Twenty-first-century management of non-specific spinal pain: A narrative review of the paradigm shift in management of back and neck pain

@#Non-specific spinal pain is a leading cause of disability worldwide and traditional approaches to management have failed to address the societal burden of spinal pain. This narrative review describes the shift in approach to the management of non-specific spinal pain over the past two decades and outlines key recommendations in modern practice guidelines that are informed by these changes. Implementation of evidence-based practice for spinal pain remains a challenge.

Accelerometer-based facilitated walking program in addition to usual care for the management of patients with low back pain at medium or high risk of chronicity: a randomised controlled trial protocol

Background:The synergistic action of local anesthetics and morphine is well known, morphine probably more superior for postoperative analgesia, when compared to other opioids. Preservative-free morphine is now available in India making intrathecal administration possible. The present randomized double blind study was designed to evaluate the effect of adding preservative free morphine to hyperbaric bupivacaine given intrathecally for abdominal hysterectomy.Methods:Following approval by the institutional review board and institutional research grant committee, eighty patients presenting for elective abdominal hysterectomy were included in this randomized, double blind study. All drugs used for spinal anesthesia were autoclaved as per the departmental protocol. 3.5 ml of hyperbaric bupivacaine 0.5% [heavy] was given in both groups along with preservative free morphine accordingto study group.Results:27.5% (11/40) patients in group A, 17.5% (7/40) patients in group B received one dose of rescue analgesia (ketorolac 10 mg),during the 24 hours for pain relief while 29 patients is group A (72.5%) and 82.5% (33/40) patients in group B received 2 doses of rescue analgesia. 10% patients in Group A (4/40) and 10% patients in Group B (4/40) had a sedation score of 1(drowsy and arousable). Conclusions: The mean duration of analgesia in patients who received 250 μgms of intrathecal morphine was 18.725±1.38 hours while in patients who received 150 μgms it is 16.075±1.23 hours. We conclude that 250 μgms of preservative-free intrathecal morphine provides longer duration of analgesia when compared to 150 μgms morphine, with hardly any additional adverse effects.