has been used successfully in the past to determine lifting capacity guidelines for other situations. Also, as part of this protocol, kinematics of motion, the loading on the lower back, and muscle activity of key muscles in the back will be assessed in each condition. Sagittal plane cinematography will be combined with anthropometrics parameters to perform an inverse-dynamics analysis of the lifts. The second protocol will be conducted in the same manner as the first. However, foot placement will be staggered (one foot forward of the other) in the two inclined lifting situations while foot placement will be even in the level surface condition. Participant numbers will allow statistical comparisons of males, females, and the whole group. The results from these two protocols will be combined with the intent to produce guidelines related to lifting on inclined surfaces. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: FUNCTIONAL IMPACT OF PENS FOR 65+ CHRONIC LOW BACK PAIN Principal Investigator & Institution: Weiner, Debra K.; Associate Professor; Medicine; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-MAY-2007 Summary: (provided by applicant): Chronic low back pain (CLBP) plagues greater than 6 million community dwelling older adults, and causes physical and psychosocial dysfunction as well as increased utilization of health care resources. While the mainstay of treatment for these individuals consists of non-opioid analgesics and physical therapy
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(PT), frail older adults with unrelieved symptoms have limited therapeutic alternatives. Opioid analgesics and surgical treatment may be inapplicable to those with prohibitive physical or cognitive comorbidities. Many individuals with chronic musculoskeletal pain seek out complementary and alternative treatments, although most have not been subjected to rigorous scientific investigation. Acupuncture is among the most commonly employed of these modalities. The purpose of this investigation is to explore the utility of percutaneous electrical nerve stimulation (PENS), a neuroanatomically guided form of electroacupuncture, as a safe non-pharmacologic analgesic alternative for the older adult with CLBP. In order to optimize physical performance and diminish disability, the value of a general conditioning and aerobic exercise (GCAE) program with and without PENS will also be studied. A randomized controlled clinical trial will be performed. Two hundred community dwelling older adults equal to or > age 65 with CLBP will receive either (1) PENS alone, (2) sham PENS alone, (3) PENS + GCAE, or (4) sham PENS + GCAE, twice a week for 6 weeks. All outcome measures will be collected pretreatment, at the completion of the 6 weeks protocol, and 6 months later. Primary outcome measures include pain intensity (short form McGill Pain Questionnaire) and pain-related disability (Roland Disability Scale). Because chronic pain is a complex, multidimensional experience, important secondary outcome measures will also be collected that assess key aspects of (1) physical function (self-reported and performancebased), (2) psychosocial function (mood, self-efficacy, self-rated health, cognitive coping, fear, sleep), and (3) health care utilization. This study represents the first wellcontrolled, comprehensive examination of an alternative medicine intervention for CLBP in older adults. If effective, this trial could lead to improved quality of life for millions of suffering older Americans, and by diminishing pain intensity and the use of toxic analgesic regimens, lead to substantial cost savings by decreasing health care utilization. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GEOGRAPHIC VARIATION IN SPINE CARE AMONG INJURED WORKERS Principal Investigator & Institution: Rischitelli, Gary; None; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 29-SEP-2005 Summary: (provided by applicant): This proposal addresses two National Occupational Research Agenda priority areas: occupational health services research and low back pain. Back pain among workers is an enormous medical, social, and economic burden in the United States. Back disorders account for 27% of all disabling occupational injuries in the United States and the average direct cost of a low back injury claim is more than twice that of other occupational injury claims combined. The primary goal of the study is to examine community differences in the rate and types of spinal surgery performed on injured workers using small area analysis. Small area analysis is a commonly employed method in health services research but there have been limited applications of this technique in occupational health research. Oregon, as well as a number of neighboring Western states, has been identified as having elevated rates of spine surgery compared to the rest of the nation and significant local variation exists among communities based on prior analyses of Medicare claims data. We plan to evaluate whether a similar pattern of local variation exists for workers' compensation claims and to evaluate factors contributing to observed variations including physician specialty, physician supply, source of payment, and the effect of managed care. This project will pilot the use of an existing comprehensive state database of workers' compensation
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medical payments that provides rich opportunities for health services and outcomes research in occupational health. The methods described in this application can be applied to other geographic units or other diagnoses and thereby serves as a model for analyzing the individual, community and provider variables that influence the treatment of work-related injuries and illnesses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HUMAN LUMBAR FACET CAPSULE BIOMECHANICS Principal Investigator & Institution: Khalsa, Partap S.; Assistant Professor; Orthopaedics; State University New York Stony Brook Stony Brook, Ny 11794 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2005 Summary: (provided by applicant): Lumbar facet joints serve neurophysiological as well as biomechanical functions and, when subject to noxious stimulation, can produce low back pain. The facet joints are comprised of the articulating processes of adjacent vertebrae and a ligamentous capsule that tends to constrain the articular movements. As loads are transmitted by the facet joints, the joint surfaces move relative to each other and the capsule is deformed. Capsular deformations are thought to be an adequate neurological stimulus, evoking the discharge of sensory nerves innervating the capsule. Since the capsule is innervated by mechanoreceptors and nociceptors, it may function to signal position or loading of the facet joint. However, to date there are few quantitative studies of the mechanical state of the facet capsule during normal physiological ranges of motion of the spine. Thus, it is unknown if the capsule can be sufficiently loaded under physiological conditions to result in stimulation of the mechanically sensitive neurons known to innervate it. The long term goal of the investigators is to understand the functional interactions between spinal biomechanics and the nervous system. Knowledge gained through these studies will provide important and novel information regarding the mechanisms by which spine disorders can affect the nervous system. For example, disc degeneration and chemonucleolysis may increase the load on the facets. Until we know how the facet capsules respond under load, we will not be able to determine the relevance of these changes to the pathogenesis of low back pain. The short range goal of the investigators is to elucidate how the human facet joint capsule is loaded during physiological loads of the lumbar spine and to develop a computational model that will enable us to ultimately examine how manipulations of the spine affect capsule loading. This project, using un-embalmed human cadaveric lumbar spines, will: 1) Measure the plane strains developed during physiological motions of the lumbar spine; 2) Determine material properties of the facet joint capsule; and 3) Develop a mathematical model of the capsule using finite element analysis to enable estimating stress at any location within the capsule during loading. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: INTERVERTEBRAL DISC MECHANOREGULATION: AN EXPLANT MODEL Principal Investigator & Institution: Lee, Cynthia R.; Mechanical Engineering; University of Vermont & St Agric College 340 Waterman Building Burlington, Vt 05405 Timing: Fiscal Year 2003; Project Start 16-JUN-2003; Project End 15-JUN-2005 Summary: (provided by applicant): The first part of the proposed work is the development and validation of an intervertebral disc explant culture system. The second part of the proposed work is experimental studies investigating the effects of mechanical compression of the disc explants on the metabolic activity of the disc cells. Elucidation of
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the loading parameters that are beneficial and detrimental to disc health is necessary for the development of appropriate preventative measures and treatment therapies for low back pain and for the design of tissue engineered replacements of the degenerate disc. The establishment of a reliable in vitro culture system for intervertebral disc implants is an important step in furthering our understanding of the effects of mechanical loading on disc metabolism. The development of an in vitro explant culture system would provide for compromise between the in vivo and isolated cell systems, allowing for controlled evaluation of the effects of mechanical loading on disc cell metabolism. The initial experimental work that will be conducted under this proposed project will lay the groundwork for future in vitro and in vivo studies on intervertebral disc mechanobiology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INTERVERTEBRAL DISC RESPONSE TO CYCLIC LOADING IN VIVO Principal Investigator & Institution: Hung, Clark T.; Associate Professor; Biomedical Engineering; Columbia Univ New York Morningside 1210 Amsterdam Ave, Mc 2205 New York, Ny 10027 Timing: Fiscal Year 2002; Project Start 26-SEP-2002; Project End 31-AUG-2006 Summary: This grant proposal has been submitted in response to RFA-OH-02-004: Musculoskeletal Disorders: Prevention and Treatment, falling under the Biomechanical and Mechanobiology Research bullet. This grant brings together a multidisciplinary research team in the Departments of Biomedical Engineering and Orthopaedic Surgery at Columbia University to develop an animal model that can be used to establish the critical threshold loading level at which degenerative changes are observed in intervertebral discs (IVDs) subjected to cyclic loading under physiologic conditions. Occupational exposures (e.g., overstressed, high repetitive loading, whole body vibration) are generally accepted as an important cause of low back pain reports in industrialized countries. In the United States, back and spine problems represent the second greatest leading cause of disability among persons aged 15 years and older with low back pain from vibration exposure estimated to cost $80 billion annually. To better understand the impact of biomechanical factors on the etiology of disc degeneration, various animal models have introduced mechanical interventions on the spine or tail. These mechanical interventions cause morphologic changes in the intervertebral disc (IVD) and vertebrae similar to degenerative disc disease in humans. Amongst these models, pin instrumented mouse and rat tails have permitted significant insights to the effect of static loading or disuse on disc degeneration. There are,however, apparently no published studies using such models to study applied cyclic loading of the IVD in vivo. To address this apparent gap in spine research, we propose to adapt the in vivo rat tail model currently used by one of the co-Investigators (XE Guo) to study trabecular bone adaptation, to study loading-induced changes in the IVD. In this model, a well-defined loading regiment (static or temporally varying) can be applied to a specific vertebra and its adjacent discs via loading to surgical pins implanted in the neighboring vertebrae. With the ultimate goal of isolating the influence of joint-loading conditions on the response of the IVD, we set forth a number of specific hypotheses and specific aims test our global hypothesis that there exists a range of loading magnitudes and frequencies that will safely maintain normal function and properties of the IVD. Outside of this range, non-physiologic compressive loading (overloading, high frequency, or static loading) of the IVD leads to disc degeneration as measured by decreased material
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properties (stiffness and modulus) and alterations to expression and levels of aggrecan, type I and II collagen, and cartilage oligomeric protein (COMP). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INTRAMUSCULAR ELECTRICAL STIMULATION FOR LOW BACK PAIN Principal Investigator & Institution: Fang, Zi-Ping; Vice President for Research and Developm; Neurocontrol Corporation 8333 Rockside Rd, 1St Fl Valley View, Oh 44125 Timing: Fiscal Year 2003; Project Start 24-SEP-2003; Project End 31-AUG-2004 Summary: (provided by applicant): The long-term goal of the proposed research is to develop and commercialize a cost-effective product for the treatment of chronic low back pain of muscular origin by using intramuscular electrical stimulation (IMES). In IMES, wire electrodes are temporarily implanted into muscles through the skin and connected to a portable stimulator for several weeks of stimulation treatment. The IMES product and treatment are expected to be: (1) more effective than transcutaneous electrical nerve stimulation (TENS) and conventional neuromuscular electrical stimulation (NMES) as the IMES uses intramuscular instead of skin-surface stimulation, permitting more intense and specific stimulation; (2) more effective than percutaneous electrical nerve stimulation (PENS) as the IMES uses indwelling wire electrodes instead of acupuncture needles, permitting more frequent and longer-lasting treatment sessions on a daily basis for many weeks; and (3) more convenient to use than the PENS as patients only need to visit the clinic once for electrode insertion and once for electrode pull-out instead of many treatment visits, saving time and money. A case-series clinical study will be conducted to assess the feasibility of the proposed IMES product and treatment. Specifically, (1) a total of 10 subjects with chronic low back pain will be enrolled in the study according to the proposed subject eligibility criteria; (2) a set of 8 intramuscular electrodes will be implanted into the low back muscles of each subject according to the proposed protocol; (3) a 6-week stimulation treatment will be completed in at least 8 subjects according to the proposed paradigm; (4) a complete set of data will be collected and analyzed on the results of the IMES treatment according to the proposed outcome measures and data collection schedule. The proposed Phase I feasibility study is critical to the ultimate market success of the IMES product. Specifically, (1) the clinical experience gained and experimental data collected during the Phase I study will provide a firm basis for the design of a pivotal randomized controlled trial to demonstrate the safety and effectiveness of the device and treatment in a Phase II study; and (2) the design and test results of the prototype device used in the Phase I study will provide a firm basis for the refinement of the product design during the Phase II study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: LBP WITH RADICULOPATHY: AN INFLAMMATORY RESPONSE Principal Investigator & Institution: Deleo, Joyce A.; Associate Professor; Anesthesiology; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, Nh 03755 Timing: Fiscal Year 2002; Project Start 03-SEP-1997; Project End 31-JUL-2006 Summary: (provided by applicant): Low back pain is a major clinical problem second only to the common cold in its financial and symptomatic impact on human suffering. Our long-term objective is to understand the pathophysiological mechanisms of low back pain associated with lumbar radiculopathy. To achieve this goal, we will apply experience with animal models of lumbar radiculopathy and chronic neuropathic pain
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to evaluate and test our hypothesis. In the current proposal, we apply data from the previous funding period to investigate the following hypothesis: Lumbar nerve root injury produces a CNS immune mediator imbalance, which leads to an "autoimmune" syndrome that in turn manifests as persistent radicular pain. The research proposed in the present application, when integrated with our previous data, will determine the individual roles and the collective interactions of specific cytokines and chemotaxic cytokines, (chemokines) and cell trafficking in the etiology of persistent radicular pain. The central hypothesis will be tested by using established methods in our laboratory to investigate the following Specific Aims: 1. Assess the role of chemokines in the etiology of persistent radicular pain using the Chromic Lumbar Radiculopathy (C-LR) rodent model. 2. Continue to address importance of site of injury in relationship to the DRG to pain generation. 3. Determine whether cells traffic from the periphery into the central nervous system in response to lumbar nerve root injury that results in persistent radicular pain. 4. Assess the contribution of mechanical root injury versus chemical inflammatory components in the generation of radicular pain. 5. Determine the effect of selective and global immunosuppressive therapy on the potential to alter sensory processing and on the central inflammatory cascade. When completed, this project will provide: Information on the in vivo kinetics of spinal proinflammatory cytokine and chemokine expression and production in a rodent radiculopathy models; Preliminary data to guide and support new pharmacological treatments of acute and chronic low back pain; New insight into the relationship between the neuroimmune response of nerve root injury and the clinical phenomenon of low back pain; Preliminary data to direct future studies that evaluate the impact of central neuroimmune activation in causation of low back pain with radiculopathy; New information on the pathogenetic distinction between nerve injury central or peripheral to the dorsal root ganglion (a clinically relevant anatomical location). This new knowledge will guide development of novel, non-addictive preventive therapies and treatments for chronic low back pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: LOAD INDUCED DISC DEGENERATION IN A RAT TAIL MODEL Principal Investigator & Institution: Iatridis, James C.; Orthopedics and Rehabilitation; University of Vermont & St Agric College 340 Waterman Building Burlington, Vt 05405 Timing: Fiscal Year 2002; Project Start 01-SEP-1999; Project End 31-JUL-2004 Summary: The proposed K01 project was designed to test important hypotheses while creating an opportunity to increase the candidate's research skills in focal training areas. Dr. Iatridis proposes an intensive training program overseen by an Advisory Board to allow him to progress from mentored to independent scientist. His Advisory Board is comprised of members who are well-recognized for their contributions to biomechanical, computational, and biochemical research on the spine and intervertebral disc. Along with regular meetings with mentors, course work, and seminars, Dr. Iatridis will participate in extended training programs in biochemistry and molecular biology, computational modeling, and magnetic resonance imaging which address specific hypotheses of his research plan and increase his skill base. The long-term goal of the research plan is to isolate mechanical factors that lead to degenerative disc disease and spine pathology. The primary objective of the proposed research is to investigate the effect of mechanical loading conditions applied to the intervertebral disc on the physical signals that cuase a biosynthetic response from the cells and tissue remodeling. Specific aims were developed that are consistent with several future directions for research recommended by the 1995 NIH/AAOS workshop on low back pain and NIH PA97-058. A general hypothetical model is introduced where the intervertebral joint forces are
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related to dominant load carriage mechanics in the disc tissue and those physical signals that cause a biosynthetic response. The hypotheses test the influence of specific joint forces on on observed intervertebral disc remodeling. External fixators allow precise control over the joint forces applied to a rat tail in vivo. The tail will chronically be exposed to immobilization, low-force compression, high-force compression, and shear loading, as well as loading followed by removal of the fixators to probe for recovery (independent variables). Dependent variables describing the composition and biosynthetic response of the disc tissue will be measured using biochemical, in situ hybridization, and MRI techniques. The mechanical and electrochemical fields in the disc tissue will be calculated using a poroelastic and chemical electric finite element model and mechanical properties measured in this study as input parameters. The biosynthetic response of the disc will be compared to the dominant load carriage mechanisms in the disc tissue in a site-specific manner. This combined experimental and theoretical project provides a framework for future developments on the cell scale by investigating cellular transduction mechanisms, and on the full joint scale by isolating joint forces that may acccelerate intervertebral disc degeneration in human spines. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: LOW BACK PAIN IN CYCLIC AND PROLONGED ACTIVITIES Principal Investigator & Institution: Solomonow, Moshe; J. Calten Professor; Orthopaedics; Louisiana State Univ Hsc New Orleans New Orleans, La 70112 Timing: Fiscal Year 2002; Project Start 01-MAY-2000; Project End 30-OCT-2003 Summary: The role of spinal ligaments in causing spinal instability, injury and low back pain in two types of occupational activities will be investigated. It is hypothesized that mechano-receptors in the spinal ligaments, when deformed due to loading, initiate sustained reflex activity in the paraspinal muscles. As creep sets in the ligaments, over time, the receptors are desensitized and the reflexive muscular activity is lost, rendering the spine exposed to instability, injury and low back pain. This research, therefore, may provide an insight for a wide range of low back pain types, ranging from idiopathic pain due to ligament strain, to that resulting from the chain reaction of injury, disc herniation and nerve damage due to lack of musculature support. A three year experimental research program consisting of the feline model will systematically explore the relationship between the electrophysiological and mechanical properties of spinal ligaments in vivo and the activity of motor units of the paraspinal and abdominal muscles in cyclic and stationary loading conditions, when the ligaments are subjected to creep as well as their recovery pattern with rest. The results of this research will provide strong insight into the neurophysiology of low back pain in common occupational activities; provide an insight to the cause of lost muscle strength and coordination and prolongation of low back pain; and delineate occupational conditions that result in low back pain and other occupational conditions that may prevent it. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: LOW BACK PAIN QUANTIFYING RISK FACTORS Principal Investigator & Institution: Garg, Arun; Professor; Indust & Manufacturing Engr; University of Wisconsin Milwaukee Graduate School Milwaukee, Wi 532010340 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 29-SEP-2006 Summary: This multi-center prospective cohort study will: (i) Determine baseline prevalence rates and subsequent incidence rates over a 2 year period for low back pain (LBP), LBP with neurological signs (sciatica), LBP-related impairments, lost time and
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modified duty-related LBP for 3 levels of job physical exposures (low, medium, high), (ii) Quantify job and individual risk factors (e.g., weights, frequency, horizontal and vertical locations, low back moments, etc.), (iii) Validate existing job analysis methods (especially Revised NIOSH Lifting Equation, Maximum Acceptable Weights land Forces, 3-D Static Strength Biomechanical Model, the Proposed TLV for Lifting, and the Washington State Checklist, and (iv) Develop a final model for determining MSD risks. A cohort of 678 workers (study drop-outs replaced) from 10 very different industries with a total worker population of over 10,000 in three diverse states will;) participate in the study to help ensure generalizability of the study results. To maximize objectivity and accuracy, job physical exposures will rely primarily on measurements to quantify exposures. To maximize clinical and epidemiological validity and reliability, all participants will have health outcomes assessments by Physical Therapists and qualified physicians. These will include: baseline questionnaires, structured interviews and standardized physical examinations. Changes in job physical exposures will be monitored monthly. LBP symptoms, sciatica, LBP impairments and LBP severity measures will be assessed monthly using a symptom questionnaire on all, and structured interviews/physical examinations on those with symptoms. Job physical exposure and health outcomes assessment teams will be blinded to each other throughout the field observation phase. Multivariate logistic regression models and survival analyses will be utilized to explore relationships between job physical risk factors and low back pain (LBP), sciatica, LBP impairments and LBP severity measures. In addition to quantifying ergonomic risk factors, interactions between various jobs, psychosocial and individual risk factors will be explored. This project is expected to result in the ability to improve the existing ergonomic job evaluation models that have robust predictive capabilities for a broad range of industries. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: LOW BACK PAIN: A MOTOR CONTROL IMPAIRMENT? Principal Investigator & Institution: Henry, Sharon M.; Physical Therapy; University of Vermont & St Agric College 340 Waterman Building Burlington, Vt 05405 Timing: Fiscal Year 2002; Project Start 01-JUN-1998; Project End 31-MAY-2003 Summary: The candidate for this Mentored Research Scientist Development Award, Sharon M. Henry, Ph.D. PT, is a physical therapist. Her clinical work covers the rehabilitation of persons with neurological and musculoskeletal impairments particularly low back pain (LBP). She has assisted with several clinical studies of LBP patients conducted through the Rehabilitation Engineering Center (REC) for LBP at the University of Vermont (UVM). Being interested in the role of somatosensory information in motor control, Dr. Henry proceeded to earn her Ph.D. in the Anatomy and Neurobiology Department at UVM, and completed her post- doctoral fellowship with Dr. Fay Horak in Portland OR. During this time, Dr. Henry received three postdoctoral awards and completed studies examining postural responses in healthy and spinal cord injured subjects. Her long term goals include examining motor control issues in patients with musculoskeletal impairments, specifically LBP. As a researcher and clinician, Dr. Henry wishes to contribute to the field of medical to the field of medical rehabilitation and conduct research that will impact on the way physical therapists and other rehabilitation specialists treat patients. Dr. Henry has a position as assistant professor in the Physical Therapy Department at UVM. The Department has committed to starting a new 2100 square foot state-of-the-art Motion Analysis Laboratory and has committed to fostering Dr. Henry's career as an independent investigator. Within the Department, there are several other faculty members who are involved in motor control
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and LBP research. In addition, there is an active scientific community on campus through the REC that has been conducting LBP research since 1982. The studies proposed in this application reflect a merging of Dr. Henry's background and interests. It has long been thought that poor neuromuscular control of trunk muscles may lead to injury by causing local mechanical damage to spinal structures, and thus, LBP. However, little is known about the function of specific trunk muscles in normal subjects during various activities of daily living (Specific aim 1), and the precise muscle dysfunction associated with LBP has not been satisfactorily characterized (Specific aim 2). Therefore, a better understanding is needed of when trunk muscles in active spinal and postural stabilization in healthy and in selected groups of persons with LBP. This goal will be achieved by characterizing muscle, kinematic, and force strategies used to control truck/spine in postural responses to multi-directional, multi-velocity surface translations. By having a better understanding of trunk motor coordination, evaluation and treatment strategies can be more specific and more effective in the rehabilitation of persons with LBP. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MATRIX INTERVERTEBRAL DISC
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Principal Investigator & Institution: Thonar, Eugene J-Ma.; Professor; Rush University Medical Center Chicago, Il 60612 Timing: Fiscal Year 2002 Summary: (provided by applicant): This interdisciplinary (Orthopedics and Biochemistry) project is aimed at improving our current knowledge of the metabolic processes involved in the onset and progression of degenerative disc disease and at providing information that may lead to the development of better approaches for the diagnosis, prevention and treatment of this condition. The first aim is to relate early and late degenerative changes detected by magnetic resonance imaging (MRI) of the human spines studied in project I of this program project to changes in the gross and histochemical/immunological appearances as well as the composition and organization of the matrix of IVDs isolated from these spines. With the goal of determining if degenerative changes occurring at specific stages (i.e. early vs late) are associated with specific metabolic changes we will characterize the sequence of progressive changes in gene expression by the NP and AF cells in those discs. The second aim is to develop models of discs degeneration by culturing discs with their endplates or IVD cells that have reestablished a matrix in alginate gel in the presence of interleukin-1 (IL-1). We postulate that, at the doses it has been detected in degenerating human disc tissues, IL-1 will be effective in causing loss of matrix synthesis, principally by shutting down matrix synthesis. We then propose to determine how effective osteogenic protein- 1 (OP- 1) is in promoting the repair of the IL- 1 -treated IVD and its matrix. Metabolic experiments will be performed to identify through what metabolic mechanisms this bone morphogenetic protein promotes the return to and subsequent maintenance of matrix homeostasis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MECHANICALLY-BASED IMPAIRMENT MEASURES OF LOW BACK PAIN Principal Investigator & Institution: Van Dillen, Linda R.; Physical Therapy Education; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 01-MAR-2000; Project End 28-FEB-2005
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Summary: (Adapted from Applicant's Description): The goal of this Mentored Research Scientist Development Award is to allow the applicant to develop the research skills necessary to be independent in the investigation of movement impairments in people with spinal pain conditions using clinical and instrumented measures. The long term goals of the proposed research are to understand the nature and specificity of the movement impairments found in spinal pain conditions and to use this information to design and test rehabilitation and prevention strategies for these conditions. Studies have been designed to test the general hypothesis that mechanical low back pain (MLBP) results, in part, from a tendency of the lumbar spine to favor movement in a specific direction when moving the trunk or limbs. The tendency to move in a specific direction is proposed to develop as a consequence of repetition of movements performed during daily work and leisure activities. The experiments will address whether or not (1) distinguishable groups of MLBP can be identified based on directionspecific impairments measured during a clinical examination, (2) there is a relationship between the specific directions in which trunk movements are performed repeatedly and specific types of movement impairments identified in people with MLBP, and (3) there are altered patterns of trunk muscle recruitment in people with MLBP that perform trunk movements repeatedly in a specific direction. To address these hypotheses, data from tests from a clinical examination that assesses direction-specific, mechanically-based impairments, as well as kinematic and electromyographic (EMG) data will be examined. In the first experiment, a data set of direction-specific clinical examination variables from people with MLBP will be tested for the presence of distinguishable groups of MLBP using advanced, multivariate techniques. A second experiment will compare the number and extent of direction-specific impairments in a cohort of people with MLBP performing repeated trunk movements in a specific direction, and a control group. A third experiment will examine the relationship between hip and trunk rotation impairments in people with and without MLBP performing repeated trunk rotation movements. Finally, trunk muscle recruitment patterns during extremity movements will be compared in a cohort of people with MLBP performing repeated trunk movements in a specific direction, and a control group. The proposed experiments are designed to determine the nature of the movement impairments in MLBP and to relate these impairments to specific, everyday activities the persons perform repeatedly. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MINIMALLY INVASIVE VERTEBRAL TRACKING SYSTEM FOR CAS Principal Investigator & Institution: Glossop, Neil D.; Traxtal Technologies 5116 Bissonnet, #324 Bellaire, Tx 77401 Timing: Fiscal Year 2002; Project Start 26-SEP-2002; Project End 31-AUG-2003 Summary: (provided by applicant): This project will characterize the accuracy of a small magnetic tracking system and develop techniques to improve image-guided, minimally invasive spine interventions. Tracking systems are an integral part of image-guided surgery systems and allow the position of instruments to be followed in threedimensional space. This new generation of magnetic trackers is well suited to less invasive, percutaneous spine interventions because of their small size. The accuracy of the magnetic tracking system will be compared with existing optical tracking systems using well-established engineering methods. New techniques and instrumentation will be developed for embedding these trackers in vertebral bodies and evaluated using an interventional phantom (Phase I) and animal models and cadavers (Phase II). It is
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anticipated that improved tracking systems for image guidance will enhance minimally invasive spine procedures and lead to decreased morbidity in these commonly performed interventions. Potential clinical applications include percutaneous interventions for low back pain and therapeutic treatments for spinal metastases. The commercial potential for these tracking systems is large, as the market for minimally invasive spine interventions has expanded dramatically in the past decade and is expected to continue to do so. The instrumentation developed here will be offered to computer assisted surgery (CAS) vendors for incorporation into their product lines. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MOTOR CONTROL DEFICIT IN LOW BACK PAIN: CAUSE OR EFFECT? Principal Investigator & Institution: Cholewicki, Jacek; Associate Professor; Orthopedics and Rehabilitation; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2002; Project Start 01-MAY-2001; Project End 30-APR-2004 Summary: (Verbatim from application) Revised Application: Because the specific causes underlying low back pain LBP have not yet been identified, it continues to be a significant public health problem. Many of the factors associated with low-back pain are mechanical in nature. Epidemiological and biomechanical studies have suggested that there is a link between sudden and unexpected loading, such as slips and falls, and lowback injuries. Under these circumstances, motor control of the mechanical stability of the lumbar spine is crucial in determining trunk kinematic response to sudden loading and the subsequent likelihood of injury. Compared to healthy controls, however, LBP patients exhibit deficits in motor control such as delayed trunk muscle reflex response, poor trunk positioning sense, and impaired postural control. These deficits may constitute predisposing risk factors for sustaining an injury, a compensation/pain avoidance mechanism, or they may be the consequence of damage sustained by the lumbar spine tissues. The objective of the proposed research is to improve our understanding of the relationship between the measured motor control deficit and LBP. Two experimental studies and a post-hoc analysis of the entire data set form the 3 specific aims. The first prospective design study will consist of the initial testing and a 2year follow-up of varsity athletes. The goal is to determine whether poor motor control of the lumbar spine increases the risk for sustaining a low-back injury. The second randomized prospective study will be conducted to document the changes in motor control of the lumbar spine in LBP patients before and after standard and modified rehabilitation programs that emphasize motor control training. Several tests, developed in preliminary studies, will quantify the deficit in the motor control in LBP individuals: response of trunk muscles to a sudden, multi-directional load release and the stability of the lumbar spine, and postural control of the trunk in unstable sitting. Correlations between the above measures of motor control and other variables in the LBP population will be determined in the third specific aim. These additional variables will include: trunk position and motion proprioception, objective and subjective measures of physical function, diagnosis and duration of symptoms, and personal characteristics such as age and gender. The results of the proposed research will have a significant clinical relevance for designing more effective prevention, diagnosis, and rehabilitation strategies for LBP. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MUSCLE OVEREXERTION DURING REPETITIVE LIFTING Principal Investigator & Institution: Marras, William S.; Professor and Director; Industrial, Welding & Sys Engr; Ohio State University 1960 Kenny Road Columbus, Oh 43210 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 29-SEP-2004 Summary: Occupationally-related low back disorders (LBDs) are the leading cause of lost workdays and the most costly occupational safety and health problem facing industry today. LBDs are particularly prevalent in manufacturing, distribution center, and warehousing environments where repetitive lifting is common. Although assessments have successfully evaluated LBD risk during a single exertion, none have been able to effectively assess how risk changes during repetitive lifting at various lifting frequencies throughout a workday. This study will assess how exposure to different frequencies of lift over time can result in unacceptable biomechanical risk of LBD. Our preliminary studies point to two mechanisms of risk. First, different lift frequencies affect lifting kinematics and the subsequent muscle recruitment patterns. These changes alter the nature (direction) and magnitude of spinal loading, thereby exceeding spine tolerance limits. Second, exposure to a repetitive lift throughout the workday can also result in muscle recruitment pattern changes over the work period, thereby, increasing the spinal loading throughout the day. Hence a lift frequency that is acceptable early in the workday may exceed biomechanical tolerance limits as the workday progresses. This study will explore the changes in muscle recruitment and spinal loading when workers lift one of three weights (corresponding to the range of industrial exposures) at six different lift rates over extended workdays. The frequency and duration of lift will be judged risky and unacceptable when the spinal loads exceed documented spine tolerance limits. These findings will result in an understanding of the portion of the population at risk for spine structure (disc) injury as a function of load magnitude, lifting frequency, and lift period duration. These results will provide quantitative guidance for the mediation of work-related LBDs for the millions of workers performing materials handling tasks in manufacturing and distribution center environments. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MUTATIONS CAUSING DISC DISEASE AND SCIATICA Principal Investigator & Institution: Ala-Kokko, Leena M.; Center for Gene Therapy; Tulane University of Louisiana New Orleans, La New Orleans, La 70112 Timing: Fiscal Year 2002; Project Start 27-SEP-1999; Project End 31-AUG-2004 Summary: Low back pain and sciatica are the most common musculoskeletal complaints. Even though secondary factors such as environmental and anthropometric risk factors contribute to intervertebral disc disease, genetic factors may play a significant role in the pathogenesis of the disease. The role of genetic factors is supported by our recent findings: We showed that a tryptophan for glutamine substitution in the alpha2 chain of collagen IX co- segregated with sciatica and intervertebral disc disease in four families with a LOD score of 4.5. Subsequent linkage disequilibrium analysis conditional on linkage gave an additional LOD score of 7.1. Thus, the joint lod score is 11.6 (4.5 + 7.1). In addition, we identified another tryptophan mutation in collagen IX (alpha3 chain). The mutation is significantly associated with the disease (p value: 0.000013) and it increases the relative risk for the disease by a factor of 2.6 (95 percent confidence interval, 1.6 to 4.3). The Specific Aims of the present proposal are: (1) To use the new sequence data from the genes and the new protocols we have
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developed to analyze DNA from 150 probands with sciatica and 100 probands that have had surgery for herniated discs for mutations in eight candidate genes: three genes for collagen IX (COL9A1, COL9A2 and COL9A3), three genes for collagen XI (COL11A1, COL11A2 and COL11A3 or COL2A1), the aggrecan gene, and the gene for link protein. (2) To evaluate the significance of the sequence variations as disease-causing mutations by analyzing the family members of the probands and non-symptomatic individuals for the presence of the sequence variations. (3) To distinguish neutral polymorphisms from mutations that cause or predispose to intervertebral disc disease, we will also synthesize the normal and mutated recombinant human proteins and determine whether the mutations alter the biological function of collagens IX and XI by assays that include (a) the thermostability of triple helices of the collagens; (b) binding to collagen II; and (c) potential of the collagen IX and XI to alter the self-assembly of collagen II into fibrils in vitro. (4) To do genome-wide screen on 100 affected sib pairs and/or families to identify additional loci for intervertebral disc disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: NEUROBIOLOGY OF MUSCULOSKELETAL PAIN Principal Investigator & Institution: Sluka, Kathleen A.; Physical Therapy and Rehabilitation Science; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 01-JUL-2001; Project End 30-JUN-2006 Summary: (Taken from the applicant's abstract): The long-term goals are to gain a better understanding of pain associated with the musculoskeletal system and the analgesia produced by physical therapy treatments. The award will allow more research-related time to expand current and develop new collaborative efforts. These collaborative efforts will be aimed at developing new techniques (isolated primary afferent recording and push-pull perfusion), new ideas (mechanisms of analgesia produced by joint mobilization) and expanding current ideas (TENS, microdialysis, muscle hyperalgesia). Interactions with scientists from multiple basic science (Anatomy, Neurosciences, Pharmacology, Chemistry, Molecular Biology) and clinical disciplines (Physical Therapy, Internal Medicine, Anesthesia, Pathology, Chiropractic) provide an interdisciplinary perspective to the examination of musculoskeletal pain and physical therapy pain treatments. Group journal clubs and laboratory meetings are held weekly with several laboratories (Gebhart, Brennan, Hammond, Proudfit, Sluka) investigating pain. The research proposal in this application is designed to characterize a newly developed animal model of chronic pain induced by two unilateral injections of low pH saline into the gastrocnemius muscle. In the work proposed they hypothesize that the development of the long lasting bilateral hyperalgesia is dependent initially on activation of acid sensing ion channels (ASIC) from the site of injection. Activation of acid sensing ion channels results in long lasting, widespread hyperalgesia that is sustained by activation of central mechanisms in the spinal cord. These proposed studies are intended to help in the understanding and thus potential treatment of chronic muscle pain including such conditions as fibromyalgia, myofascial pain and low back pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: NIAMS MCRC IN MUSCULOSKELETAL DISEASES Principal Investigator & Institution: Weinstein, James N.; Professor; Community and Family Medicine; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, Nh 03755 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2008
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Summary: The proposed Dartmouth Multidisciplinary Clinical Research Center (MCRC) in Musculoskeletal Diseases seeks to promote rigorous clinical research through a focused collaboration of diverse disciplines with an overall objective of improving the health of patients suffering from musculoskeletal diseases. Dartmouth has long had an active clinical research program, primarily associated with two well-established interdepartmental centers in outcomes research and cancer which feature internationally recognized programs in medical care epidemiology and cancer chemoprevention. As Dartmouth's research base has grown, new opportunities have arisen to extend our expertise to NIAMS-related disease areas with a particular emphasis on musculoskeletal diseases. The infrastructure in biostatistics and outcomes evaluation developed for our existing clinical research programs, combined with the initiation of a major NIAMSsponsored multi-center clinical trial for patient outcomes in surgery for low back pain, provides a unique opportunity to create a new MCRC at Dartmouth. The proposed Dartmouth MCRC will provide methodological and administrative support for achieving the research objectives summarized as follows: Project 1: To assess the prognostic value of lumbar spine MRI for the purpose of improving treatment recommendations and health outcomes of patients with chronic low back pain by assessing the role of magnetic resonance imaging (MRI) of the lumbar spine as an indicator of prognosis; Project 2: To better understand the roles of geography, race, and socioeconomic factors in determining musculoskeletal disease treatment and outcomes; Project 3: To study disability and health-related quality of life outcomes among working patients being treated for a disc herniation; Project 4 (a developmental project): To characterize orthopaedic surgeons' opinions on the principles and practice of using patient decision aids for elective musculoskeletal surgery. We also seek to enhance educational opportunities for clinicians and researchers in training, thereby fostering new clinical research initiatives that will ultimately improve the health of patients with musculoskeletal disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: NIAMS MUILTIDISCIPLINARY CLINICAL RESEARCH CENTER IN. Principal Investigator & Institution: Deyo, Richard A.; Professor; Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 15-FEB-2002; Project End 31-DEC-2006 Summary: (provided by applicant): The University of Washington proposes a Multidisciplinary Clinical Research Center devoted to the study of spine and upper extremity disorders. These conditions, especially low back pain and carpal tunnel syndrome, are among the most common and disabling conditions in working age populations. This Center will incorporate investigators from the Departments of Medicine, Radiology, Orthopaedics and Sports Medicine, Neurological Surgery, Rehabilitation Medicine, and Psychiatry and Behavioral Sciences in the School of Medicine; and the Departments of Biostatistics and Health Services in the School of Public Health. The Methodology Core will provide key support to each project: assistance with protocol details choice and implementation of outcome measures, central data accumulation, data quality monitoring, analytic strategies, statistical analysis, advice on presentation of results, and education of investigators regarding research architecture and statistical techniques. The projects proposed address key controversies and uncertainties related to spinal disorders and upper extremity complaints. These include: 1. Carpal Tunnel Syndrome. Diagnostic and Treatment Strategies: this incorporates a randomized trial to evaluate the efficacy of surgery for early but well-documented carpal tunnel syndrome, and will determine whether the
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new technique of MR neurographic imaging (MRNI) accurately identifies the patients most likely to benefit from early surgery. 2. Cohort Study of Treatment for Discogenic Back Pain: a prospective cohort study will compare patients undergoing lumbar arthrodesis for degenerative discogenic pain with those having non-surgical treatments. We seek to identify any differences in baseline characteristics as well as outcomes, and to identify characteristics that may predict unique success from either surgical or nonsurgical therapy. 3. Epidemiology of Lumbar Spine Surgery: Rates and Trends: this analysis of national survey data, state hospital discharge registries, and Medicare claims will update the U.S. rates of various forms of back surgery; examine a possible increase in spine fusion rates with the introduction of interbody fusion cages; quantify the shift of spine surgery to the ambulatory setting; and determine if reoperation rates are increasing over time, as suggested in some earlier analyses. 4. Synthesis of CT and MR images of the Cervical Spine: This feasibility project will assess the potential for combining data from CT and MRI scans of the cervical spine to produce more useful imaging for surgical planning purposes than either test alone. It will require computer modeling, based on precedents in MR-PET scanning. We will determine if surgeons will accept the synthesized images as a replacement for CT-myelography for purposes of surgical planning. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PAIN IN ADOLESCENTS: BIOLOGIC/PSYCHOSOCIAL RISK FACTORS Principal Investigator & Institution: Leresche, Linda A.; Research Professor; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002 Summary: We propose a five-year program of research aimed at assessing the prevalence and incidence of temporomandibular disorder (TMD) pain, headache, back pain, and abdominal pain in adolescents., and identifying risk factors for onset of each of these common pain {{symptoms}}. Because the prevalence of headache and TMD pain is much higher in adult women than in adult men, the studies are designed to test the global hypothesis that this prevalence differences begin in adolescence and are associated with the hormonal change of puberty. The specific aims of study 1 are: 1) In a telephone survey, assess the prevalence, severity and temporal characteristics of TMD pain, headache, backpain and abdominal pain in an age- and sex-stratified random sample of adolescents, ages 11- 17 (final n= 2970) from a defined population; 2) Identify potential risk factors for pain at each of these four sites; 3) Conduct standardized examinations and interviews for all respondents reporting TMD pain, as well as a sample of those without TMD pain (expected n's = 130 per respondents reporting TMD pain, as well as a sample of those without TMD pain (expected n's = 130 peer group) in order to: a) compare the rates of clinical signs and symptoms of temporomandibular disorders in cases and controls, and b) estimate the prevalence of specific clinical subtypes of TMD (myofascial pain, disc displacements, arthralgia, arthritis/arthrosis) using standardized examination methods and diagnostic algorithms. Examinations will be conducted in subjects' homes by Registered Dental Hygienists training and calibrated for reliability. The specific aims of Study 2 are: 1) Follow the cohort of 11 year old respondents from Study 1 (n= 1902) over a 3-year follow up period, using brief mail-in surveys and more extensive follow up data collection at 18 months and 3 years. Monitor rates of onset of TMD pain, headache, back pain and abdominal pain. Assess the impact of these pain problems in terms of interference with activities, use of medications and rates of health care use for pain; 2) Identify risk factors for onset of {{TMD pain,
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headache, back and abdominal pain}}> Hypothesized risk factors for all pains include: female gender, number of existing pain complaints, and other somatic symptoms, numbers of health care visits in the prior year, and psychological distress; in addition, we hypothesize that sexual maturity is a risk factor for onset of TMD pain and headache; 3) Estimate rates of offset and recurrence of each of the pain c9ompliants over the 3-year follow up period; and, 4) Conduct examinations of the incidence cases of TMD pain, using examination methods and diagnostic algorithms as described for Study 1, to estimate the prevalence of specific subtypes of TMD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PAIN REGULATORY SYSTEM DYSFUNCTION IN CHRONIC PAIN Principal Investigator & Institution: Bruehl, Stephen; Anesthesiology; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2002; Project Start 15-JAN-1999; Project End 30-JUN-2004 Summary: Elevated resting blood pressure (BP) is consistently related to diminished acute pain sensitivity. Ibis cardIovascular-related antinociception (mediated in part by endogenous opioids) is an important component of adaptation to pain in healthy individuals. it is unknown whether these antinociceptive mechanisms operate normally in chronic pain patients. Previous research indicates deficits in endogenous opioid levels in chronic pain patients, although little is known about the functional impact (e.g., diminished analgesia) of these deficits. Given the mediating role of endogenous opioids in cardiovascular-related antinociception and likely opioid deficits in chronic pain conditions, it is hypothesized that chronic pain patients will display alterations in these normally adaptive cardiovascular-pain regulatory relationships. The long-term objective of these studies is to explore the nature of dysfunction in the endogenous pain regulatory systems of chronic pain patients. improved understanding of the mechanisms contributing to chronic pain has the potential to lead to improved treatment for chronic pain patients. The specific aims of these studies are threefold: 1) examine the relationship between resting blood pressure and acute pain sensitivity in both neuropathic and nociceptive chronic pain patients as contrasted to normals, 2) examine possible differences in degree of endogenous opioid mediation of the relationship between resting blood pressure and acute pain sensitivity across the pain patient and normal control subgroups, and 3) examine whether endogenous opioid dysfunction in chronic pain is progressive and therefore related to pain duration. Sixty chronic pain patients (study l=neuropathic back pain, study 2=nociceptive back pain) and 60 healthy controls will undergo a laboratory ischemic pain stimulus once under placebo and once under opioid blockade with naloxone (randomized, counterbalanced order). in both sessions, resting BP will be determined at baseline. Pain patients will also rate their clinical pain before and after drug administration. it is expected that controls will display significant negative correlations between resting BP and acute pain sensitivity, which is at least partially eliminated by naloxone. Pain patients are expected to demonstrate no correlation or a positive correlation between resting BP and acute pain responsiveness, and will be unresponsive to opioid blockade. Greater pain duration is expected to be associated with smaller changes in the BP/pain relationship in response to opioid blockade. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PARASPINAL MUSCLE DENERVATION AND SYMPTOMS IN LUMBAR SS Principal Investigator & Institution: Haig, Andrew J.; Phys Med and Rehabilitation; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 01-JUN-2001; Project End 31-MAY-2004 Summary: Objectives: The clinical syndrome of spinal stenosis is a significant problem for older Americans. Although stenosis causes neurogenic claudication, spinal canal size does not accurately predict the severity of symptoms. A pilot study shows that paraspinal muscle denervation relates to spinal canal size in symptomatic persons. It is possible that paraspinal denervation is a more accurate marker for the clinical syndrome than anatomical imaging. Other research shows that paraspinal denervation in a particular distribution also occurs in younger asymptomatic persons, and denervation increases with age. It is possible that paraspinal denervation causes subtle hypermobility and contributes to Kirkaldy-Willis's degenerative cascade of facet hypertrophy and canal stenosis. Specific Aims: 1. To assess whether paraspinal EMG scores or MRI measurements of stenosis relate best with the clinical syndrome in older persons. 2. To assess whether paraspinal EMG scores predict future symptoms of stenosis and future symptom severity in older persons with and without spinal stenosis. 3. To assess whether change in clinical status relates better to change in paraspinal EMG scores or change in MRI measurement of stenosis. 4. To assess the rate of denervation of the paraspinal muscles in older persons with and without back symptoms. Research Design: Blinded longitudinal study. Methods: Five groups of 30 subjects older than 55 years old, including: asymptomatic persons (healthy persons without low back pain) from the community, persons with lock back pain (LBP) but no stenosis on MRI, persons with stenosis symptoms with mild, moderate, and severe radiographic findings. An experienced neuroradiologist will measure spinal canal size and assign subjects to appropriate categories. A patient questionnaire, physical examination, a walking tolerance test with long latency nerve conduction studies (F- and H- waves) before and after walking, a 7-day pedometer test, and a measure of the flexion-relaxation phenomenon will be administered to the subjects. An unblinded examiner will perform one aspect of the MiniPM paraspinal EMG technique to acclimatize the patient, then a blinded examiner will perform the entire MiniPM, one extremity EMG, sensory and motor nerve conduction studies. Subjects will repeat the test battery (MRI, EMG, and clinical evaluation) approximately 18 months later. Appropriate statistics will test each of the four hypotheses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PHYSICAL CAM THERAPIES FOR CHRONIC LOW BACK PAIN Principal Investigator & Institution: Eisenberg, David M.; Instructor in Medicine; Medicine; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 30-JUN-2004 Summary: Back problems are among the most prevalent conditions afflicting adults in general and the second most common condition reported by persons over age 65. Furthermore, back pin in general is the leading reason for the use of complimentary or alternative medicine (CAM) therapies by adults of all ages. Despite the common use of CAM therapies for back pain, little is known about how they compare with each other or with conventional medical therapies in terms of effectiveness and cost. Studies
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evaluating back pin treatments for older adults (greater than or equal to 65 years old) are particularly rare. This study will lay the groundwork for a full-scale trial that evaluates the relative effectiveness and costs of the three most commonly used physical CAM therapies (acupuncture, chiropractic, and massage) for both older and younger adults with chronic low back pain. During Phase I, we will develop, test and refine specific components of a randomized clinical trial evaluating acupuncture, chiropractic and massage for chronic low back pain. This will include specification of treatment and comparison groups, subject selection criteria, recruitment and retention strategies, and development of Phase I to conduct a pilot study designed to evaluate the three physical CAM treatments. Thirty persons with chronic low back pain will be randomized to each of the following groups: acupuncture, chiropractic, massage, and continued usual care. The subjects randomized to each intervention will be equally divided between persons over and under age 65. (Recruitment will include subjects in their 70s, 80s, and older.) The pilot study will permit us to identify and resolve unanticipated problems and to estimate the sample sizes required for an adequately powered full-scale trial. At the conclusion of this project, we will be prepared to write a competitive grant proposal to evaluate the most commonly used CAM therapies for treating both older and younger adults with chronic low back pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PILOT--SYNTHESIS OF CT AND MR IMAGES OF CERVICAL SPINE Principal Investigator & Institution: Haynor, David R.; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 15-FEB-2002; Project End 31-DEC-2006 Summary: (provided by applicant): Degenerative disease of the cervical spine is common in the US population and causes significant morbidity and expense. Of the patients who ultimately come to surgery (70,000 per year), many have CT-myelography (CTM). an invasive procedure which is expensive and carries some risks. Nearly all of these patients will also have had magnetic resonance imaging (MRI). We propose to use new methods for 3D image fusion to create fused images from MRI scans and plain CT scans (i.e., without myelography) of the neck, potentially saving $15-30 million in healthcare costs per year. We hypothesize that these fused CT-MRI images will be equivalent for both diagnostic and surgical planning purposes to CTM and MRI. This hypothesis will be tested using MRI and plain CT scans from 50 consecutive patients undergoing both CTM and MRI and comparing the diagnoses and surgical plans formulated from the fused images to those formulated using MRI and CTM. Plans and diagnoses will be evaluated by panels of 7 spine surgeons and 4 neuroradiologists, respectively. Statistical evaluation of the systematic differences in plans and diagnoses, if present, will also be performed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PSYCHOSOCIAL, BEHAVIOR AND IMMUNE FACTORS IN BACK PAIN Principal Investigator & Institution: Hurwitz, Eric L.; Assistant Professor; Epidemiology; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 01-MAY-2000; Project End 30-APR-2005 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: QUANTATIVE MEASUREMENT OF LOW BACK IMPAIRMENT Principal Investigator & Institution: Kotzar, Geoffrey M.; Research Scientist; Biomec, Inc. 1771 E 30Th St Cleveland, Oh 441144407 Timing: Fiscal Year 2002; Project Start 19-SEP-2002; Project End 31-AUG-2003 Summary: (provided by applicant): Injuries to the lower back are the second most prevalent disorder presented to medical practitioners today (second only to upper respiratory ailments) and are often the most difficult to diagnose or treat. The myriad of current methods used in evaluating lower back injuries and disorders (LBDs) are very subjective. Consequentially, the number of insurance claims and the amount of each claim push this ailments costs over the $100 billion mark in the US alone. There are no clinical methods/devices that remove the subjectivity from the assessment of impairment due to LBDs for most patients. A quantitative laboratory research tool (device) has been developed and shown to add objectivity to the evaluation of LBDs. One objective of this project is to update the technology, making a device suitable for clinical use. Another objective is to assess the new tool against the current one in the laboratory to assure that no feature of the original device has been lost or compromised. Based on this assessment, a clinically viable device will be available for the quantitative evaluation of LBDs, which promises to reduce the subjectivity of the clinical evaluation and the subsequent costs in treating the disorder. PROPOSED COMMERCIAL APPLICATION: According to the U.S. Center for Healthcare Statistics, 80% of adults seek care for low back pain at some time in their lives, and 50% of adults have an episode of low back pain in any given year. The problem is wide spread, difficult to diagnose and expensive to treat. The potential markets for the device we propose to develop are physical therapy clinics, insurance companies, government organizations (NIOSH, OSHA, etc.), manufacturing companies (workplace assessment), orthopedic clinics, and companies that make office equiment (ergonomic assessment). Focussing only on the physical therapy clinics, there are over 98,000 such clinics according to data from the American Physical Therapy Association and the American Hospital Association. This number has remained relatively stable and could be expected to remain static over a forecast period of the next five years. Even with a small market penetration of only 0.1% per year, our sales can be expected to reach $2 million the first year and increase by $2 million per year over the next five years, for a total of 0.5% penetration and $10 million annually at the end of five years. At this rate, market saturation will not occur in any forseeable future. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: RACE AND OUTCOMES IN WORK-RELATED BACK INJURIES Principal Investigator & Institution: Tait, Raymond C.; Psychiatry; St. Louis University St. Louis, Mo 63110 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 31-JAN-2005 Summary: Occupational low back injury, a significant economic and healthcare problem in the U.S., has proven difficult to manage consistently and cost-effectively. Recent studies have shown medical management of low back pain to be highly variable. With respect to Workers' Compensation, apparent disparities in assessment and treatment associated with race have also been identified. While this research demonstrated potentially inequitable treatment of injured minorities with low back injuries, the representativeness of the results and their implications for post-settlement outcomes (i.e., clinical adjustment and employability) remain unknown. This historical cohort study is designed to identify potential race-related disparities in occupational
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healthcare, define the scope of the problem, and to assess the impact of such disparities on post-settlement adjustment. The study will examine a cohort of African Americans and White workers who incurred disabling low back injuries in the State of Missouri and whose disability claims were settled during the year 2001. Records of the Missouri Division of Workers' Compensation (MODWC) will be used to identify those claims from three Missouri population centers (St. Louis City, St. Louis County, Jackson County), where the majority of African Americans in Missouri reside. MODWC records will provide data relevant to medical costs, temporary total disability costs, permanent disability costs, and other injury-related matters for all claimants with work-related low back injuries leading to missed work time. Computer Assisted Telephone Interviewing methods will be used to assess post-settlement adjustment. Regression models will be used to assess the relationship of race and legal representation, alone and in interaction, with Workers' Compensation outcomes and post-settlement adjustment of claimants. The historical cohort design will address three weaknesses in the present state of knowledge. First, it addresses potential associations between race, treatment, and disability outcomes, an area that has been neglected. Second, it addresses relations among the above constructs and the post-settlement adjustment of claimants. Moreover, because of the sample size and the design, we will be able to separate the effects of potentially confounding variables (e.g., job type, socioeconomic status), both alone and in interaction with race. Finally, by dint of the procedures needed to recruit participants, the study will establish a cohort of injured workers whose adjustment can be monitored not only at the time of this study, but potentially beyond that time frame. If the cohort is examined at a later point in time, it will be possible to track true long-term outcomes of occupational healthcare. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: RACE IN PHYSICIAN DECISION TO PRESCRIBE OPIOID ANALGESIA Principal Investigator & Institution: Sarver, Joshua H.; Metrohealth System 2500 Metrohealth Dr Cleveland, Oh 44109 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2004 Summary: (provided by applicant) Several studies have shown that racial and ethnic minorities are less likely to receive analgesics. This study presents a theoretical framework for understanding these differences. The aim of this study is to begin to test this framework by conducting a series of mail surveys with case scenarios to determine: 1) the effect of race on physicians? use of analgesics for 3 acute, painful conditions (back pain with sciatica, ankle fracture, and migraine headache); 2) whether providing information on patients? socioeconomic status, role impairment, and likelihood that narcotics might be misused mitigates the effect of race on physicians? decisions to prescribe analgesics; and 3) whether physician characteristics are related to differential treatment of racial and ethnic minorities. Phase 1 of this study will determine clinical factors that influence physicians? decisions to prescribe opioid analgesics for the 3 conditions (regardless of patients? race/ethnicity) using individual physician interviews and a mail survey of 650 emergency department physicians. In phase 2, information from phase 1 will be used to construct scenarios that include information on the most important clinical factors affecting prescribing opioid analgesics. Two versions of each of the 3 scenarios will be constructed: 1) clinical factors plus race (race only); and 2) clinical factors, race, and information on patients? socioeconomic status, role impairment, and likelihood that narcotics might be misused (race plus). These scenarios will be mailed in random order to 6075 emergency department physicians. Responses
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will be analyzed to determine whether racial and ethnic minorities are less likely to receive opioids with the race only scenarios (Aim 1), whether any difference in treatment persists for the race plus scenarios (Aim 2), and whether physician characteristics obtained from the phase 2 mailing explain lower use of opioid analgesics (Aim 3). This study moves investigation beyond documentation of racial disparities in treatment and toward theory based hypothesis testing. Understanding the causes of racial disparities will permit careful development of targeted interventions to address possible racial disparities in physician treatment decisions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: REDUCING LOW-BACK DISORDERS USING A NEW SITTING DESIGN Principal Investigator & Institution: Makhsous, Mohsen; Chief Scientist & Director; Rehabilitation Institute of Chicago Chicago, Il 60645 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2004 Summary: Work-related low back musculoskeletal disorders are common and affect a large portion of the workforce. Occupational risk factors for LBP include sustained static muscle load, and inappropriate curvature/position of the spine and pelvis. Sitting may cause backward rotation of the pelvis, reduction in lumbar lordosis, changes in muscle activities and disc pressure, excessive pressure over the ischium and coccyx, and certainly the associated LBP. A new seat design, of which the back part of seat (BPS) can be dynamically tilted downward and upward with respect to the front part of the seat (FPS) providing adjustment of thigh and ischial support and the back support is adjustable in height and volume, will be investigated. It was found in the pilot study that sitting with lowered BPS and adjustment of low back support resulted in more evenly distributed contact pressure, reduced peak pressure under the ischia, increased total and segmental lumbar lordosis, forwardly rotated the pelvis, and increased lumbar intervertebral heights. We believe that the functional relations of the seat and backrest need to be further investigated in order to not only prevent flattening of the lumbar spine but also reduce the ischial load in long term sitting, which are related to LBP. We propose to study the biomechanical and neuromuscular effects of the new sitting concept, and evaluate quantitatively the benefits in the LBP patients for using appropriate lumbar support that increases lordosis and decreases the sitting pressure and load carried by the ischial tuberosities. Hypothesis 1: When the BPS is tilted downward, load on the ischial tubercles and lumbar spine will be reduced and shifted to the thighs and the thoracic spine, respectively. Low back muscle activities will also be reduced. Specific aim 1: Contact pressure distributions between the buttock-thighs and seat, and between the back and backrest, load carried at the seat and back will be evaluated with and without ischial support, combined with flat or adjusted back support. The muscular activities involved in stabilizing the trunk under these conditions will be investigated. Hypothesis 2: Increase in lumbar lordosis, forward rotation of the pelvis, and larger intervertebral heights will be observed when the BPS is tilted down to reduce ischial support. Specific aim 2: The total and segmental lumbar lordosis, pelvis inclination, and intervertebral spaces of lumbar spine, will be measured using X-ray images and compared under the different sitting conditions. Hypothesis 3: Sitting alternately between the postures with the BPS at level and tilted down positions will reduce the discomfort/pain associated with sitting. As a result, patients with LBP will better tolerate prolonged sitting. Specific aim 3: The subjective evaluation and impressions gained from the use of such a sitting design for a period of four months will
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be evaluated using questionnaire in two groups of chronic LBP patients with pain history and symptoms. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: RELAXATION-RELATED CAM THERAPIES FOR CHRONIC BACK PAIN Principal Investigator & Institution: Cherkin, Daniel C.; Associate Director and Sr Investigator; Center for Health Studies Seattle, Wa 98101 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 30-JUN-2003 Summary: American College of Surgeons Oncology Group, Chicago, Illinois complementary or alternative medical (CAM) therapies by adults of all ages. Despite the common use of CAM therapies for back pain, little is known about how they compare with each other or with conventional medical therapies in terms of effectiveness and cost. Studies evaluating back pain treatments for older adults are particularly rare. This study will lay the groundwork for a full-scale trial that evaluates the relative effectiveness and costs of three promising relaxation-related techniques (massage, tai chi, and meditation) that are appropriate for both older and younger adults with chronic low back pain. During Phase I, we will develop, test and refine specific components of a randomized clinical trial evaluating tai chi, massage and meditation for chronic back pain. This will include specification of treatment and comparison groups, subject selection criteria, recruitment and retention strategies, and development of instruments for measuring outcomes. During Phase II, we will use the study components developed during Phase I to conduct a pilot study designed to evaluate the three relaxation-related treatments. Thirty persons with chronic low back pain will be randomized to each of the following groups: tai chi, massage, meditation and continued usual care. The subjects randomized to each intervention will be divided equally between persons over and under age 65. (Recruitment will include subjects in their 70s, 80s, and older.) The pilot study will permit us to identify and resolve unanticipated problems and to estimate the sample sizes required for an adequately powered full-scale trial. At the conclusion of this project, we will be well positioned to prepare a competitive grant proposal to evaluate relaxation-related CAM therapies for treating both older and younger adults with chronic low back pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ROLE OF BIOMECHANICS/NEURAL PLASTICITY IN RADICULAR PAIN Principal Investigator & Institution: Winkelstein, Beth A.; Assistant Professor; Anesthesiology; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, Nh 03755 Timing: Fiscal Year 2002; Project Start 01-MAR-2002 Summary: The mechanism of low back pain is believed to involve a mechanical component. However, there is an incomplete understanding of the local mechanical response of neural tissue and no defined threshold of mechanical loading of individual tissue structures for pain onset and maintenance. While animal models are presently used to examine radiculopathy, the extent of damage to the lumbar nerve roots, dorsal root ganglia ~ nerves in these models remains solely qualitative in nature. It is the broad aim of this work to examine mechanical factors influencing local tissue injury in a rat model of lumbar radiculopathy by (1) characterizing the time course of local tissue mechanics and the associated pain response for loading to the lumbar nerve root, dorsal root ganglion, and spinal nerve, (2) quantifying the differences in mechanical and
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physiologic responses for ligation of the lumbar nerve root using loose, tight, and chromic gut sutures, (3) determining compression load thresholds for onset and maintenance of a pain response. Mechanical tissue deformation data will be acquired by imaging at the time of injury and at time points following surgery. age analysis will be used to determine the local strain tensor for particular tissue components. Tissue bins will be correlated with mechanical allodynia and neuroimmune mediators of persistent pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ROLE OF SPOUSE RESPONSES ON LATINOS' ADJUSTMENT TO PAIN Principal Investigator & Institution: Freedman, Carolyn M.; Psychology; University of Denver Office of Sponsored Programs Denver, Co 80208 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2007 Summary: (provided by applicant): Research on chronic pain patients' perceived spousal responses suggests that these responses can be categorized into three groups: solicitous responses, punishing responses, and distracting responses. Combinations of these responses have been found to interact with marital satisfaction to affect pain severity and depressive symptomatology. Researchers have increasingly started conducting cross-cultural research examining management of chronic diseases, highlighting the fact that culture defines how individuals respond to chronic diseases. However, these findings have yet to be incorporated into the mainstream chronic pain literature. The proposed study seeks to integrate the literature on spousal response to chronic pain with cultural-based findings on disease management into an examination of the role of culture/ethnicity in mediating the influence of perceived spousal responses on pain severity and depressive symptomatology. Hispanics males who are married will be the primary focus of this study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: SAFETY OF LUMBAR FUSION SURGERY FOR CHRONIC BACK PAIN Principal Investigator & Institution: Mirza, Sohail K.; Associate Professor; Orthopaedics/Sports Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 30-JUN-2007 Summary: (provided by applicant): Although I have been successful as a spine surgeon in an academic environment, building a respected clinical practice and completing spine biomechanics research for competitively funded projects, I realize that clinical research most directly addresses my motivation for choosing an academic career, and that highquality clinical research is complex, requiring a long-term commitment and specialized skills. I am in an excellent environment to develop these skills, with supportive colleagues and a supportive chairman. I have developed a five-year training schedule, with the first three years devoted to obtaining an MPH degree. A team of three outstanding individuals has committed to working with me for the next five years and guiding my career development. My immediate goal is to gain practical clinical research experience by conducting a five-year prospective study with this team of experienced and highly respected researchers. My long-term career goals are to help identify spine patient populations more concretely, measure end-results of spinal disorders in general, and define outcomes for treated and untreated back pain and whiplash injuries in
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particular. Research Project: The use of surgery for back pain is rapidly growing; data on its safety and outcomes are sorely needed. We propose a prospective cohort study to measure the frequency of complications in lumbar fusion surgery, variation in rates of specific serious complications with different types of lumbar fusion, clinical and functional consequences for specific types of complications, and patient or treatment characteristics that predict particularly severe complications. Over a two-year interval, we propose to enroll 1000 patients choosing fusion surgery for treatment of disc degeneration, spondylolisthesis, spinal stenosis, and adult degenerative scoliosis. We will follow these patients for two years, measure predictor patient and treatment characteristics, and measure consequences with clinical and functional outcomes. Accumulating data will be stored in an existing central database. The analysis will use appropriate univariate and multivariate techniques to address the study questions. This study will provide data on the relative benefits and risks of lumbar fusion surgery in treating back pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: SEGMENTAL SPINE MOTION OF THE LUMBAR SPINE Principal Investigator & Institution: Lim, Tae-Hong; Rush University Medical Center Chicago, Il 60612 Timing: Fiscal Year 2002 Summary: (provided by applicant): Segmental instability and degenerative changes of the lumbar spine is considered a major etiology of persistent low back pain. However, the anatomic changes in the intervertebral disc, vertebral body, and facet joints associated with instability are not clearly known yet, and their relationship with pain is even more elusive. Because of the widespread nature of disc degeneration which can occur with and without segmental instability, it is essential to develop methods to diagnose this entity and to provide effective treatment, which is the long-term goal of our research. We propose a 5-year study of the in vivo relationship of degenerative changes and segmental instability of the lumbar spine. In this study, we will compare 56 asymptomatic normal volunteers and 56 age- and sex-matched symptomatic patients. Hypotheses that we will test in this study are: (1) in vivo torsional instability of the lumbar spine is greater in grade 3 or 4 (moderate or severe) degenerated discs than in normal or grade 5 (advanced) degenerated discs; (2) Degenerative changes in the facet joints and vertebral bodies are significantly correlated with torsional instability and disc degeneration; and (3) There are significant differences in these relationships between the asymptomatic volunteers? group and the symptomatic patients? group. The specific aims are: (1) To establish an in vivo relationship between segmental motion characteristics and degenerative conditions of the intervertebral disc and facet joints; and (2) To compare the in vivo relationship between motion and degenerative conditions found in asymptomatic normal volunteers with that determined in age- and sex-matched symptomatic patients. Torsional motions resulting from passive manipulation of the trunk will be measured using computed tomography (CT) based non-invasive 3-D motion analysis method that we have previously developed. Flexionextension motions will be measured from dynamic radiographs taken in the lateral decubitus position when the subjects produce the maximum voluntary motions. Dynamic radiographs will also be used to measure any osteophytes on the vertebral bodies. Degenerative changes of the discs and facet joints will be measured using T2weighted sagittal and proton density axial magnetic resonance (MR) images. Pain level will be evaluated using an analogue visual scale from 0 to 10, and the subjects' physical
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conditions, such as other disease and activity levels, will be evaluated using a Subject Information Sheet designed for patient evaluation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: SELF SYSTEM THERAPY AND CHRONIC LOW BACK PAIN Principal Investigator & Institution: Keefe, Francis J.; Professor and Associate Director; Psychiatry; Duke University Durham, Nc 27710 Timing: Fiscal Year 2003; Project Start 15-JUN-2003; Project End 31-MAY-2007 Summary: (provided by applicant): Patients with chronic low back pain (CLBP) cope with numerous major life challenges associated with their disorder, including changes in their ability to work, as well as decrements in physical and emotional well being. These changes alter CLBP patients' ability to pursue and achieve important personal goals and live up to personal standards. As a result, CLBP patients are highly likely to experience substantial difficulties with self-regulation, i.e., the ongoing process of evaluating and regulating one's behaviors so as to meet important personal goals and standards. In turn, the inability to attain important goals and standards increases risk for depression. The long-range goal of this research is to reduce the depression, pain, psychological disability, and physical disability experienced by CLBP patients suffering from depression. The proposed study seeks to evaluate the efficacy of Self-System Therapy (SST), a new therapy for depression specifically targeting problems in selfregulation. A total of 174 CLBP patients who meet DSM-IV criteria for major depressive disorder will be randomly assigned to one of three conditions: 1) Self-System Therapy (SST) - a twelve-session version of SST adapted to the concerns of CLBP patients; 2) Back Pain Education - a comparison condition that provides patients with information on the nature and treatment of chronic low back pain; or, 3) Standard Care Condition - a control condition in which patients will receive care requested by them and made available to them by their health care provider. Assessment measures to be gathered before and after treatment and at 6- and 12-month follow-up will include depression, physical and psychosocial disability, pain and coping self-efficacy, self-regulatory focus, and self-discrepancies. Daily measures of pain, mood, goal activation/attainment, and stress will also be gathered. Converting basic knowledge about the causes and consequences of unsuccessful self-regulation to the diagnosis and treatment of depression in CLBP patients represents a promising avenue for identifying treatment options appropriate for these individuals. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: STABILITY OF MUSCULAR LOADING OF THE LUMBAR SPINE Principal Investigator & Institution: Stokes, Ian A.; Research Professor; Orthopedics and Rehabilitation; University of Vermont & St Agric College 340 Waterman Building Burlington, Vt 05405 Timing: Fiscal Year 2002; Project Start 01-SEP-1994; Project End 31-DEC-2003 Summary: A combination of muscle stiffness and spinal motion segment stiffness protect the lumbar spine against the possibility of buckling instabilities. This is an application to support continued research (of R01 AR 44119) analyzing and quantifying the degree of muscle stiffness required for stability under a variety of loading conditions and spinal postures. Previous analyses have predicted that antagonistic muscle activation would increase stability, and the existence of such antagonistic activity has been confirmed in experimental studies documenting muscle activation electromyographically. The overall hypothesis is that impaired muscular control might
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predispose the lumbar spine to injurious buckling episodes. The proposed continuation studies will focus on four main areas of work: (1) human subject experiments to characterize muscle activation patterns under gradually increasing efforts and under perturbed loading conditions, and to measure driving point stiffness of the trunk, from which muscle stiffness will be deduced under differing activation conditions; (2) Experimental quantification of the stiffness of lumbar spinal motion segments (with and without intact posterior elements) under physiological conditions of axial compressive loading and surrounding fluid medium. (3 Simulations of these experiments will be performed using a new analytical model which calculates the muscle activation pattern required to optimize a variable combination of five cost function components, namely the global motion of the spine, intervertebral displacements, loading of intervertebral motion segments, the sum of cubed muscle stress and stability (via the magnitude of eigenvalues of the system stiffness). Some of the experimental data from human subject and motion segment studies will be used to assign values to parameters in the model, other data will be used to validate the model. (4) Longitudinal studies of muscle function in subjects with intermittent low back pain will indicate whether these individuals have muscle activation behaviors conducive to spinal instability. These studies will help to define the relative roles of muscle stiffness and spinal stiffness in stabilizing the spinal column. They will identify the conditions under which (1) reduced motion segment stiffness, (2) reduced muscular stiffness or (3) abnormal patterns of muscle recruitment might place the lumbar spine at risk for self-injurious buckling episodes under apparently benign external loading conditions. In addition, the specific roles of individual muscles will be better elucidated, which will be helpful in guiding therapy for people with low back dysfunction. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: STUDY OF CHEMOGENIC LOW BACK PAIN Principal Investigator & Institution: Zhang, Junming; Associate Professor; Anesthesiology; University of Arkansas Med Scis Ltl Rock Little Rock, Ar 72205 Timing: Fiscal Year 2002; Project Start 01-JUL-2000; Project End 30-JUN-2004 Summary: (adapted from applicant's abstract): The overall goal of our research is to better understand the etiology and mechanisms of low back pain and sciatica. Clinical studies indicate that degenerative changes and traumatic injuries of the spine are often associated with mechanical compression and chemical irritation of dorsal root ganglia (DRG). DRG neurons can be exposed to inflammatory cytokines that are released from a herniated nucleus pulposus (HNP) or synthesized inside the ganglion in response to injury. However, the specific role of cytokines and cytokine-induced inflammation in the generation of spontaneous activity and enhancement of neuronal excitability is still unknown. We hypothesize that DRG neurons may develop hyperexcitability in response to peripheral nerve or ganglion injury such that the release of inflammatory cytokines from the injured neurons, the macrophages, the glial cells or the HNP activate hyperexcitable DRG neurons and lead to pain. Using a new animal model of neuropathic pain, involving compression of the L5 lumbar ganglion with a hollow stainless steel rod, we will test our hypothesis via 3 Specific Aims. SA1. Determine whether elevated release/synthesis of cytokines enhances the excitability of normal DRG neurons. SA2. Determine if endogenous inflammatory cytokines contribute to the generation and maintenance of spontaneous activity in compressed DRG neurons and if exogenous cytokines enhance this activity. SA3. Determine whether cytokines contribute to the development and maintenance of cutaneous hypersensitivity in CCD rats. A novel feature of our animal model is that the inserted rod allows local delivery of cytokines to
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the compressed ganglion in vivo. With this model, we will study how cytokines affect the excitability of DRG neurons and correlate these effects to behavioral measures of hyperalgesia and allodynia. If a relationship between specific cytokines and the sensory hyperexcitability responsible for neuropathic pain is identified, then new therapeutic approaches involving pharmacological modulation of cytokine release or synthesis could be developed to control pain in individuals with an acutely herniated lumbar disc, spinal stenosis, tumor, or other injury or disease of the spine. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: TRUNK CONTROL IN SUBJECTS WITH AND WITHOUT LOW BACK PAIN Principal Investigator & Institution: Cacciatore, Timothy W.; None; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2002; Project Start 14-JUN-2001 Summary: The overall goals of the proposed research are to gain a better understanding of how the nervous system coordinates the trunk to maintain equilibrium, and to determine if subjects with idiopathic low back pain have abnormal coordination. A movable platform will be used to translate the support surface and perturb equilibrium. The resulting response to maintain balance will be examined by extensively measuring trunk kinematics, surface reaction forces, and the activity of many trunk muscles. The first specific aim is to examine normal subjects: (A) To determine the overall kinematic and muscular strategies for stabilizing the trunk during sitting and standing in response to perturbations in different directions. This will address is there are different strategies and whether they are similar for sitting and standing; (b) To determine the degree to which the nervous system controls trunk muscles together or in fixed patterns. This will be determined by measuring spatial and temporal correlations of trunk muscles, and will address how the nervous system controls the large number of back muscles. The second specific aim is to determine if selected groups of patients with idiopathic low back pain have abnormal coordination of the trunk. To avoid confounding different pathologies, this study will only examine patients which fall into two homogeneous classes based on clinical measures. Using the same protocols as normals, the proposed study will examine whether either group of low back pain patients has abnormal motor control, and if abnormalities are different between the two groups. Through measuring kinematics, forces and muscular activity, this study will increase our basic knowledge of how the trunk is controlled and determine if subjects with low back pain have altered motor control. A detailed characterization of the abnormalities of low back pain subjects will provide a basis to examine causal relationships between motor control and back pain and to develop therapeutic interventions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: VERTEBRAL POSITION ALTERS MUSCLE SPINDLE SENSITIVITY Principal Investigator & Institution: Pickar, Joel G.; Associate Professor; Research and Development; Palmer Chiropractic Universtiy 1000 Brady St Davenport, Ia 52803 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2007 Summary: (provided by applicant): Idiopathic low back pain and the therapeutic use of spinal manipulation make a significant impact clinically, socially, and financially. It has been estimated that more than 75 percent of us will experience low-back pain at some time in our lives costing an estimated $20-$50 billion annually. Recent findings from meta-analyses indicate that spinal manipulation can be recommended clinically for the
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treatment of acute and chronic idiopathic low back pain. Chiropractors deliver more than 90 percent of spinal manipulations performed in the United and annual expenditures on chiropractic services exceed $4.7 billion annually. Neither the causes of idiopathic low back pain nor the mechanisms underlying the physiological effects of spinal manipulation are well understood. Recent investigations by the applicant indicate that the mechanical history of a vertebra alters the sensitivity of lumbar paraspinal muscle spindles to subsequent vertebral movement. Muscle spindle discharge in response to vertebral gliding (translation) depended upon whether the vertebra had been previously held in a position that unloaded or loaded the spindle for as little as 5 seconds. We believe this novel finding in the spine is important because motion segments are continually subjected to passive forces that can fix their spatial orientation. The proposed experiments are based upon 3 hypotheses. (1) Sensitivity of paraspinal muscle spindles to vertebral translation increases when linear displacement of the vertebra has previously unloaded the paraspinal muscle spindle. (2) Sensitivity of paraspinal muscle spindles to vertebral translation decreases when linear displacement of the vertebra has previously loaded the paraspinal muscle spindle. (3) The therapeutic effects of spinal manipulation may be mediated, in part, by its ability to correct the positional-history-dependent changes in paraspinal muscle spindle sensitivity. Historydependent alterations in sensory feedback from paraspinal muscle spindles could lead to proprioceptive errors and adversely affect neural control of segmental motion. Knowledge of mechanical factors that affect sensory input from vertebral tissues will help provide a better understanding of the most appropriate preventive and therapeutic interventions for spinal care. Spinal manipulation is inherently a biomechanical intervention and the therapeutic successes of spinal manipulation for idiopathic low back pain may relate, in part, to the mechanical component of idiopathic low back. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: VIRTUAL RELAXATION ENVIRONMENT FOR CHRONIC BACK PAIN Principal Investigator & Institution: Tannenbaum, Libby R.; Virtually Better, Inc. 2450 Lawrenceville Hwy, Ste 101 Decatur, Ga 300333226 Timing: Fiscal Year 2004; Project Start 15-MAY-2004; Project End 14-MAY-2005 Summary: (provided by applicant): Chronic lower back pain (CLBP) is a widespread problem, affecting 25-45 percent of adults at some time in their life, and disabling 25 percent of adults in any one year. Psychological factors contribute to both the exacerbation and recovery process. Relaxation therapy is an empirically validated cognitive-behavioral technique that is frequently used for CLBP. Pharmacological agents such as opioid analgesics have proven effective, however, the risk of physical and psychological dependence is a problem, particularly for persons at higher risk for dependence. Nonpharmacological treatments provide an alternative or adjunct to treatment without posing these threats and can therefore benefit the broader population affected by CLBP. This study is designed to test an innovative nonpharmacological treatment approach that incorporates relaxation therapy with virtual reality to create a virtual relaxation environment for persons with CLBP. Virtual reality (VR) environments combine computer graphics with sensory input devices including tracking devices, visual head mount displays, and directional audio designed to immerse the user into the environment. Previous research has demonstrated that immersive VR is effective at distracting patients from painful medical procedures. In this controlled study, 20 adults with CLBP will be randomly assigned to the virtual relaxation treatment condition or wait list control. The relaxation environment will
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incorporate a breathing and guided progressive muscle relaxation exercise lasting approximately 20 minutes. Participants will complete 5 therapy sessions. Physiological measures of muscle tension and self-report measures of pain, relaxation, and medication intake will be compared at pre- and post-treatment and three month follow-up. The primary objective of this study is to develop and test the feasibility of the virtual relaxation environment for reducing pain and medication use among persons with CLBP. The long term objective is to test a comprehensive, computerbased, cognitivebehavioral treatment package for CLBP. Potential exists to extend such a package to address a broad range of psychological and health issues. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with backache, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “backache” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for backache (hyperlinks lead to article summaries): •
"Occupational backache" - surface electromyography demonstrates the advantage of an ergonomic versus a standard microscope workstation. Author(s): Kofler M, Kreczy A, Gschwendtner A. Source: European Journal of Applied Physiology. 2002 April; 86(6): 492-7. Epub 2002 February 19. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11944096
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A case of backache on Polaris patrol. Author(s): Pace T. Source: J R Nav Med Serv. 1975 Summer; 61(2): 83-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1195178
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PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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A comparative trial of azapropazone and ketoprofen in the treatment of acute backache. Author(s): Hingorani K, Templeton JS. Source: Current Medical Research and Opinion. 1975; 3(6): 407-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=126848
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A dangerous backache. Author(s): Bernat JL. Source: Hosp Pract. 1977 December; 12(12): 36-7, 43. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=144695
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A man with backache and renal failure. Author(s): Peel R, Sellars L, Long ED, Bhandari S. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 January; 41(1): E1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12500252
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A new interest in an old remedy for headache and backache for our obstetric patients: a sphenopalatine ganglion block. Author(s): Cohen S, Trnovski S, Zada Y. Source: Anaesthesia. 2001 June; 56(6): 606-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11412202
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A rare cause of backache in an adult male. Author(s): Trikha V, Gupta V. Source: Postgraduate Medical Journal. 2002 December; 78(926): 760, 761. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12509700
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A study of subcutaneous rhizolysis in the treatment of chronic backache. Author(s): Houston JR. Source: J R Coll Gen Pract. 1975 September; 25(158): 692-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=127040
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A to Z of backache. Author(s): Cochrane Database Syst Rev. 2002;(1):CD001139 Source: The Nursing Journal of India. 1999 June; 90(6): 128. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11869592
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A visible and palpable cause of backache. Author(s): Serhan E, Newton P, FitzGerald R, Jassim I. Source: Annals of the Rheumatic Diseases. 2000 March; 59(3): 164-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10700421
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Acute backache. Author(s): Golding DN. Source: Nurs Times. 1974 February 7; 70(6): 184-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4274245
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Addison's disease presenting with chronic low backache. Author(s): Sheridan P, Murray-Leslie CF, Golding JR. Source: British Medical Journal. 1976 January 10; 1(6001): 77. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=128397
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An approach to backache. Author(s): Waddell G. Source: Br J Hosp Med. 1982 September; 28(3): 187, 190-1, 193-4, Passim. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6215081
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An unorthodox look at backaches. Author(s): Tauber J. Source: J Occup Med. 1970 April; 12(4): 128-30. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4247002
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Assessing long term backache after childbirth. Author(s): Russell R, Groves P, Taub N, O'Dowd J, Reynolds F. Source: Bmj (Clinical Research Ed.). 1993 May 15; 306(6888): 1299-303. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8518569
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Autothermal treatment of backache. Author(s): Page IH. Source: The New England Journal of Medicine. 1981 April 23; 304(17): 1049. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6451806
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Avoiding the back-to-school backache. Author(s): Weir E. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2002 September 17; 167(6): 669. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12358203
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Backache after extradural anaesthesia in the postpartum period: dissection of thoracic aneurysm. Author(s): Kao YJ, Zavisca FG, Tellez JM, Norton RG, Racz GB. Source: British Journal of Anaesthesia. 1991 September; 67(3): 335-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1832921
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Backache after spinal anesthesia. Author(s): Shutt LE. Source: Reg Anesth. 1995 May-June; 20(3): 253. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7547667
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Backache after spinal anesthesia. Author(s): Sprung J, Devcic A, Maitra-D'Cruze A, Haddox JD, Bourke DL. Source: Reg Anesth. 1994 September-October; 19(5): 364-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7848943
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Backache and its prevention. Author(s): Dwyer AP. Source: Clinical Orthopaedics and Related Research. 1987 September; (222): 35-43. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2957137
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Backache and sciatica. A report of 90 patients treated by intradiscal injection of chymopapain (discase). Author(s): Graham CE. Source: The Medical Journal of Australia. 1974 January 5; 1(1): 5-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4273527
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Backache and the Guillain-Barre syndrome. Author(s): Grant R. Source: British Medical Journal (Clinical Research Ed.). 1986 August 23; 293(6545): 506. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2943357
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Backache and the Guillain-Barre syndrome: a diagnostic problem. Author(s): Clague JE, Macmillan RR. Source: British Medical Journal (Clinical Research Ed.). 1986 August 2; 293(6542): 325-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2942218
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Backache and the lumbar spinal canal. Author(s): Porter RW, Hibbert C, Wellman P. Source: Spine. 1980 March-April; 5(2): 99-105. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6446166
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Backache and work incapacity in Japan. Author(s): Hadler NM. Source: J Occup Med. 1994 October; 36(10): 1110-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7830169
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Backache as a gynaecological problem. Author(s): Rhodes P. Source: The Practitioner. 1969 March; 202(209): 344-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4237429
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Backache due to osteoporosis in an industrial population. A survey of 481 patients. Author(s): Devlin HB, Goldman M. Source: Ir J Med Sci. 1966 April; 6(484): 141-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4222445
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Backache in bacterial endocarditis. Author(s): Holler JW, Pecora JS. Source: N Y State J Med. 1970 July 15; 70(14): 1903-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4246641
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Backache in boys-a new problem? Author(s): Grantham VA. Source: The Practitioner. 1977 February; 218(1304): 226-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=138853
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Backache in general practice. Author(s): Fisk JW. Source: J R Coll Gen Pract. 1970 February; 19(91): 92-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4244854
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Backache in general practice. Author(s): Burn L. Source: The Practitioner. 1992 November; 236(1520): 1084-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1305754
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Backache in gynaecologists. Author(s): Dolan LM, Martin DH. Source: Occupational Medicine (Oxford, England). 2001 October; 51(7): 433-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11719613
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Backache in industry. Author(s): Kosiak M, Aurelius JR, Hartfiel WF. Source: J Occup Med. 1966 February; 8(2): 51-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4221782
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Backache in oarsmen. Author(s): Stallard MC. Source: British Journal of Sports Medicine. 1980 July; 14(2-3): 105-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6447528
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Backache in pregnancy II: prophylactic influence of back care classes. Author(s): Mantle MJ, Holmes J, Currey HL. Source: Rheumatol Rehabil. 1981 November; 20(4): 227-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6458080
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Backache in pregnancy. Author(s): Mantle MJ, Greenwood RM, Currey HL. Source: Rheumatol Rehabil. 1977 May; 16(2): 95-101. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=141093
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Backache in the aged. Author(s): Sarkin TL. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1977 March 26; 51(13): 418-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=140467
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Backache- its nature, incidence and cost. Author(s): Pheasant HC. Source: The Western Journal of Medicine. 1977 April; 126(4): 330-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=140532
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Backache relieved by polystyrene mattress. Author(s): Hill H. Source: Lancet. 1973 January 6; 1(7793): 36. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4118550
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Backache, headache and bladder dysfunction after delivery. Author(s): Grove LH. Source: British Journal of Anaesthesia. 1973 November; 45(11): 1147-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4274480
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Backache, headache, and neurologic deficit after regional anesthesia. Author(s): Munnur U, Suresh MS. Source: Anesthesiology Clinics of North America. 2003 March; 21(1): 71-86. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12698833
•
Backache. Author(s): Edgar MA. Source: Br J Hosp Med. 1985 May; 33(5): 298. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3159457
•
Backache. Author(s): Chalmers J. Source: Br J Hosp Med. 1985 April; 33(4): 238. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2931149
•
Backache. Author(s): Edgar MA. Source: Br J Hosp Med. 1984 December; 32(6): 290-301. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6239671
•
Backache. Author(s): Nelson MA. Source: The Practitioner. 1981 February; 225(1352): 135-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6455659
•
Backache. Author(s): Scott JH. Source: Journal of the Royal College of Surgeons of Edinburgh. 1980 November; 25(6): 477-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6453224
•
Backache. Author(s): Mathews JA. Source: British Medical Journal. 1977 February 12; 1(6058): 432-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=138470
•
Backache. I. Author(s): Chamberlain GV. Source: British Medical Journal. 1971 April 10; 2(753): 99-100. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4251644
52
Backache
•
Backache: a primary care problem. Author(s): Gillette RD. Source: Ohio Med. 1990 September; 86(9): 662. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2146576
•
Backache: a rare diagnosis and unusual complication. Author(s): Buick RG, Chowdhary SK. Source: Pediatric Surgery International. 1999; 15(8): 586-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10631743
•
Backache: a second look. Author(s): Bellows JG, McCarthy MM. Source: Compr Ther. 1985 March; 11(3): 3-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3156712
•
Backache: its changing prevalence. Author(s): Borelli LN. Source: The Western Journal of Medicine. 1980 September; 133(3): 273-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6447949
•
Backache: lean back and exercise. Author(s): Evans D. Source: Nurs Mirror. 1981 June 10; 152(24): 16-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6454125
•
Backache--II. Author(s): Chamberlain GV. Source: British Medical Journal. 1971 April 17; 2(754): 159-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4253136
•
Beware backache in chronic dialysis patients. Author(s): Amir-Ansari B, Negus S, Cairns H, Walters H. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2000 May; 15(5): 72930. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10809823
•
Brucella spondylitis: an important treatable cause of low backache. Author(s): Gokhle YA, Bichile LS, Gogate A, Tillu AV, Zamre. Source: J Assoc Physicians India. 1999 April; 47(4): 384-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10778520
Studies
53
•
Brucellosis as a cause of backache. Author(s): Sadat-Ali M, al-Mousa MS, al-Salem AH. Source: Trop Geogr Med. 1991 January-April; 43(1-2): 148-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1836289
•
Chemonucleolysis. A preliminary report on a double blind study comparing chemonucleolysis and intradiscal administration of hydrocortisone in the treatment of backache and sciatica. Author(s): Graham CE. Source: The Orthopedic Clinics of North America. 1975 January; 6(1): 259-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=123053
•
Chemonucleolysis: a double blind study comparing chemonucleolysis with intra discal hydrocortisone: in the treatment of backache and sciatica. Author(s): Graham CE. Source: Clinical Orthopaedics and Related Research. 1976 June; (117): 179-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=132326
•
Chronic backache is not an emergency. Author(s): Tawhai M. Source: N Z Nurs J. 1983 May; 76(5): 29. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6224101
•
Chronic backache, distress, illness behaviour and surgery. Author(s): Waddell G, Main CJ. Source: Acta Orthop Belg. 1987; 53(2): 265-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2961194
•
Chronic backache. Author(s): Fisk JW. Source: N Z Med J. 1977 November 23; 86(600): 487-90. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=146833
•
Clinicopathologic conference: backache and abnormal findings on chest films. Author(s): Bruno MS, Ober WB. Source: N Y State J Med. 1970 November 1; 70(21): 2692-702. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4248532
54
Backache
•
Comparison of Sprotte and Quincke needles with respect to post dural puncture headache and backache. Author(s): Tarkkila PJ, Heine H, Tervo RR. Source: Reg Anesth. 1992 September-October; 17(5): 283-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1419942
•
Compensable psychogenic backache. Author(s): Schwartz W. Source: Ind Med Surg. 1966 May; 35(5): 400-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4222944
•
Diagnosis and treatment of backache. Author(s): Quinet RJ, Hadler NM. Source: Seminars in Arthritis and Rheumatism. 1979 May; 8(4): 261-87. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=157522
•
Diazepam in backache. A double-blind controlled trial. Author(s): Hingorani K. Source: Ann Phys Med. 1966 November; 8(8): 303-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4224750
•
Disabling backache in France, Switzerland, and The Netherlands: contrasting sociopolitical constraints on clinical judgment. Author(s): Hadler NM. Source: J Occup Med. 1989 October; 31(10): 823-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2532680
•
Does chloroprocaine (Nesacaine MPF) for epidural anesthesia increase the incidence of backache? Author(s): Levy L, Randel GI, Pandit SK. Source: Anesthesiology. 1989 September; 71(3): 476. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2528307
•
Double beds and backache. Author(s): Pratap HJ. Source: The Practitioner. 1966 December; 197(182): 810. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4224309
•
Driving for backache. Author(s): McMillan W. Source: Lancet. 1973 January 27; 1(7796): 202. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4118815
Studies
55
•
Epidural anaesthesia and long term backache after childbirth. Author(s): MacArthur C, Lewis M, Knox EG, Crawford JS. Source: Bmj (Clinical Research Ed.). 1990 July 7; 301(6742): 9-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2143425
•
Epidural analgesia and backache. Author(s): Scott DB, Loudon JD. Source: Bmj (Clinical Research Ed.). 1992 August 22; 305(6851): 476-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1392979
•
Epidural analgesia and backache: a randomized controlled comparison with intramuscular meperidine for analgesia during labour. Author(s): Loughnan BA, Carli F, Romney M, Dore CJ, Gordon H. Source: British Journal of Anaesthesia. 2002 September; 89(3): 466-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12402727
•
Epidural analgesia and chronic backache. Author(s): Russell R, Reynolds F. Source: Anesthesia and Analgesia. 1998 September; 87(3): 747-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9728876
•
Epidural analgesia during childbirth. Association with backache is real. Author(s): MacArthur C, Knox G, Lewis M. Source: Bmj (Clinical Research Ed.). 1993 July 3; 307(6895): 64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8343694
•
Epidural dexamethasone reduces the incidence of backache after lumbar epidural anesthesia. Author(s): Wang YL, Tan PP, Yang CH, Tsai SC, Chung HS. Source: Anesthesia and Analgesia. 1997 February; 84(2): 376-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9024032
•
Epidural steroid injection in non-specific low backache. Author(s): Sagar JV, Sharma R, Sharma S. Source: J Indian Med Assoc. 1989 September; 87(9): 208-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2533601
•
Epidurals and backache: again? Author(s): Reynolds F. Source: Bmj (Clinical Research Ed.). 2002 November 2; 325(7371): 1037. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12411376
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Backache
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Evaluation of a maternity cushion (Ozzlo pillow) for backache and insomnia in late pregnancy. Author(s): Thomas IL, Nicklin J, Pollock H, Faulkner K. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1989 May; 29(2): 133-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2529841
•
Evidence for sacroiliac disease as a common cause of low backache in women. Author(s): Davis P, Lentle BC. Source: Lancet. 1978 September 2; 2(8088): 496-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=79866
•
Examination and diagnosis of low backache. Author(s): Murtagh J. Source: Aust Fam Physician. 1983 May; 12(5): 322, 325-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6225415
•
Exercise therapy for backache. Author(s): Hefford JE. Source: N Z Med J. 1994 July 13; 107(981): 276. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8022589
•
Facet blocks: a new treatment for acute and recurrent backache. Author(s): Bower RD. Source: Ona J. 1976 May; 3(5): 159-61. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=133310
•
Facet rhizotomy. Another armamentarium for treatment of low backache. Author(s): Banerjee T, Pittman HH. Source: N C Med J. 1976 July; 37(7): 354-60. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=133295
•
Fever and backache in a haemodialysis patient. Author(s): Kuo KL, Hung SC, Tarng DC. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2001 November; 16(11): 2267-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11682683
Studies
57
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Finding of relation between epidural anaesthesia and long-term backache remains valid. Author(s): MacArthur C, Lewis M, Knox G. Source: Bmj (Clinical Research Ed.). 1997 September 13; 315(7109): 679. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9310582
•
Headache and backache after epidural block for postpartum sterilisation. Author(s): Ben-David B, Solomon E, Levin H. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1995 June; 85(6): 548; Author Reply 548-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7652652
•
Headache and backache after epidural block for postpartum sterilisation. Author(s): Boezaart AP, Cripwell IT, Irvine JD, van der Spuy G. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1995 June; 85(6): 546, 548. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7652651
•
Headache and backache after epidural block for postpartum sterilisation. Author(s): Downing SE, Schneider DJ, de Villiers VP. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1994 November; 84(11): 788. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7495029
•
Headaches, backaches--healthcare's industrial revolution. Author(s): Bodenheimer T. Source: Adm Radiol J. 1996 March; 15(3): 29-30, 32-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10156167
•
Histoplasmosis presenting with progressively worsening backache--a case report. Author(s): Lachmanan SR, Haniza O, Hisham AN, Subramaniam J, Merican I. Source: Ann Acad Med Singapore. 2001 November; 30(6): 656-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11817299
•
Incidence of postdural puncture headache and backache, and success rate of dural puncture: comparison of two spinal needle designs. Author(s): Pan PH, Fragneto R, Moore C, Ross V. Source: Southern Medical Journal. 2004 April; 97(4): 359-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15108829
58
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Increased sacral angle and chronic low backache. Author(s): Gokhale YA, Verma C. Source: J Assoc Physicians India. 2000 October; 48(10): 1032, 1035. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11200912
•
Industrial backache. Author(s): Meyers TJ. Source: Dis Nerv Syst. 1967 March; 28(3): 155-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4225392
•
Industrial rheumatology. The Australian and New Zealand experiences with arm pain and backache in the workplace. Author(s): Hadler NM. Source: The Medical Journal of Australia. 1986 February 17; 144(4): 191-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2935719
•
Interventions for preventing and treating backache in pregnancy. Author(s): Young G, Jewell D. Source: Cochrane Database Syst Rev. 2000; (2): Cd001139. Review. Update In: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10796248
•
Iron deficiency anemia, backache, and abdominal pain attacks during sexual intercourse in a 42-year-old woman. Author(s): Mulari S, Mustonen M, Sotaniemi EA. Source: Scandinavian Journal of Gastroenterology. 1996 June; 31(6): 622-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8789904
•
Letters to the editor: Psychogenic backache. Author(s): Pace JB. Source: The Journal of Family Practice. 1974 November-December; 1(3-4): 2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4156047
•
Long term backache after childbirth: prospective search for causative factors. Author(s): Russell R, Dundas R, Reynolds F. Source: Bmj (Clinical Research Ed.). 1996 June 1; 312(7043): 1384-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8646094
Studies
59
•
Long-term backache after childbirth. Potential confounding by obstetric malposition was not considered. Author(s): Stephens IF. Source: Bmj (Clinical Research Ed.). 1996 September 21; 313(7059): 755; Author Reply 755-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8819469
•
Long-term backache after childbirth. Study should have been randomised. Author(s): Loughnan BA, Gordon H, Frank AO. Source: Bmj (Clinical Research Ed.). 1996 September 21; 313(7059): 755; Author Reply 755-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8819470
•
Long-term backache after extradural or general anaesthesia for manual removal of placenta. Author(s): Sah N. Source: British Journal of Anaesthesia. 1993 July; 71(1): 171. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8343338
•
Long-term backache after extradural or general anaesthesia for manual removal of placenta: preliminary report. Author(s): Vickers RJ, May AE. Source: British Journal of Anaesthesia. 1993 February; 70(2): 214-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8435267
•
Low backache during pregnancy. Acute hemodynamic effects of a lumbar support. Author(s): Beaty CM, Bhaktaram VJ, Rayburn WF, Parker MJ, Christensen HD, Chandrasekaran K. Source: J Reprod Med. 1999 December; 44(12): 1007-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10649810
•
Low backache. Author(s): Cozen L. Source: S D J Med. 1965 November; 18(11): 26-30. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4221262
•
Malignant spinal cord compression: when a backache signals danger. Author(s): Frierson-Stroud L. Source: Tex Med. 1990 January; 86(1): 48-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2137265
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Management of backache in general practice. Author(s): Dossetor AE. Source: British Medical Journal. 1975 October 4; 4(5987): 32-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=126106
•
Management of backache. Author(s): Bassett S, Buswell J. Source: N Z Med J. 1987 December 9; 100(837): 756. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2967937
•
Manipulative treatment of backache in a young acromegalic: a case report. Author(s): Woo CC. Source: Journal of Manipulative and Physiological Therapeutics. 1986 December; 9(4): 279-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2949039
•
Medical assessment after injury--problems encountered: IV. Backache. Author(s): Hicks A. Source: East Afr Med J. 1991 March; 68(3): 225-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1830002
•
Modern poetry and the backache. Author(s): Fardon DF. Source: The Spine Journal : Official Journal of the North American Spine Society. 2001 November-December; 1(6): 446. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14626236
•
Monosynaptic reflex as a tool to diagnose spinal root irritation in patients suffering from low backache and TENS therapy for relief of pain. Author(s): Prakash U, Rastogi V, Dey PK. Source: J Indian Med Assoc. 1987 May; 85(5): 157-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2958559
•
Night backache in pregnancy. Hypothetical pathophysiological mechanisms. Author(s): Fast A, Weiss L, Parikh S, Hertz G. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 1989 October; 68(5): 227-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2529882
Studies
61
•
Non-specific backache. Author(s): Cyriax J. Source: British Medical Journal. 1971 October 16; 4(780): 173. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4255858
•
Normality and reliability in the clinical assessment of backache. Author(s): Waddell G, Main CJ, Morris EW, Venner RM, Rae PS, Sharmy SH, Galloway H. Source: British Medical Journal (Clinical Research Ed.). 1982 May 22; 284(6328): 1519-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6211214
•
Onchocerciasis presenting with backache. Author(s): Pearson CA. Source: Trop Doct. 1982 April; 12(2): 70. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6210983
•
Orphenadrin-paracetamol in backache-a double-blind controlled trial. Author(s): Hingorani K. Source: Br J Clin Pract. 1971 May; 25(5): 227-31. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4253016
•
Osteitis condensans ilii misdiagnosed as post-epidural block backache. Author(s): Markowitz A, Farcon EL, Marx GF. Source: Reg Anesth. 1992 November-December; 17(6): 355. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1286058
•
Osteoporosis in pregnancy: more than postural backache. Author(s): Topping J, Black AJ, Farquharson RG, Fraser WD. Source: Prof Care Mother Child. 1998; 8(6): 147-50. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10197021
•
Patient assistance in reduction of medical costs for backache. Author(s): Ahmad I. Source: J Occup Med. 1979 June; 21(6): 392. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=157388
•
Percutaneous posterolateral lumbar discectomy. An alternative to laminectomy in the treatment of backache and sciatica. Author(s): Graham CE. Source: Clinical Orthopaedics and Related Research. 1989 January; (238): 104-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2521316
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Posterior spinal compression by the cephalad edge of the laminae and its role in the etiology of backache. Author(s): Chandnani PC, Chhabria PB. Source: Neurology India. 1978 March; 26(1): 7-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=150547
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Post-lumbar puncture headache and backache in pediatrics: a case series and demonstration of magnetic resonance imaging findings. Author(s): Atabaki S, Ochsenschlager D. Source: Archives of Pediatrics & Adolescent Medicine. 1999 July; 153(7): 770-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10401816
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Postoperative backache. Author(s): Rafferty AM. Source: Nurs Times. 1988 November 16-22; 84(46): 32-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2974949
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Postoperative backache: the use of an inflatable wedge. Author(s): O'Donovan N, Healy TE, Faragher EB, Wilkins RG, Hamilton AA. Source: British Journal of Anaesthesia. 1986 March; 58(3): 280-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2936368
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Prevention of backache in industry through preplacement medical examnation in Egypt. Author(s): el-Attar OA. Source: J Egypt Med Assoc. 1967; 50(10): 586-92. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4233744
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Pseudodisc--the problem of backache. Author(s): Kraus H. Source: Proc Rudolf Virchow Med Soc City N Y. 1964; 23: 50-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4223048
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Psychiatric aspects of backache. Author(s): Yochelson L. Source: Curr Pract Orthop Surg. 1966; 3: 253-72. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4226282
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Psychogenic backache: the missing dimension. Author(s): Sarno JE. Source: The Journal of Family Practice. 1974 August; 1(2): 8-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4281437
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Psychological aspects of backache. Author(s): Minc S. Source: The Medical Journal of Australia. 1968 June 1; 1(22): 964-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4231738
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Psychosomatic backache. Author(s): Sarno JE. Source: The Journal of Family Practice. 1977 September; 5(3): 353-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=143507
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Reduction of postlumbar puncture backache by the use of field block anesthesia prior to lumbar puncture. Author(s): Peng AT, Behar S, Blancato LS. Source: Anesthesiology. 1985 August; 63(2): 227-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3161427
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Relief of osteoporotic backache with fluoride, calcium, and calciferol. Author(s): Grove O, Halver B. Source: Acta Med Scand. 1981; 209(6): 469-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6455048
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Sacral and non-spinal tumors presenting as backache. A retrospective study of 17 patients. Author(s): Burger EL, Lindeque BG. Source: Acta Orthopaedica Scandinavica. 1994 June; 65(3): 344-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8042492
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Sacral arch defect and low backache. Author(s): Tulsi RS. Source: Australasian Radiology. 1974 March; 18(1): 43-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4278433
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Sacral extradural cysts. A rare cause of low backache and sciatica. Author(s): Crellin RQ, Jones ER. Source: The Journal of Bone and Joint Surgery. British Volume. 1973 February; 55(1): 2031. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4266462
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Sacroiliac disease and low backache in women. Author(s): De Roo M, Walravens M, Dequeker J. Source: Lancet. 1978 October 28; 2(8096): 942-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=81955
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Sacroiliac disease and low backache. Author(s): Golding DN. Source: Lancet. 1978 October 14; 2(8094): 837-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=81386
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School Christmas shows. 'look out the backache is behind you'. Author(s): Morris IM. Source: British Journal of Rheumatology. 1996 December; 35(12): 1335-6. Erratum In: Br J Rheumatol 1997 April; 36(4): 510. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9010078
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Sciatica and backache: when to operate? Author(s): Lewinnek GE, Warfield CA. Source: Hosp Pract (Off Ed). 1985 June 15; 20(6): 166-7, 170-1, 174-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3159738
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Severe backache as a presenting sign of bacterial endocarditis. Author(s): Harkonen M, Olin PE, Wennstrom J. Source: Acta Med Scand. 1981; 210(4): 329-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6459002
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Severe backache during thrombolytic therapy with streptokinase. Author(s): Suresh V, Maliyil MV. Source: J Assoc Physicians India. 1996 October; 44(10): 743. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9251356
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Severe backache in Guillain-Barre syndrome. Author(s): Sanchez-Guerra M, Infante J, Pascual J, Berciano J. Source: Muscle & Nerve. 2002 March; 25(3): 468. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11870731
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Should backache be treated with spinal fusion? Spinal fusion is the only treatment for discogenic pain. Author(s): O'Brien JP. Source: Bmj (Clinical Research Ed.). 1996 January 6; 312(7022): 38-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8555861
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Should backache be treated with spinal fusion? The case for spinal fusion is unproved. Author(s): Wilson-MacDonald J. Source: Bmj (Clinical Research Ed.). 1996 January 6; 312(7022): 39-40. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8555862
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Spinal manipulation in acute backache. Author(s): Wood L. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1985 September 28; 68(7): 449-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2931839
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Spondylopathy. A clinical study of backache in the aged. Author(s): Bick EM. Source: Geriatrics. 1966 January; 21(1): 136-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4222449
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Surgical treatment of low backache and sciatica. Author(s): Thomas M, Grant N, Marshall J, Stevens J. Source: Lancet. 1983 December 24-31; 2(8365-66): 1437-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6140540
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Syphilis as a cause of backache. Author(s): Waugh M. Source: British Medical Journal. 1972 March 25; 1(803): 803. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4259219
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The anatomy of backache. Author(s): Bradley KC. Source: The Australian and New Zealand Journal of Surgery. 1974 July; 44(3): 227-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4282245
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The differential diagnosis of backache. Author(s): Waddell G, Hamblen DL. Source: The Practitioner. 1983 July; 227(1381): 1167-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6225080
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The disabling backache. An international perspective. Author(s): Hadler NM. Source: Spine. 1995 March 15; 20(6): 640-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7604338
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The general practitioner and the patient with backache. Author(s): Chertok L, Bourguignon O, Velluet L. Source: International Journal of Psychiatry in Medicine. 1974 Summer; 5(3): 243-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9335918
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The health (treatment of backache) bill 1979. Author(s): Nowlan D. Source: Ir Med J. 1979 January 12; 72(1): 5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=759399
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The incidence of failed spinal anesthesia, postdural puncture headache and backache is similar with Atraucan and Whitacre spinal needles. Author(s): Pan PH, Fragneto R, Moore C, Ross V, Justis G. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2002 JuneJuly; 49(6): 636-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12067883
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The influence of indemnification by workers' compensation insurance on recovery from acute backache. North Carolina Back Pain Project. Author(s): Hadler NM, Carey TS, Garrett J. Source: Spine. 1995 December 15; 20(24): 2710-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8747249
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The labor productivity effects of chronic backache in the United States. Author(s): Rizzo JA, Abbott TA 3rd, Berger ML. Source: Medical Care. 1998 October; 36(10): 1471-88. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9794341
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The predicament of backache. Author(s): Hadler NM. Source: J Occup Med. 1988 May; 30(5): 449-50. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2967356
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The problem of backache. Author(s): Jayson MI. Source: The Practitioner. 1970 November; 205(229): 615-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4250126
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The sacroiliac joint: a major cause of backache in pregnancy. Author(s): Wicks T. Source: Midwifery Today Childbirth Educ. 1996 Fall; (39): 33-4, 39. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9016046
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The severely involved child: maternal backache. Author(s): Svirsky HS. Source: Clinical Orthopaedics and Related Research. 1966 July-August; 47: 57-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4224247
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Treating backache--a topical comment. Author(s): Grieve GP. Source: Physiotherapy. 1983 September 10; 69(9): 316. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6227924
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Treatment of backache with local injections. Author(s): Bourne IH. Source: The Practitioner. 1979 May; 222(1331): 708-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=158186
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Treatment of backache with spinal injections of local anesthetics, spinal and systemic steroids. A review. Author(s): Kepes ER, Duncalf D. Source: Pain. 1985 May; 22(1): 33-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3159998
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Unexplained acute backache in longstanding ankylosing spondylitis. Author(s): Dunn N, Preston B, Jones KL. Source: British Medical Journal (Clinical Research Ed.). 1985 December 7; 291(6509): 1632-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2934108
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Vascular backache and consideration of its pathomechanisms: report of two cases. Author(s): Yabuki S, Kikuchi S, Midorikawa H, Hoshino S. Source: Journal of Spinal Disorders. 1999 April; 12(2): 162-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10229533
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Vertebral and paravertebral sepsis in diabetes: an easily missed cause of backache. Author(s): Baldwin N, Scott AR, Heller SR, O'Donoghue D, Tattersall RB. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 1985 September; 2(5): 395-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2951099
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Weakness and backache. Author(s): Misa RS. Source: Minn Med. 1969 October; 52(10): 1643-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5346969
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Women have headaches, men have backaches: patterns of illness in an Appalachian community. Author(s): Horton CF. Source: Social Science & Medicine (1982). 1984; 19(6): 647-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6238417
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Your backache. Author(s): Murtagh JE. Source: Aust Fam Physician. 1981 January; 10(1): 31, 33. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6453576
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CHAPTER 2. ALTERNATIVE MEDICINE AND BACKACHE Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to backache. At the conclusion of this chapter, we will provide additional sources.
The Combined Health Information Database The Combined Health Information Database (CHID) is a bibliographic database produced by health-related agencies of the U.S. federal government (mostly from the National Institutes of Health) that can offer concise information for a targeted search. The CHID database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “backache” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: •
Foods that Fight Pain: Revolutionary New Strategies for Maximum Pain Relief Source: New York, NY: Harmony Books. 1999. 347 p. Contact: Available from Harmony Books. 231 Broad Street, Nevada City, CA 95959. (530) 265-9564. PRICE: $14.00. ISBN: 0609804367. Summary: This book is intended to help people fight pain by using common foods, traditional supplements, and herbs. It explains which foods contribute to pain and how to avoid them, which foods are pain-safe but high in nutrition, and which foods can actively soothe pain by improving blood circulation, relieving inflammation, and balancing hormones. An introduction describes how food can fight pain at any of the stages of the pain process: the initial injury, the inflammatory response, the pain message traveling through the nerves, and the brain's perception of pain. Part 1 discusses conditions related to poor circulation, such as backaches and chest pain. Part 2 addresses conditions caused by food sensitivities and inflammation, including
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migraines, other headaches, joint ailments, stomach aches and digestive problems, and fibromyalgia. Part 3 discusses hormone-related conditions such as menstrual pain, breast pain, and cancer pain. Part 4 discusses metabolic and immune problems, including carpal tunnel syndrome, diabetes, herpes and shingles, sickle cell anemia, kidney stones, and urinary infections. Part 5 discusses the roles of exercise, rest, and sleep in pain relief; describes several stress-reducing exercises; and explains why the body rebels against certain foods. The book includes menus and recipes, a glossary of ingredients, a list of resources, a list of suggested readings, and an index.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to backache and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “backache” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to backache: •
Back pain. Beyond the backache. Author(s): Cherkin D, Sherman K, Eisenberg D. Source: Newsweek. 2002 December 2; 140(23): 56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12501512
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.healthnotes.com/
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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine
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Open Directory Project: http://dmoz.org/Health/Alternative/
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HealthGate: http://www.tnp.com/
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WebMDHealth: http://my.webmd.com/drugs_and_herbs
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
The following is a specific Web list relating to backache; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •
General Overview Endometriosis Source: Integrative Medicine Communications; www.drkoop.com Irritable Bowel Syndrome Source: Healthnotes, Inc.; www.healthnotes.com Pelvic Inflammatory Disease Source: Integrative Medicine Communications; www.drkoop.com PMS Source: Integrative Medicine Communications; www.drkoop.com Premenstrual Syndrome Source: Integrative Medicine Communications; www.drkoop.com Vaginal Inflammation Source: Integrative Medicine Communications; www.drkoop.com Vaginitis Source: Integrative Medicine Communications; www.drkoop.com
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Alternative Therapy Colon Therapy Source: Healthnotes, Inc.; www.healthnotes.com
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Homeopathy Actaea Racemosa Source: Healthnotes, Inc.; www.healthnotes.com Aesculus Hippocastanum Source: Healthnotes, Inc.; www.healthnotes.com Arnica Source: Healthnotes, Inc.; www.healthnotes.com Bryonia Source: Healthnotes, Inc.; www.healthnotes.com
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Calcarea Carbonica Source: Healthnotes, Inc.; www.healthnotes.com Calcarea Phosphorica Source: Healthnotes, Inc.; www.healthnotes.com Cimicifuga Source: Healthnotes, Inc.; www.healthnotes.com Dulcamara Source: Healthnotes, Inc.; www.healthnotes.com Ignatia Source: Healthnotes, Inc.; www.healthnotes.com Kali Carbonicum Source: Healthnotes, Inc.; www.healthnotes.com Natrum Muriaticum Source: Healthnotes, Inc.; www.healthnotes.com Nux Vomica Source: Healthnotes, Inc.; www.healthnotes.com Rhus Toxicodendron Source: Healthnotes, Inc.; www.healthnotes.com Ruta Graveolens Source: Healthnotes, Inc.; www.healthnotes.com Sulphur Source: Healthnotes, Inc.; www.healthnotes.com •
Herbs and Supplements Arctium Alternative names: Burdock, Gobo; Arctium lappa L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hydrangea Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Pau d’Arco Alternative names: Tabebuia avellanedae, Tabebuia impestiginosa Source: Healthnotes, Inc.; www.healthnotes.com Tanacetum V Alternative names: Tansy; Tanacetum vulgare (L.) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org
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General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.
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CHAPTER 3. BOOKS ON BACKACHE Overview This chapter provides bibliographic book references relating to backache. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on backache include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “backache” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “backache” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “backache” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •
How to Conquer Backache (A Consultation with Dr Vernon Coleman) by Vernon Coleman; ISBN: 0600575217; http://www.amazon.com/exec/obidos/ASIN/0600575217/icongroupinterna
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Joseph Corvo's Backache Cure by Joseph Corvo; ISBN: 0091771366; http://www.amazon.com/exec/obidos/ASIN/0091771366/icongroupinterna
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Natural Medicine for Back Pain: The Best Alternative Methods for Banishing Backache : From Acupressure & Chiropractic to Nutrition & Yoga by Glenn S., Md Rothfeld, Suzanne Levert; ISBN: 0875962882; http://www.amazon.com/exec/obidos/ASIN/0875962882/icongroupinterna
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Natural Medicine for Back Pain: The Best Alternative Methods for Banishing Backache from Acupressure & Chiropractic to Nutrition & Yoga by Glenn S. Rothfeld, Suzanne Levert; ISBN: 0783820267; http://www.amazon.com/exec/obidos/ASIN/0783820267/icongroupinterna
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The Practical Treatment of Backache and Sciatica by John Barrett, Douglas N. Golding; ISBN: 0852007736; http://www.amazon.com/exec/obidos/ASIN/0852007736/icongroupinterna
Chapters on Backache In order to find chapters that specifically relate to backache, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and backache using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “backache” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on backache: •
Ineffective Therapies Source: in Manu, P. Pharmacotherapy of Common Functional Syndromes: EvidenceBased Guidelines for Primary Care Practice. Binghamton, NY: Haworth Medical Press. 2000. p. 153-167. Contact: Available from Haworth Medical Press, an imprint of Haworth Press, Inc. 10 Alice Street, Binghamton, New York 13904-1580. (800) HAWORTH or (800) 429-6784. Outside United States and Canada (607) 722-5857. Fax (800) 895-0582. E-mail:
[email protected]. Website: www.haworthpressinc.com. PRICE: $69.95 plus shipping and handling. ISBN: 0789005883. Summary: This chapter is from a book that evaluates drug therapies for each of the four major functional disorders: chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome (IBS), and premenstrual syndrome. In this chapter, the fourth of six short chapters that focus on IBS, the author introduces and reviews the ineffective therapies presently in use for the condition. The author focuses on dietary fiber, lactase, and ondansetron. The author's evidence based analysis of a number of studies demonstrates that research performed in the past two decades has established with a high degree of certainty that the administration of dietary fiber is not useful for treating IBS. Lactose (milk sugar) maldigestion can be identified in close to one third of patients diagnosed with IBS, and the symptoms of lactose intolerance or maldigestion are so close to those for IBS as to prevent the clinical identification of this subgroup. Treatment with lactase provided no statistical improvement over placebo. The author reports on a study of ondansetron, in which the drug treatment did not decrease significantly the severity of abdominal pain or the total number of symptoms experienced during the trial. Stool consistency increased after ondansetron therapy. In another study, ondansetron was similar to placebo with regard to its effect on abdominal pain, abdominal distention, backache, urinary symptoms, and depression and anxiety. The only symptoms improved by ondansetron in this population with IBS were postprandial (after a meal) discomfort, belching, and heartburn.
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CHAPTER 4. PERIODICALS AND NEWS ON BACKACHE Overview In this chapter, we suggest a number of news sources and present various periodicals that cover backache.
News Services and Press Releases One of the simplest ways of tracking press releases on backache is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “backache” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to backache. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “backache” (or synonyms). The following was recently listed in this archive for backache: •
EU shrugs off backache to tackle stress at work Source: Reuters Health eLine Date: July 02, 2002
•
Epidural anesthesia during labor does not increase long-term backache risk Source: Reuters Medical News Date: February 06, 2001
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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “backache” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “backache” (or synonyms). If you know the name of a company that is relevant to backache, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “backache” (or synonyms).
Academic Periodicals covering Backache Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to backache. In addition to
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these sources, you can search for articles covering backache that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”
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APPENDICES
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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.
NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute4: •
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25
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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm
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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm
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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375
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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/
4
These publications are typically written by one or more of the various NIH Institutes.
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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm
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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm
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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm
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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/
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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html
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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm
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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm
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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html
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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm
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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp
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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/
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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp
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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html
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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.5 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:6 •
Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
5
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 6 See http://www.nlm.nih.gov/databases/databases.html.
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
The NLM Gateway7 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.8 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “backache” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total
Items Found 16946 755 893 66 19 18679
HSTAT9 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.10 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.11 Simply search by “backache” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
7
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
8
The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 9 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 10 11
The HSTAT URL is http://hstat.nlm.nih.gov/.
Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.
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Coffee Break: Tutorials for Biologists12 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.13 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.14 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
•
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
12 Adapted 13
from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.
The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 14 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on backache can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to backache. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to backache. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “backache”:
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Arthritis http://www.nlm.nih.gov/medlineplus/arthritis.html Back Injuries http://www.nlm.nih.gov/medlineplus/backinjuries.html Sciatica http://www.nlm.nih.gov/medlineplus/sciatica.html Spinal Stenosis http://www.nlm.nih.gov/medlineplus/spinalstenosis.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on backache. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •
Inside Look at Your Back and How To Care for It, An Source: South Deerfield, MA: Channing L. Bete Co., Inc. 1999. 16 p. Contact: Available from Channing L. Bete Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. E-mail:
[email protected]. PRICE: Contact company for pricing information; available in bulk. Order Number 74948A-07-99. Summary: This illustrated booklet provides the general public with information on caring for the back, which is composed of vertebrae, the spinal cord, muscles, the sciatic nerve, disks, facet joints, nerves, and ligaments. Causes of back pain include strains, sprains, or spasms; a herniated disk; osteoarthritis; weak muscles, poor posture, or weight problems; sciatica; emotional stress; certain health conditions; structural problems; and pregnancy. Correct body mechanics should be used when standing, walking, sitting, driving, sleeping, gardening, shoveling, and vacuuming. Proper lifting techniques can help prevent back strain. Ergonomics can be used to reduce back strain at work. Back problems can also be avoided by losing excess weight, wearing sensible shoes, eating properly, and choosing furniture with the back in mind. In addition, regular physical activity is important to reduce the risk of injury. The booklet presents several exercises for the back, including the pelvic tilt, hip rolls, the cat stretch, elbow props, the knee to chest lift, and bent leg situps. In addition, the booklet offers tips on relieving backache.
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The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to backache. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDHealth: http://my.webmd.com/health_topics
Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to backache. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with backache. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about backache. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at
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http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “backache” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “backache”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “backache” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “backache” (or a synonym) into the search box, and click “Submit Query.”
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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.15
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of
15
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)16: •
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
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California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/
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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/
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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html
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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
16
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/
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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm
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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/
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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp
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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
Finding Medical Libraries
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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp
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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/
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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72
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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
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On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/
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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp
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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on backache: •
Basic Guidelines for Backache Backaches and stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002130.htm
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Signs & Symptoms for Backache Back pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003108.htm Back pain, low Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003108.htm Loss of bladder or bowel control Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003142.htm Numbness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm
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Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
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MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
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Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
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BACKACHE DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Cramps: Abdominal pain due to spasmodic contractions of the bowel. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Abscess: A localized, circumscribed collection of pus. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adhesions: Pathological processes consisting of the union of the opposing surfaces of a wound. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerobic Exercise: A type of physical activity that includes walking, jogging, running, and dancing. Aerobic training improves the efficiency of the aerobic energy-producing systems that can improve cardiorespiratory endurance. [NIH] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Aggravation: An increasing in seriousness or severity; an act or circumstance that intensifies, or makes worse. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps
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to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH]
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Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiolytic: An anxiolytic or antianxiety agent. [EU] Aponeurosis: Tendinous expansion consisting of a fibrous or membranous sheath which serves as a fascia to enclose or bind a group of muscles. [NIH] Aqueous: Having to do with water. [NIH] Arteries: The vessels carrying blood away from the heart. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Arthralgia: Pain in the joint. [NIH] Arthrosis: A disease of a joint. [EU] Articular: Of or pertaining to a joint. [EU] Ascites: Accumulation or retention of free fluid within the peritoneal cavity. [NIH] Aspartic Acid: One of the non-essential amino acids commonly occurring in the L-form. It is found in animals and plants, especially in sugar cane and sugar beets. It may be a neurotransmitter. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Back Injuries: General or unspecified injuries to the posterior part of the trunk. It includes injuries to the muscles of the back. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Belching: Noisy release of gas from the stomach through the mouth. Also called burping. [NIH]
Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]
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Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biomechanics: The study of the application of mechanical laws and the action of forces to living structures. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Blind spot: (1) A small area of the retina where the optic nerve enters the eye; occurs normally in all eyes.(2) Any gap in the visual field corresponding to an area of the retina where no visual cells are present; associated with eye disease. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone Remodeling: The continuous turnover of bone matrix and mineral that involves first, an increase in resorption (osteoclastic activity) and later, reactive bone formation (osteoblastic activity). The process of bone remodeling takes place in the adult skeleton at discrete foci. The process ensures the mechanical integrity of the skeleton throughout life and plays an important role in calcium homeostasis. An imbalance in the regulation of bone remodeling's two contrasting events, bone resorption and bone formation, results in many of the metabolic bone diseases, such as osteoporosis. [NIH] Bone Resorption: Bone loss due to osteoclastic activity. [NIH]
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Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Carpal Tunnel Syndrome: A median nerve injury inside the carpal tunnel that results in symptoms of pain, numbness, tingling, clumsiness, and a lack of sweating, which can be caused by work with certain hand and wrist postures. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Cauda Equina: The lower part of the spinal cord consisting of the lumbar, sacral, and coccygeal nerve roots. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cerebrospinal: Pertaining to the brain and spinal cord. [EU]
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Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemokines: Class of pro-inflammatory cytokines that have the ability to attract and activate leukocytes. They can be divided into at least three structural branches: C (chemokines, C), CC (chemokines, CC), and CXC (chemokines, CXC), according to variations in a shared cysteine motif. [NIH] Chemoprevention: The use of drugs, vitamins, or other agents to try to reduce the risk of, or delay the development or recurrence of, cancer. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chiropractic: A system of treating bodily disorders by manipulation of the spine and other parts, based on the belief that the cause is the abnormal functioning of a nerve. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromic: Catgut sterilized and impregnated with chromium trioxide. [NIH] Chromium: A trace element that plays a role in glucose metabolism. It has the atomic symbol Cr, atomic number 24, and atomic weight 52. According to the Fourth Annual Report on Carcinogens (NTP85-002,1985), chromium and some of its compounds have been listed as known carcinogens. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic Fatigue Syndrome: Fatigue caused by the combined effects of different types of prolonged fatigue. [NIH] Chymopapain: A cysteine endopeptidase isolated from papaya latex. Preferential cleavage at glutamic and aspartic acid residues. EC 3.4.22.6. [NIH] Cisplatin: An inorganic and water-soluble platinum complex. After undergoing hydrolysis, it reacts with DNA to produce both intra and interstrand crosslinks. These crosslinks appear to impair replication and transcription of DNA. The cytotoxicity of cisplatin correlates with cellular arrest in the G2 phase of the cell cycle. [NIH] Claudication: Limping or lameness. [EU] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic
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engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Cochlear: Of or pertaining to the cochlea. [EU] Cochlear Diseases: Diseases of the cochlea, the part of the inner ear that is concerned with hearing. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collagen disease: A term previously used to describe chronic diseases of the connective tissue (e.g., rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis), but now is thought to be more appropriate for diseases associated with defects in collagen, which is a component of the connective tissue. [NIH] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the
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standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computer Graphics: The process of pictorial communication, between human and computers, in which the computer input and output have the form of charts, drawings, or other appropriate pictorial representation. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contrast medium: A substance that is introduced into or around a structure and, because of the difference in absorption of x-rays by the contrast medium and the surrounding tissues, allows radiographic visualization of the structure. [EU] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group.
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[NIH]
Conventional treatment: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Curare: Plant extracts from several species, including Strychnos toxifera, S. castelnaei, S. crevauxii, and Chondodendron tomentosum, that produce paralysis of skeletal muscle and are used adjunctively with general anesthesia. These extracts are toxic and must be used with the administration of artificial respiration. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cystitis: Inflammation of the urinary bladder. [EU] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytotoxic: Cell-killing. [NIH] Cytotoxic chemotherapy: Anticancer drugs that kill cells, especially cancer cells. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Decidua: The epithelial lining of the endometrium that is formed before the fertilized ovum reaches the uterus. The fertilized ovum embeds in the decidua. If the ovum is not fertilized, the decidua is shed during menstruation. [NIH] Decubitus: An act of lying down; also the position assumed in lying down. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of
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sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Dexamethasone: (11 beta,16 alpha)-9-Fluoro-11,17,21-trihydroxy-16-methylpregna-1,4diene-3,20-dione. An anti-inflammatory glucocorticoid used either in the free alcohol or esterified form in treatment of conditions that respond generally to cortisone. [NIH] Dexterity: Ability to move the hands easily and skillfully. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Dietary Fiber: The remnants of plant cell walls that are resistant to digestion by the alimentary enzymes of man. It comprises various polysaccharides and lignins. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Dissection: Cutting up of an organism for study. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Distention: The state of being distended or enlarged; the act of distending. [EU] Diverticula: Plural form of diverticulum. [NIH] Diverticulitis: Inflammation of a diverticulum or diverticula. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dorsum: A plate of bone which forms the posterior boundary of the sella turcica. [NIH]
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Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dysphoric: A feeling of unpleasantness and discomfort. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Effector cell: A cell that performs a specific function in response to a stimulus; usually used to describe cells in the immune system. [NIH] Efferent: Nerve fibers which conduct impulses from the central nervous system to muscles and glands. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electroacupuncture: A form of acupuncture using low frequency electrically stimulated needles to produce analgesia and anesthesia and to treat disease. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocardium: The innermost layer of the heart, comprised of endothelial cells. [NIH]
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Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]
Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epidural block: An injection of an anesthetic drug into the space between the wall of the spinal canal and the covering of the spinal cord. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Escalation: Progressive use of more harmful drugs. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]
Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]
Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrinolytic: Pertaining to, characterized by, or causing the dissolution of fibrin by enzymatic action [EU] Fibrinolytic Agents: Fibrinolysin or agents that convert plasminogen to fibrinolysin (plasmin). [NIH] Finite Element Analysis: A computer based method of simulating or analyzing the behavior of structures or components. [NIH] Flexion: In gynaecology, a displacement of the uterus in which the organ is bent so far forward or backward that an acute angle forms between the fundus and the cervix. [EU] Foramen: A natural hole of perforation, especially one in a bone. [NIH]
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Forearm: The part between the elbow and the wrist. [NIH] Functional Disorders: Disorders such as irritable bowel syndrome. These conditions result from poor nerve and muscle function. Symptoms such as gas, pain, constipation, and diarrhea come back again and again, but there are no signs of disease or damage. Emotional stress can trigger symptoms. Also called motility disorders. [NIH] Functional magnetic resonance imaging: A noninvasive tool used to observe functioning in the brain or other organs by detecting changes in chemical composition, blood flow, or both. [NIH]
Fundus: The larger part of a hollow organ that is farthest away from the organ's opening. The bladder, gallbladder, stomach, uterus, eye, and cavity of the middle ear all have a fundus. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]
Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]
Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]
Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]
Glutamine: A non-essential amino acid present abundantly throught the body and is
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involved in many metabolic processes. It is synthesized from glutamic acid and ammonia. It is the principal carrier of nitrogen in the body and is an important energy source for many cells. [NIH] Glycoproteins: Conjugated protein-carbohydrate compounds including mucins, mucoid, and amyloid glycoproteins. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an N-acetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide involves alternate 1,4- and 1,3-linkages consisting of either N-acetylglucosamine or Nacetylgalactosamine. [NIH] Gonadal: Pertaining to a gonad. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Gynaecological: Pertaining to gynaecology. [EU] Haemodialysis: The removal of certain elements from the blood by virtue of the difference in the rates of their diffusion through a semipermeable membrane, e.g., by means of a haemodialyzer. [EU] Hair Cells: Mechanoreceptors located in the organ of Corti that are sensitive to auditory stimuli and in the vestibular apparatus that are sensitive to movement of the head. In each case the accessory sensory structures are arranged so that appropriate stimuli cause movement of the hair-like projections (stereocilia and kinocilia) which relay the information centrally in the nervous system. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH]
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Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hemodiafiltration: The combination of hemodialysis and hemofiltration either simultaneously or sequentially. Convective transport (hemofiltration) may be better for removal of larger molecular weight substances and diffusive transport (hemodialysis) for smaller molecular weight solutes. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemofiltration: Extracorporeal ultrafiltration technique without hemodialysis for treatment of fluid overload and electrolyte disturbances affecting renal, cardiac, or pulmonary function. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells, cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herniated: Protrusion of a degenerated or fragmented intervertebral disc into the intervertebral foramen compressing the nerve root. [NIH] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hydration: Combining with water. [NIH] Hydrocortisone: The main glucocorticoid secreted by the adrenal cortex. Its synthetic counterpart is used, either as an injection or topically, in the treatment of inflammation, allergy, collagen diseases, asthma, adrenocortical deficiency, shock, and some neoplastic
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conditions. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperalgesia: Excessive sensitiveness or sensibility to pain. [EU] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]
Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive therapy: Therapy used to decrease the body's immune response, such as drugs given to prevent transplant rejection. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Impotence: The inability to perform sexual intercourse. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In Situ Hybridization: A technique that localizes specific nucleic acid sequences within intact chromosomes, eukaryotic cells, or bacterial cells through the use of specific nucleic acid-labeled probes. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate
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agents. [EU] Infections: The illnesses caused by an organism that usually does not cause disease in a person with a normal immune system. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]
Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Interleukin-1: A soluble factor produced by monocytes, macrophages, and other cells which activates T-lymphocytes and potentiates their response to mitogens or antigens. IL-1 consists of two distinct forms, IL-1 alpha and IL-1 beta which perform the same functions but are distinct proteins. The biological effects of IL-1 include the ability to replace macrophage requirements for T-cell activation. The factor is distinct from interleukin-2. [NIH] Interleukin-2: Chemical mediator produced by activated T lymphocytes and which regulates the proliferation of T cells, as well as playing a role in the regulation of NK cell activity. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravenous: IV. Into a vein. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]
Involuntary: Reaction occurring without intention or volition. [NIH]
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Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress. Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Ischial: A pointed projection on the posterior margin of the ischium. [NIH] Joint Capsule: The sac enclosing a joint. It is composed of an outer fibrous articular capsule and an inner synovial membrane. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Ketoprofen: An ibuprofen-type anti-inflammatory analgesic and antipyretic. It is used in the treatment of rheumatoid arthritis and osteoarthritis. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Kinetics: The study of rate dynamics in chemical or physical systems. [NIH] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Latency: The period of apparent inactivity between the time when a stimulus is presented and the moment a response occurs. [NIH] Lesion: An area of abnormal tissue change. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Linkage Disequilibrium: Nonrandom association of linked genes. This is the tendency of the alleles of two separate but already linked loci to be found together more frequently than would be expected by chance alone. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Lod: The lowest analyte content which, if actually present, will be detected with reasonable statistical certainty and can be identified according to the identification criteria of the
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method. If both accuracy and precision are constant over a concentration range. [NIH] Lod Score: The total relative probability, expressed on a logarithmic scale, that a linkage relationship exists among selected loci. Lod is an acronym for "logarithmic odds." [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumbar puncture: A procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give anticancer drugs intrathecally. Also called a spinal tap. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]
Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant tumor: A tumor capable of metastasizing. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]
Mechanoreceptors: Cells specialized to transduce mechanical stimuli and relay that information centrally in the nervous system. Mechanoreceptors include hair cells, which mediate hearing and balance, and the various somatosensory receptors, often with nonneural accessory structures. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Median Nerve: A major nerve of the upper extremity. In humans, the fibers of the median
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nerve originate in the lower cervical and upper thoracic spinal cord (usually C6 to T1), travel via the brachial plexus, and supply sensory and motor innervation to parts of the forearm and hand. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Health: The state wherein the person is well adjusted. [NIH] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Meperidine: 1-Methyl-4-phenyl-4-piperidinecarboxylic acid ethyl ester. A narcotic analgesic that can be used for the relief of most types of moderate to severe pain, including postoperative pain and the pain of labor. Prolonged use may lead to dependence of the morphine type; withdrawal symptoms appear more rapidly than with morphine and are of shorter duration. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Metastatic cancer: Cancer that has spread from the place in which it started to other parts of the body. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microdialysis: A technique for measuring extracellular concentrations of substances in tissues, usually in vivo, by means of a small probe equipped with a semipermeable membrane. Substances may also be introduced into the extracellular space through the membrane. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living
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organisms, they are sometimes classified as microorganisms. [NIH] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [NIH]
Mucinous: Containing or resembling mucin, the main compound in mucus. [NIH] Multiple Myeloma: A malignant tumor of plasma cells usually arising in the bone marrow; characterized by diffuse involvement of the skeletal system, hyperglobulinemia, Bence-Jones proteinuria, and anemia. [NIH] Muscle Denervation: The resection or removal of the innervation of a muscle or muscle tissue. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Muscle Relaxation: That phase of a muscle twitch during which a muscle returns to a resting position. [NIH] Muscle Spindles: Mechanoreceptors found between skeletal muscle fibers. Muscle spindles are arranged in parallel with muscle fibers and respond to the passive stretch of the muscle, but cease to discharge if the muscle contracts isotonically, thus signaling muscle length. The muscle spindles are the receptors responsible for the stretch or myotactic reflex. [NIH] Muscle tension: A force in a material tending to produce extension; the state of being stretched. [NIH]
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Musculature: The muscular apparatus of the body, or of any part of it. [EU] Musculoskeletal Diseases: Diseases of the muscles and their associated ligaments and other connective tissue and of the bones and cartilage viewed collectively. [NIH] Musculoskeletal System: Themuscles, bones, and cartilage of the body. [NIH] Myelography: X-ray visualization of the spinal cord following injection of contrast medium into the spinal arachnoid space. [NIH] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Nerve Endings: Specialized terminations of peripheral neurons. Nerve endings include neuroeffector junction(s) by which neurons activate target organs and sensory receptors which transduce information from the various sensory modalities and send it centrally in the nervous system. Presynaptic nerve endings are presynaptic terminals. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neuropeptides: Peptides released by neurons as intercellular messengers. Many neuropeptides are also hormones released by non-neuronal cells. [NIH] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine,
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epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nociceptors: Peripheral receptors for pain. Nociceptors include receptors which are sensitive to painful mechanical stimuli, extreme heat or cold, and chemical stimuli. All nociceptors are free nerve endings. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Occupational Health: The promotion and maintenance of physical and mental health in the work environment. [NIH] Occupational Health Services: Health services for employees, usually provided by the employer at the place of work. [NIH] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Ondansetron: A competitive serotonin type 3 receptor antagonist. It is effective in the treatment of nausea and vomiting caused by cytotoxic chemotherapy drugs, including cisplatin, and it has reported anxiolytic and neuroleptic properties. [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Orthopaedic: Pertaining to the correction of deformities of the musculoskeletal system; pertaining to orthopaedics. [EU] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the
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foreign literature it is often called osteoarthrosis deformans. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Particle: A tiny mass of material. [EU] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]
Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Peer Group: Group composed of associates of same species, approximately the same age, and usually of similar rank or social status. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the
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mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peroneal Nerve: The lateral of the two terminal branches of the sciatic nerve. The peroneal (or fibular) nerve provides motor and sensory innervation to parts of the leg and foot. [NIH] Phantom: Used to absorb and/or scatter radiation equivalently to a patient, and hence to estimate radiation doses and test imaging systems without actually exposing a patient. It may be an anthropomorphic or a physical test object. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenyl: Ingredient used in cold and flu remedies. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]
Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]
Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU]
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Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postoperative: After surgery. [NIH] Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Postural: Pertaining to posture or position. [EU] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Premenstrual Syndrome: A syndrome occurring most often during the last week of the menstrual cycle and ending soon after the onset of menses. Some of the symptoms are emotional instability, insomnia, headache, nausea, vomiting, abdominal distension, and painful breasts. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Proprioception: The mechanism involved in the self-regulation of posture and movement through stimuli originating in the receptors imbedded in the joints, tendons, muscles, and labyrinth. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prosthesis: An artificial replacement of a part of the body. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein
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C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Proteoglycan: A molecule that contains both protein and glycosaminoglycans, which are a type of polysaccharide. Proteoglycans are found in cartilage and other connective tissues. [NIH]
Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]
Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulposus: Prolapse of the nucleus pulposus into the body of the vertebra; necrobacillosis of rabbits. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiculopathy: Disease involving a spinal nerve root (see spinal nerve roots) which may result from compression related to intervertebral disk displacement; spinal cord injuries; spinal diseases; and other conditions. Clinical manifestations include radicular pain, weakness, and sensory loss referable to structures innervated by the involved nerve root. [NIH]
Radioactive: Giving off radiation. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate
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objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Registries: The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Relaxant: 1. Lessening or reducing tension. 2. An agent that lessens tension. [EU]
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Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]
Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Renal pelvis: The area at the center of the kidney. Urine collects here and is funneled into the ureter, the tube that connects the kidney to the bladder. [NIH] Reoperation: A repeat operation for the same condition in the same patient. It includes reoperation for reexamination, reoperation for disease progression or recurrence, or reoperation following operative failure. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rheumatology: A subspecialty of internal medicine concerned with the study of inflammatory or degenerative processes and metabolic derangement of connective tissue structures which pertain to a variety of musculoskeletal disorders, such as arthritis. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Sacroiliac Joint: The immovable joint formed by the lateral surfaces of the sacrum and ilium. [NIH] Sagittal: The line of direction passing through the body from back to front, or any vertical plane parallel to the medial plane of the body and inclusive of that plane; often restricted to the medial plane, the plane of the sagittal suture. [NIH] Saline: A solution of salt and water. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose.
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Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Scatter: The extent to which relative success and failure are divergently manifested in qualitatively different tests. [NIH] Sciatic Nerve: A nerve which originates in the lumbar and sacral spinal cord (L4 to S3) and supplies motor and sensory innervation to the lower extremity. The sciatic nerve, which is the main continuation of the sacral plexus, is the largest nerve in the body. It has two major branches, the tibial nerve and the peroneal nerve. [NIH] Sciatica: A condition characterized by pain radiating from the back into the buttock and posterior/lateral aspects of the leg. Sciatica may be a manifestation of sciatic neuropathy; radiculopathy (involving the L4, L5, S1 or S2 spinal nerve roots; often associated with intervertebral disk displacement); or lesions of the cauda equina. [NIH] Scoliosis: A lateral curvature of the spine. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Second Messenger Systems: Systems in which an intracellular signal is generated in response to an intercellular primary messenger such as a hormone or neurotransmitter. They are intermediate signals in cellular processes such as metabolism, secretion, contraction, phototransduction, and cell growth. Examples of second messenger systems are the adenyl cyclase-cyclic AMP system, the phosphatidylinositol diphosphate-inositol triphosphate system, and the cyclic GMP system. [NIH] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sedentary: 1. Sitting habitually; of inactive habits. 2. Pertaining to a sitting posture. [EU] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sensory loss: A disease of the nerves whereby the myelin or insulating sheath of myelin on the nerves does not stay intact and the messages from the brain to the muscles through the nerves are not carried properly. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH]
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Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]
Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Security: Government sponsored social insurance programs. [NIH] Socioeconomic Factors: Social and economic factors that characterize the individual or group within the social structure. [NIH] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spasmodic: Of the nature of a spasm. [EU] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH]
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Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Cord Compression: Acute and chronic conditions characterized by external mechanical compression of the spinal cord due to extramedullary neoplasm; epidural abscess; spinal fractures; bony deformities of the vertebral bodies; and other conditions. Clinical manifestations vary with the anatomic site of the lesion and may include localized pain, weakness, sensory loss, incontinence, and impotence. [NIH] Spinal Cord Injuries: Penetrating and non-penetrating injuries to the spinal cord resulting from traumatic external forces (e.g., wounds, gunshot; whiplash injuries; etc.). [NIH] Spinal Fractures: Broken bones in the vertebral column. [NIH] Spinal Nerve Roots: The paired bundles of nerve fibers entering and leaving the spinal cord at each segment. The dorsal and ventral nerve roots join to form the mixed segmental spinal nerves. The dorsal roots are generally afferent, formed by the central projections of the spinal (dorsal root) ganglia sensory cells, and the ventral roots efferent, comprising the axons of spinal motor and autonomic preganglionic neurons. There are, however, some exceptions to this afferent/efferent rule. [NIH] Spinal Stenosis: Narrowing of the spinal canal. [NIH] Spinal tap: A procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give anticancer drugs intrathecally. Also called a lumbar puncture. [NIH] Spondylitis: Inflammation of the vertebrae. [EU] Spondylolisthesis: Forward displacement of one vertebra over another. [NIH] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Stabilization: The creation of a stable state. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]
Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU]
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Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Streptococci: A genus of spherical Gram-positive bacteria occurring in chains or pairs. They are widely distributed in nature, being important pathogens but often found as normal commensals in the mouth, skin, and intestine of humans and other animals. [NIH] Streptokinase: Streptococcal fibrinolysin . An enzyme produced by hemolytic streptococci. It hydrolyzes amide linkages and serves as an activator of plasminogen. It is used in thrombolytic therapy and is used also in mixtures with streptodornase (streptodornase and streptokinase). EC 3.4.-. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subcutaneous: Beneath the skin. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatology: 1. That branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. The combined symptoms of a disease. [EU] Synapses: Specialized junctions at which a neuron communicates with a target cell. At classical synapses, a neuron's presynaptic terminal releases a chemical transmitter stored in synaptic vesicles which diffuses across a narrow synaptic cleft and activates receptors on the postsynaptic membrane of the target cell. The target may be a dendrite, cell body, or axon of another neuron, or a specialized region of a muscle or secretory cell. Neurons may also communicate through direct electrical connections which are sometimes called electrical synapses; these are not included here but rather in gap junctions. [NIH] Synovial: Of pertaining to, or secreting synovia. [EU] Synovial Membrane: The inner membrane of a joint capsule surrounding a freely movable joint. It is loosely attached to the external fibrous capsule and secretes synovial fluid. [NIH] Systemic: Affecting the entire body. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Tendon: A discrete band of connective tissue mainly composed of parallel bundles of collagenous fibers by which muscles are attached, or two muscles bellies joined. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thoracic: Having to do with the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or
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intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombolytic: 1. Dissolving or splitting up a thrombus. 2. A thrombolytic agent. [EU] Thrombolytic Therapy: Use of infusions of fibrinolytic agents to destroy or dissolve thrombi in blood vessels or bypass grafts. [NIH] Tibial Nerve: The medial terminal branch of the sciatic nerve. The tibial nerve fibers originate in lumbar and sacral spinal segments (L4 to S2). They supply motor and sensory innervation to parts of the calf and foot. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Transcutaneous: Transdermal. [EU] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH]
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Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Triage: The sorting out and classification of patients or casualties to determine priority of need and proper place of treatment. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tumour: 1. Swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. A new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Ultrafiltration: The separation of particles from a suspension by passage through a filter with very fine pores. In ultrafiltration the separation is accomplished by convective transport; in dialysis separation relies instead upon differential diffusion. Ultrafiltration occurs naturally and is a laboratory procedure. Artificial ultrafiltration of the blood is referred to as hemofiltration or hemodiafiltration (if combined with hemodialysis). [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Ventricles: Fluid-filled cavities in the heart or brain. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Vestibulocochlear Nerve: The 8th cranial nerve. The vestibulocochlear nerve has a cochlear part (cochlear nerve) which is concerned with hearing and a vestibular part (vestibular nerve) which mediates the sense of balance and head position. The fibers of the cochlear nerve originate from neurons of the spiral ganglion and project to the cochlear nuclei (cochlear nucleus). The fibers of the vestibular nerve arise from neurons of Scarpa's ganglion and project to the vestibular nuclei. [NIH] Vestibulocochlear Nerve Diseases: Diseases of the vestibular and/or cochlear (acoustic) nerves, which join to form the vestibulocochlear nerve. Vestibular neuritis, cochlear neuritis, and acoustic neuromas are relatively common conditions that affect these nerves. Clinical manifestations vary with which nerve is primarily affected, and include hearing loss, vertigo, and tinnitus. [NIH]
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Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Visual field: The entire area that can be seen when the eye is forward, including peripheral vision. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]
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INDEX A Abdominal, 4, 23, 31, 58, 76, 101, 118, 124, 126 Abdominal Cramps, 4, 101 Abdominal Pain, 31, 58, 76, 101, 118 Abscess, 4, 101, 132 Activities of Daily Living, 25, 101 Adaptation, 20, 32, 101 Adhesions, 4, 101 Adjustment, 8, 35, 37, 101 Adolescence, 31, 101, 124 Adrenal Cortex, 101, 115, 126 Adverse Effect, 101, 131 Aerobic, 18, 101 Aerobic Exercise, 18, 101 Afferent, 29, 101, 132 Aggravation, 7, 101 Agonist, 101, 122 Algorithms, 31, 101, 104 Alimentary, 102, 110 Alkaline, 102, 105 Alleles, 102, 118 Alternative medicine, 18, 33, 78, 102 Amino Acids, 102, 103, 124, 125, 127, 129, 134 Ammonia, 102, 114 Amputation, 4, 102 Anaesthesia, 46, 48, 50, 55, 57, 59, 62, 66, 102, 116 Anal, 11, 12, 30, 102, 119 Analgesic, 6, 18, 102, 116, 118, 120, 121 Anatomical, 10, 22, 33, 102, 116 Anemia, 58, 70, 102, 121 Anesthesia, 29, 48, 51, 54, 55, 63, 66, 77, 102, 109, 111 Anesthetics, 67, 102 Aneurysm, 48, 102 Animal model, 20, 21, 26, 29, 38, 42, 102 Ankle, 36, 102 Antibody, 102, 103, 107, 120, 132 Antigen, 102, 103, 107, 116, 120 Anti-inflammatory, 103, 110, 113, 116, 118 Antipyretic, 103, 118 Anus, 102, 103, 107 Anxiety, 4, 8, 10, 76, 103 Anxiolytic, 103, 123 Aponeurosis, 103, 113 Aqueous, 103
Arteries, 103, 104 Artery, 102, 103 Arthralgia, 31, 103 Arthrosis, 31, 103 Articular, 6, 19, 103, 118, 123 Ascites, 4, 103 Aspartic Acid, 103, 106 Asymptomatic, 33, 40, 103 B Back Injuries, 9, 27, 35, 90, 103 Bacteria, 103, 120, 130, 133, 134, 135 Bacterial Physiology, 101, 103 Basal Ganglia, 103, 113 Base, 22, 30, 103, 118, 133 Belching, 76, 103 Benign, 5, 42, 103, 113, 114, 122 Bilateral, 29, 104 Bile, 104, 113, 118, 132 Biochemical, 22, 102, 104, 123, 131 Biomechanics, 14, 15, 19, 39, 104 Biopsy, 104, 124 Biotechnology, 45, 78, 85, 104 Bladder, 3, 50, 99, 104, 109, 113, 116, 122, 129, 135 Blastocyst, 104, 125 Blind spot, 4, 104 Bloating, 104, 118 Blood Coagulation, 104, 105 Blood pressure, 32, 104, 116 Blood vessel, 104, 105, 115, 118, 124, 134, 135 Bone Marrow, 104, 121 Bone Remodeling, 6, 104 Bone Resorption, 104 Bone scan, 7, 105, 130 Bowel, 4, 99, 101, 102, 105, 117, 124, 133 Bypass, 105, 134 C Calcium, 63, 104, 105, 107 Capsules, 19, 105 Carbon Dioxide, 105, 125 Carcinogenic, 105, 117, 132 Cardiac, 105, 111, 112, 115, 132 Cardiorespiratory, 101, 105 Cardiovascular, 8, 32, 105, 131 Carpal Tunnel Syndrome, 30, 70, 105 Case report, 57, 60, 105, 106 Case series, 62, 105, 106
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Cauda Equina, 5, 105, 130 Caudal, 105, 125 Causal, 43, 105 Central Nervous System, 22, 105, 111, 113, 114, 121, 123, 131 Central Nervous System Infections, 105, 114 Cerebrospinal, 9, 105, 106, 119, 132 Cerebrospinal fluid, 9, 106, 119, 132 Cervical, 31, 34, 106, 120 Cervix, 106, 112 Character, 106, 109 Chemokines, 22, 106 Chemoprevention, 30, 106 Chest Pain, 4, 69, 106 Chiropractic, 5, 29, 34, 43, 44, 75, 106 Cholesterol, 104, 106, 132 Chromic, 22, 39, 106 Chromium, 106 Chromosome, 106, 118 Chronic, 4, 6, 7, 10, 11, 13, 14, 16, 17, 21, 29, 30, 32, 34, 38, 39, 41, 44, 46, 47, 52, 53, 55, 58, 66, 76, 103, 106, 107, 110, 119, 132 Chronic Disease, 39, 106, 107 Chronic Fatigue Syndrome, 76, 106 Chymopapain, 48, 106 Cisplatin, 106, 123 Claudication, 33, 106 Clinical study, 21, 65, 106, 108 Clinical trial, 5, 6, 8, 12, 30, 85, 106, 108, 111, 127, 128 Cloning, 104, 106 Cochlear, 107, 134, 135 Cochlear Diseases, 107, 134 Colitis, 107, 117, 118 Collagen, 15, 21, 28, 107, 115, 126 Collagen disease, 107, 115 Colon, 71, 107, 117, 118 Complement, 107 Complementary and alternative medicine, 7, 69, 70, 73, 107 Complementary medicine, 70, 107 Computational Biology, 85, 108 Computed tomography, 40, 108, 130 Computer Graphics, 44, 108 Computerized axial tomography, 108, 130 Computerized tomography, 108 Conduction, 33, 108 Confounding, 36, 43, 59, 108 Congestion, 4, 108 Congestive heart failure, 4, 108
Connective Tissue, 104, 107, 108, 113, 119, 122, 127, 129, 133 Consciousness, 102, 108, 110 Constipation, 108, 113, 118 Contraindications, ii, 4, 108 Contrast medium, 108, 122 Control group, 4, 26, 108, 127 Controlled clinical trial, 18, 108, 128 Controlled study, 44, 108 Conventional treatment, 16, 109 Coordination, 11, 23, 25, 43, 109 Cortex, 109, 112 Cortical, 13, 109 Cortisone, 109, 110 Cost Savings, 18, 109 Cranial, 109, 114, 117, 123, 135 Craniocerebral Trauma, 109, 114, 134 Curare, 109, 121 Curative, 109, 123, 133 Cutaneous, 42, 109 Cyclic, 20, 23, 109, 130 Cysteine, 106, 109 Cystitis, 3, 109 Cytokine, 22, 42, 109 Cytotoxic, 109, 123 Cytotoxic chemotherapy, 109, 123 D Data Collection, 21, 31, 109 Decidua, 109, 125 Decubitus, 40, 109 Degenerative, 8, 12, 15, 20, 22, 25, 31, 33, 34, 40, 42, 109, 123, 129 Delivery of Health Care, 109, 114 Dementia, 4, 109 Dendrites, 110, 122 Depressive Disorder, 41, 110 Dexamethasone, 55, 110 Dexterity, 4, 110 Diagnostic procedure, 78, 110 Dialyzer, 110, 115 Diarrhea, 110, 113, 118 Dietary Fiber, 76, 110 Diffusion, 110, 114, 135 Digestion, 102, 104, 105, 110, 117, 118, 133 Direct, iii, 18, 22, 110, 128, 133 Discrete, 104, 110, 133 Disease Progression, 110, 129 Dissection, 48, 110 Distal, 110, 111 Distention, 76, 110 Diverticula, 110 Diverticulitis, 4, 110
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Diverticulum, 110 Dizziness, 4, 110 Dorsal, 22, 38, 42, 110, 125, 132 Dorsum, 110, 113 Double-blind, 54, 61, 111 Drug Interactions, 111 Drug Tolerance, 111, 134 Duct, 111, 132 Duodenum, 104, 111, 133 Dysphoric, 110, 111 E Effector, 107, 111 Effector cell, 111 Efferent, 111, 121, 132 Efficacy, 11, 14, 18, 30, 41, 111 Elastin, 107, 111 Elective, 12, 30, 111 Electroacupuncture, 18, 111 Electrode, 21, 111 Electromyography, 45, 111 Electrons, 103, 111, 118, 127 Embryo, 104, 111, 116 Empirical, 8, 111 Endocarditis, 49, 64, 111 Endocardium, 111 Endogenous, 32, 42, 112 Environmental Health, 84, 86, 112 Enzymatic, 105, 107, 112 Enzyme, 111, 112, 133, 136 Epidemiological, 3, 24, 27, 112 Epidural, 54, 55, 57, 61, 77, 112, 132 Epidural block, 57, 61, 112 Erythrocytes, 102, 104, 112 Escalation, 6, 112 Esophagus, 112, 115, 133 Eukaryotic Cells, 112, 116 Evoke, 112, 133 Excitability, 42, 112 Exogenous, 42, 112 Extracellular, 108, 112, 120 Extracellular Space, 112, 120 Extremity, 16, 26, 30, 33, 112, 119, 130 F Family Planning, 85, 112 Fatigue, 14, 106, 112, 114 Fetus, 112, 125, 135 Fibrinolytic, 112, 134 Fibrinolytic Agents, 112, 134 Finite Element Analysis, 19, 112 Flexion, 7, 16, 33, 40, 112 Foramen, 112, 115, 124 Forearm, 104, 113, 120
Functional Disorders, 76, 113 Functional magnetic resonance imaging, 13, 113 Fundus, 112, 113 G Gallbladder, 101, 113 Ganglia, 38, 42, 113, 122, 132 Ganglion, 22, 38, 42, 46, 113, 123, 135 Gas, 102, 103, 105, 110, 113, 116, 118, 123 Gastric, 113, 115 Gastrin, 113, 115 Gene, 25, 28, 29, 102, 104, 113 Gene Expression, 25, 113 General practitioner, 66, 113 Gestation, 113, 125 Gland, 101, 109, 113, 119, 124, 133 Glomerular, 113, 129 Glucocorticoid, 110, 113, 115 Glutamic Acid, 113, 114, 123, 126 Glutamine, 28, 113 Glycoproteins, 114, 118 Glycosaminoglycans, 114, 127 Gonadal, 114, 132 Governing Board, 114, 126 Grade, 40, 114 Gynaecological, 49, 114 H Haemodialysis, 56, 114 Hair Cells, 114, 119 Headache, 4, 11, 31, 36, 46, 50, 51, 54, 57, 62, 66, 114, 126 Headache Disorders, 114 Health Care Costs, 12, 114 Health Expenditures, 114 Health Services, 18, 30, 109, 114 Health Status, 8, 114 Heart failure, 114 Heartburn, 76, 115 Hemodiafiltration, 115, 135 Hemodialysis, 4, 110, 115, 135 Hemofiltration, 115, 135 Hemoglobin, 102, 112, 115 Hemolytic, 115, 133 Hemorrhage, 109, 114, 115 Heredity, 113, 115 Herniated, 8, 12, 29, 42, 90, 115 Herpes, 70, 115 Herpes Zoster, 115 Homeostasis, 25, 104, 115 Homogeneous, 43, 115 Hormonal, 31, 115 Hormone, 70, 109, 113, 115, 126, 129, 130
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Hydration, 15, 115 Hydrocortisone, 53, 115 Hydrogen, 13, 103, 116, 121 Hydroxylysine, 107, 116 Hydroxyproline, 107, 116 Hyperalgesia, 13, 29, 43, 116 Hypersensitivity, 42, 116, 129 Hypertension, 116, 117 Hypertrophy, 33, 116 Hypnotic, 11, 116 I Ibuprofen, 116, 118 Idiopathic, 6, 23, 43, 116 Immune response, 103, 109, 116, 136 Immune system, 111, 116, 117, 119, 135 Immunosuppressive, 22, 113, 116 Immunosuppressive therapy, 22, 116 Impairment, 9, 16, 35, 36, 116 Impotence, 116, 132 In situ, 23, 116 In Situ Hybridization, 23, 116 In vitro, 20, 29, 116 In vivo, 20, 22, 23, 40, 43, 116, 120 Incision, 116, 117 Incontinence, 116, 132 Induction, 8, 116 Infections, 4, 70, 105, 117 Inflammation, 42, 69, 71, 103, 107, 109, 110, 115, 117, 125, 132 Inflammatory bowel disease, 4, 117 Infusion, 6, 117 Initiation, 30, 117 Innervation, 117, 120, 121, 125, 130, 134 Insight, 22, 23, 117 Insomnia, 56, 117, 126 Interleukin-1, 25, 117 Interleukin-2, 117 Intermittent, 42, 117, 119, 124 Internal Medicine, 29, 117, 129 Interstitial, 3, 112, 117, 129 Intervertebral, 12, 13, 15, 19, 20, 22, 28, 37, 40, 42, 115, 117, 119, 127, 130 Intervertebral Disk Displacement, 117, 119, 127, 130 Intestine, 105, 117, 128, 131, 133 Intracranial Hypertension, 114, 117, 134 Intramuscular, 21, 55, 117 Intravenous, 117 Invasive, 15, 26, 34, 40, 117, 119 Involuntary, 117, 128 Ion Channels, 29, 118 Ions, 103, 116, 118
Irritable Bowel Syndrome, 71, 76, 113, 118 Ischial, 37, 118 J Joint Capsule, 19, 118, 133 K Kb, 84, 118 Ketoprofen, 46, 118 Kidney stone, 70, 118 Kinetics, 22, 118 L Labile, 4, 107, 118 Labyrinth, 118, 126 Latency, 33, 118 Lesion, 118, 132 Ligament, 23, 118, 132 Ligation, 39, 118 Linkage, 6, 28, 118, 119 Linkage Disequilibrium, 28, 118 Liver, 101, 104, 113, 118, 130 Liver scan, 118, 130 Localized, 6, 101, 118, 125, 132 Lod, 28, 118, 119 Lod Score, 28, 119 Longitudinal study, 33, 119 Long-Term Care, 39, 119 Lumbar puncture, 62, 63, 119, 132 Lymph, 106, 119 Lymph node, 106, 119 Lymphocytes, 103, 117, 119 M Macrophage, 117, 119 Magnetic Resonance Imaging, 22, 25, 30, 34, 62, 119, 130 Malignant, 6, 59, 119, 121, 122 Malignant tumor, 119, 121 Malnutrition, 4, 119 Mechanoreceptors, 19, 114, 119, 121 Medial, 119, 129, 134 Median Nerve, 105, 119 Mediate, 119, 120 Mediator, 22, 117, 120, 131 Medical Records, 120, 129 MEDLINE, 85, 120 Membrane, 107, 110, 112, 114, 118, 120, 129, 133 Memory, 110, 120 Meninges, 105, 109, 120 Menstrual Cycle, 120, 126 Mental, iv, 5, 84, 86, 109, 112, 120, 123, 127, 135 Mental Health, iv, 5, 84, 86, 120, 123, 127 Mentors, 22, 120
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Meperidine, 55, 120 Metastasis, 120 Metastatic, 5, 6, 120 Metastatic cancer, 5, 6, 120 Microbiology, 101, 120 Microdialysis, 29, 120 Microorganism, 120, 136 Mobilization, 29, 121 Modeling, 15, 22, 31, 121 Modification, 121, 127 Molecular, 22, 29, 85, 87, 104, 108, 115, 121, 134 Molecule, 103, 107, 111, 121, 127, 128, 135 Monocytes, 117, 121 Morphine, 120, 121, 122 Morphology, 6, 121 Motility, 113, 121, 131 Motion Sickness, 121, 122 Motor nerve, 33, 121 Mucinous, 113, 121 Multiple Myeloma, 4, 121 Muscle Denervation, 33, 121 Muscle Fibers, 121 Muscle relaxant, 5, 121 Muscle Relaxation, 45, 121 Muscle Spindles, 44, 121 Muscle tension, 45, 121 Musculature, 7, 23, 122, 132 Musculoskeletal Diseases, 30, 122 Musculoskeletal System, 29, 122, 123 Myelography, 31, 34, 122 N Naloxone, 32, 122 Narcotic, 120, 121, 122 Nausea, 4, 122, 123, 126, 135 Neoplasm, 122, 132, 135 Nerve Endings, 122, 123 Nervous System, 19, 43, 101, 105, 114, 119, 120, 122 Neural, 38, 44, 101, 119, 122 Neurogenic, 33, 122 Neuroleptic, 122, 123 Neurologic, 5, 51, 122 Neuromuscular, 21, 25, 37, 122 Neuronal, 42, 122 Neurons, 19, 42, 110, 113, 121, 122, 132, 133, 135 Neuropathy, 122, 130 Neuropeptides, 9, 122 Neurophysiology, 23, 122 Neurotransmitter, 103, 113, 118, 122, 130 Niacin, 123, 135
Nitrogen, 114, 123, 135 Nociceptors, 19, 123 Nuclear, 103, 111, 112, 113, 123 Nuclei, 111, 119, 123, 135 Nucleic acid, 116, 123 Nucleus, 42, 109, 112, 117, 119, 121, 123, 127, 135 O Occupational Health, 9, 18, 36, 123 Occupational Health Services, 9, 18, 123 Odds Ratio, 123, 128 Ondansetron, 76, 123 Opiate, 121, 122, 123 Optic Nerve, 104, 123, 129 Orthopaedic, 20, 30, 123 Osteoarthritis, 90, 118, 123 Osteoporosis, 6, 49, 61, 104, 124 P Palliative, 124, 133 Pancreas, 101, 124 Particle, 124, 131, 134 Pathologic, 104, 116, 124, 129 Pathologies, 43, 124 Pathophysiology, 4, 13, 15, 124 Patient Education, 90, 94, 96, 100, 124 Patient Satisfaction, 7, 8, 124 Pediatrics, 62, 124 Peer Group, 31, 124 Pelvic, 4, 71, 90, 124 Pelvis, 37, 119, 124, 135 Peptide, 124, 125, 127 Perception, 9, 69, 124 Percutaneous, 18, 21, 26, 61, 124 Perfusion, 29, 124 Peritoneal, 4, 103, 124 Peritoneal Cavity, 103, 124 Peritoneal Dialysis, 4, 124 Peritoneum, 124 Peroneal Nerve, 125, 130 Phantom, 26, 125 Pharmacologic, 18, 102, 125, 134 Phenyl, 120, 125 Phosphorus, 105, 125 Physical Examination, 24, 33, 125 Physical Therapy, 17, 24, 25, 29, 35, 125 Physiologic, 10, 20, 39, 101, 120, 125, 128, 129 Physiology, 13, 45, 122, 125 Pilot study, 10, 16, 33, 34, 37, 38, 125 Placenta, 59, 125, 126 Plants, 103, 105, 121, 125, 129, 134 Plasma, 115, 121, 125
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Plasma cells, 121, 125 Plexus, 120, 125, 130 Pneumonia, 108, 125 Poisoning, 122, 125 Polypeptide, 107, 125 Polysaccharide, 103, 125, 127 Posterior, 42, 62, 102, 103, 110, 118, 124, 125, 130 Postmenopausal, 124, 126 Postoperative, 62, 120, 126 Postprandial, 76, 126 Postural, 24, 27, 61, 126 Potentiates, 117, 126 Practice Guidelines, 86, 126 Precursor, 111, 112, 126, 135 Premenstrual Syndrome, 71, 76, 126 Prevalence, 10, 23, 31, 52, 123, 126 Probe, 23, 120, 126 Progesterone, 126, 132 Progression, 5, 25, 102, 126 Progressive, 25, 32, 45, 110, 111, 112, 123, 126, 129, 135 Projection, 118, 123, 126 Proline, 107, 116, 126 Proprioception, 27, 126 Prospective study, 27, 39, 119, 126 Prosthesis, 13, 126 Protein S, 104, 126, 129 Proteins, 29, 102, 103, 107, 117, 121, 123, 124, 125, 127 Proteinuria, 4, 121, 127 Proteoglycan, 15, 127 Protocol, 11, 17, 18, 21, 30, 127 Psychic, 120, 127 Psychogenic, 54, 58, 62, 127 Puberty, 31, 127 Public Health, 27, 30, 86, 127 Public Policy, 85, 127 Pulmonary, 4, 104, 115, 127 Pulmonary Artery, 104, 127 Pulposus, 42, 117, 127 Q Quality of Life, 12, 18, 30, 127 R Race, 30, 35, 36, 127 Radiation, 125, 127, 130, 136 Radiculopathy, 21, 38, 127, 130 Radioactive, 105, 116, 118, 123, 127, 130 Radiological, 124, 127 Random Allocation, 127, 128 Randomization, 11, 128
Randomized, 11, 16, 18, 21, 27, 30, 32, 34, 38, 55, 111, 128 Randomized clinical trial, 16, 34, 38, 128 Randomized Controlled Trials, 11, 128 Receptor, 101, 103, 123, 128, 131 Recombinant, 29, 128, 135 Rectum, 103, 107, 113, 116, 117, 128 Recurrence, 32, 106, 128, 129 Refer, 1, 107, 110, 115, 122, 128, 134 Reflex, 13, 23, 27, 60, 121, 128 Regimen, 7, 111, 128 Registries, 31, 128 Regurgitation, 115, 128 Relative risk, 28, 128 Relaxant, 128 Reliability, 24, 31, 61, 129 Remission, 128, 129 Renal failure, 46, 115, 129 Renal pelvis, 118, 129 Reoperation, 31, 129 Resection, 121, 129 Resorption, 104, 129 Retina, 104, 123, 129 Retrospective, 63, 129 Retrospective study, 63, 129 Rheumatoid, 107, 118, 129 Rheumatoid arthritis, 107, 118, 129 Rheumatology, 58, 64, 129 Ribosome, 129, 134 Risk factor, 5, 9, 24, 27, 28, 31, 37, 126, 128, 129 Rod, 42, 129 S Sacroiliac Joint, 67, 129 Sagittal, 17, 40, 129 Saline, 29, 129 Saponins, 129, 132 Scans, 31, 34, 130 Scatter, 125, 130 Sciatic Nerve, 90, 125, 130, 134 Sciatica, 23, 28, 36, 42, 48, 53, 61, 63, 64, 65, 76, 90, 130 Scoliosis, 40, 130 Screening, 14, 106, 130 Second Messenger Systems, 130 Sedative, 11, 130 Sedentary, 10, 130 Segmental, 37, 40, 44, 130, 132 Segmentation, 130 Self Care, 101, 130 Senile, 124, 130 Sensibility, 102, 116, 130
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Sensory loss, 127, 130, 132 Sepsis, 68, 130 Serotonin, 123, 131, 135 Sex Characteristics, 101, 127, 131 Shock, 115, 131 Side effect, 101, 131, 134 Signs and Symptoms, 31, 129, 131 Skeletal, 109, 121, 131 Skeleton, 104, 131 Skull, 109, 131, 133 Small intestine, 111, 115, 117, 131 Social Environment, 127, 131 Social Security, 128, 131 Socioeconomic Factors, 30, 131 Soma, 131 Somatic, 32, 101, 131 Sound wave, 108, 131 Spasmodic, 101, 131 Spastic, 118, 131 Spatial disorientation, 110, 131 Specialist, 91, 131 Species, 109, 124, 127, 132, 135, 136 Specificity, 7, 26, 132 Spinal cord, 13, 24, 29, 59, 90, 105, 106, 112, 113, 120, 122, 127, 128, 130, 132 Spinal Cord Compression, 59, 132 Spinal Cord Injuries, 127, 132 Spinal Fractures, 132 Spinal Nerve Roots, 127, 130, 132 Spinal Stenosis, 5, 8, 12, 33, 40, 43, 90, 132 Spinal tap, 119, 132 Spondylitis, 6, 52, 67, 132 Spondylolisthesis, 8, 12, 40, 132 Sprains and Strains, 119, 132 Stabilization, 25, 132 Staging, 130, 132 Steel, 42, 132 Stenosis, 12, 33, 132, 133 Steroid, 55, 109, 129, 132 Stimulus, 13, 19, 32, 111, 117, 118, 128, 133, 134 Stomach, 70, 101, 103, 112, 113, 115, 122, 124, 131, 133 Stool, 76, 107, 116, 118, 133 Streptococci, 133 Streptokinase, 64, 133 Stress, 14, 19, 41, 42, 70, 77, 90, 99, 100, 113, 118, 122, 129, 133 Stricture, 132, 133 Subarachnoid, 114, 133 Subcutaneous, 46, 133 Suppression, 8, 133
Symptomatic, 21, 29, 33, 40, 133 Symptomatology, 39, 133 Synapses, 133 Synovial, 118, 133 Synovial Membrane, 118, 133 Systemic, 67, 104, 107, 117, 133 T Temporal, 31, 43, 114, 133 Tendon, 113, 133 Therapeutics, 60, 133 Thermal, 10, 133 Thigh, 37, 133 Thoracic, 37, 48, 103, 120, 133 Threshold, 20, 38, 112, 116, 133 Thrombolytic, 64, 133, 134 Thrombolytic Therapy, 64, 133, 134 Tibial Nerve, 130, 134 Tinnitus, 4, 134, 135 Tolerance, 28, 33, 134 Tomography, 134 Tooth Preparation, 101, 134 Topical, 67, 134 Toxic, iv, 18, 109, 122, 134 Toxicity, 111, 134 Toxicology, 86, 134 Toxin, 134 Transcutaneous, 21, 134 Transduction, 23, 134 Transfection, 104, 134 Translation, 44, 134 Transmitter, 118, 120, 133, 134 Transplantation, 4, 52, 56, 135 Triage, 5, 135 Tryptophan, 28, 107, 131, 135 Tumour, 113, 135 U Ultrafiltration, 4, 115, 135 Unconscious, 102, 135 Uremia, 129, 135 Ureters, 118, 135 Urinary, 70, 76, 109, 116, 135 Urine, 104, 116, 118, 127, 129, 135 Uterus, 106, 109, 112, 113, 126, 135 V Vaccine, 127, 135 Vascular, 4, 67, 114, 125, 135 Vector, 134, 135 Vein, 102, 117, 123, 135 Ventricles, 106, 135 Vertebrae, 6, 19, 20, 90, 117, 132, 135 Vertebral, 6, 26, 40, 44, 68, 132, 135 Vestibulocochlear Nerve, 134, 135
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Vestibulocochlear Nerve Diseases, 134, 135 Veterinary Medicine, 85, 136 Viral, 134, 136 Virus, 105, 134, 136 Viscera, 131, 136 Visual field, 104, 136
Vitro, 20, 136 Vivo, 20, 40, 136 W Withdrawal, 120, 136 X Xenograft, 102, 136 X-ray, 10, 37, 108, 122, 123, 130, 136
