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Acevedo-González JC, Taub-Krivoy A. Tension Distension Sign (Acevedo's Sign) for the Diagnosis of Lumbar Facet Syndrome: Technical Note. World Neurosurg 2023; 179:167-170. [PMID: 37648199 DOI: 10.1016/j.wneu.2023.08.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
The treatment of low back pain has evolved from an understanding of its pathophysiology, biomechanics, and therapy. The events that characterize the degenerative cascade of modifications that produce pain are well described. Facet joints are early affected when there is a loss of intervertebral disc height and may present biomechanical overload that translates into pain. Clinical diagnosis of lumbar facet syndrome is not straightforward because there are no specific features other than pain triggered by hyperextension + forced rotation of the lumbar spine in a standing position to suspect it. This implies that its diagnostic confirmation depends on bone scintigraphy and selective anesthetic blockade of the dorsal and medial branches of the joint. In this technical note, we present a new clinical sign (Tension Distension Signo sign/Acevedo's sign) described since 2004.
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Affiliation(s)
- Juan Carlos Acevedo-González
- Neurosurgeon Specialized in Functional Neurosurgery, Pain Management and Spasticity, Pontifical Xaverian University, Hospital Universitario San Ignacio, Bogotá, Colombia.
| | - Alex Taub-Krivoy
- Neuroscience and Neurosurgery Department, Pontifical Xaverian University, Hospital Universitario San Ignacio, Bogotá, Colombia
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Li AH, Gulati A, Leong MS, Aggarwal AK, Salmasi V, Spinner D, Ottestad E. Considerations in Permanent Implantation of Peripheral Nerve Stimulation (PNS) for Chronic Neuropathic Pain: An International Cross Sectional Survey of Implanters. Pain Pract 2022; 22:508-515. [PMID: 35178863 DOI: 10.1111/papr.13105] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/11/2022] [Accepted: 02/14/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Novel minimally invasive short-term and long-term peripheral nerve stimulation (PNS) systems have revolutionized targeted treatment of chronic neuropathic pain. We present an international survey of PNS-implanting pain physicians to assess what factors they consider when offering permanent PNS. METHODS This cross-sectional study consisted of a survey (Qualtrics) that was distributed to PNS-implanting physicians in a device supplier's entire email database on November 13, 2020, with 3 weeks of response time. Physicians' contact information in the form of their email addresses had been previously collected by the supplier upon device distribution with permission to use survey responses for research. RESULTS Of 2,032 database physicians, 40 physicians representing 37 institutions responded to the survey. The most common application of PNS was mononeuropathic pain (57%). The most frequently targeted nerve was the suprascapular nerve (29%). 14% of physicians reported 81-100% of their implants were dual-lead. The representative physicians ranged broadly in their most frequently-targeted nerves. Although mononeuropathic pain was the most common indication for PNS, there was still varied response regarding other indications such as CRPS and post-surgical chronic pain. CONCLUSION In context of a low response rate, identifying such factors can help update the prevailing treatment algorithm for interventional therapies, assist pain physicians in better identifying which patients are the best candidates for PNS, and inform future clinical trial design on PNS efficacy.
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Affiliation(s)
- Alice H Li
- Department of Anesthesiology Perioperative and Pain Medicine, Stanford Stanford, CA, USA
| | - Amitabh Gulati
- Department of Chronic Pain, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - Michael S Leong
- Department of Anesthesiology Perioperative and Pain Medicine, Stanford Stanford, CA, USA
| | - Anuj K Aggarwal
- Department of Anesthesiology Perioperative and Pain Medicine, Stanford Stanford, CA, USA
| | - Vafi Salmasi
- Department of Anesthesiology Perioperative and Pain Medicine, Stanford Stanford, CA, USA
| | - David Spinner
- Department of Rehabilitation and Human Performance, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
| | - Einar Ottestad
- Department of Anesthesiology Perioperative and Pain Medicine, Stanford Stanford, CA, USA
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van der Molen HF, Visser S, Alfonso JH, Curti S, Mattioli S, Rempel D, Roquelaure Y, Kuijer PPFM, Tamminga SJ. Diagnostic criteria for musculoskeletal disorders for use in occupational healthcare or research: a scoping review of consensus- and synthesised-based case definitions. BMC Musculoskelet Disord 2021; 22:169. [PMID: 33573616 PMCID: PMC7879660 DOI: 10.1186/s12891-021-04031-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/28/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The aim of this study was to identify case definitions of diagnostic criteria for specific musculoskeletal disorders (MSDs) for use in occupational healthcare, surveillance or research. METHODS A scoping review was performed in Medline and Web of Science from 2000 to 2020 by an international team of researchers and clinicians, using the Arksey and O'Malley framework to identify case definitions based on expert consensus or a synthesis of the literature. Seven MSDs were considered: non-specific low back pain (LBP), lumbosacral radicular syndrome (LRS), subacromial pain syndrome (SAPS), carpal tunnel syndrome (CTS), lateral or medial elbow tendinopathy, and knee and hip osteoarthritis (OA). Case definitions for occupational healthcare or research were charted according to symptoms, signs and instrumental assessment of signs, and if reported, on work-related exposure criteria. RESULTS In total, 2404 studies were identified of which 39 were included. Fifteen studies (38%) reported on non-specific LBP, followed by knee OA (n = 8;21%) and CTS (n = 8;21%). For non-specific LBP, studies agreed in general on which symptoms (i.e., pain in lower back) and signs (i.e., absence of red flags) constituted a case definition while for the other MSDs considerable heterogeneity was found. Only two studies (5%), describing case definitions for LBP, CTS, and SAPS and lateral and medial elbow tendinopathy respectively, included work-related exposure criteria in their clinical assessment. CONCLUSION We found that studies on non-specific LBP agreed in general on which symptoms and signs constitute a case definition, while considerable heterogeneity was found for the other MSDs. For prevention of work-related MSDs, these MSD case definitions should preferably include work-related exposure criteria.
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Affiliation(s)
- Henk F van der Molen
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Steven Visser
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jose Hernán Alfonso
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Stefania Curti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Stefano Mattioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - David Rempel
- Division of Occupational and Environmental Medicine, University of California, San Francisco, USA
| | - Yves Roquelaure
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, F-49000, Angers, France
| | - P Paul F M Kuijer
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Sietske J Tamminga
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
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Lyu F, Zheng C, Wang H, Nie C, Ma X, Xia X, Zhu W, Jin X, Hu Y, Sun Y, Zhu Y, Kuwabara S, Cortese R, Maqbool Hassan K, Takai K, Paredes I, Webere R, Turk M, Kimura J, Jiang J. Establishment of a clinician-led guideline on the diagnosis and treatment of Hirayama disease using a modified Delphi technique. Clin Neurophysiol 2020; 131:1311-1319. [DOI: 10.1016/j.clinph.2020.02.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/21/2020] [Accepted: 02/11/2020] [Indexed: 11/27/2022]
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Ferrer-Peña R, Muñoz-García D, Calvo-Lobo C, Fernández-Carnero J. Pain Expansion and Severity Reflect Central Sensitization in Primary Care Patients with Greater Trochanteric Pain Syndrome. PAIN MEDICINE 2020; 20:961-970. [PMID: 30312451 DOI: 10.1093/pm/pny199] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aims of this study were twofold: 1) to evaluate the differences in pain sensitivity of patients with greater trochanteric pain syndrome (GTPS) and 2) to examine the association between pain expansion, pain severity, and pain-related central sensitization somatosensory variables in patients with GTPS. STUDY DESIGN A cross-sectional study. SETTING Primary health care centers. SUBJECTS The sample consisted of 49 participants with a mean age of 48.28 ± 8.13 years and included eight males (16.3%) and 41 females (83.7%). METHODS Conditioned pain modulation (CPM), pain location, temporal summation, pressure pain detection threshold (PPDT), and pain intensity were recorded. Pain severity was determined with the Graded Chronic Pain Scale (GCPS). RESULTS Several participants (34.7%) showed a negative conditioned pain modulation and a statistically significant negative moderate correlation (P < 0.05; r = -0.316) between conditioned pain modulation and right view percentage of pain location. Temporal summation at the major trochanter showed a statistically significant low negative correlation (P < 0.05; r = -0.298). The GCPS exhibited a statistically significant moderately positive correlation (P < 0.01; r = 0.467) with the PPDT at the trochanter and a significant correlation with the postero-superior iliac spine (P < 0.01; r = 0.515) and epicondyle (P < 0.01; r = 0.566). CONCLUSIONS Patients with GTPS presented altered CPM, a relationship with more pain areas associated with negative CPM, and a positive association between pain severity and mechanical hyperalgesia at remote sites. Thus, physicians could apply these outcome measurements to assess primary care patients with GTPS and determine the central sensitization presence to prescribe adequate multimodal treatment approaches.
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Affiliation(s)
- Raúl Ferrer-Peña
- Physical Therapy Department, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Salud Entrevías, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain.,Universidad Rey Juan Carlos, Escuela internacional de doctorado, Madrid, Spain
| | - Daniel Muñoz-García
- Physical Therapy Department, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - César Calvo-Lobo
- Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Universidad de León, Ponferrada, León, Spain
| | - Josué Fernández-Carnero
- Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain.,Hospital La Paz Institute for Health Research, IdiPAz, Madrid, Spain
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The Impact of Chronic Discogenic Low Back Pain: Costs and Patients' Burden. Pain Res Manag 2018; 2018:4696180. [PMID: 30364097 PMCID: PMC6188764 DOI: 10.1155/2018/4696180] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/12/2018] [Indexed: 12/31/2022]
Abstract
Introduction Chronic discogenic low back pain (CDP) is frequently diagnosed in patients referred to specialized pain clinics for their back pain. The aim of this study is to assess the impact of CDP both on the individual patient and on society. Materials and Methods Using the baseline records of 80 patients in a randomized trial assessing the effectiveness of a new intervention for CDP, healthcare and societal costs related to back pain are calculated. Furthermore, the impact of the condition on perceived pain, disability, health-related quality of life, Quality of life Adjusted Life Years (QALY), and QALY loss is assessed. Results Using the friction costs approach, we found that the annual costs for society are €7,911.95 per CDP patient, 51% healthcare and 49% societal costs. When using the human capital approach, total costs were €18,940.58, 22% healthcare and 78% societal costs. Healthcare costs were mainly related to pain treatment. Mean pain severity was 6.5 (0-10), and 46% suffered from severe pain (≥7/10). Mean physical limitations rate was 43.7; 13.5% of the patients were very limited to disabled. QALY loss compared to a healthy population was 64%. Discussion This study shows that in patients with CDP referred to a pain clinic, costs for society are high and the most used healthcare resources are pain therapies. Patients suffer severe pain, are physically limited, and experience a serious loss in quality of life.
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Gómez Vega JC, Acevedo-González JC. Clinical diagnosis scale for pain lumbar of facet origin: systematic review of literature and pilot study. Neurocirugia (Astur) 2018; 30:133-143. [PMID: 29910103 DOI: 10.1016/j.neucir.2018.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/07/2018] [Accepted: 05/08/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Lumbar pain affects between 60-90% of people. It is a frequent cause of disability in adults. Pain may be generated by different anatomical structures such as the facet joint. However, nowadays pain produced by the facet joint has no clinical diagnosis. Therefore, the purpose of this article is to propose a clinical diagnostic scale for lumbar facet syndrome. MATERIALS AND METHODS The study was conducted by means of 6 phases as follows, Phase 1, a systematic review of the literature was performed regarding the clinical diagnosis of facet-based lumbar pain based on the PRISMA checklist; Phase 2, a list of signs and symptoms proposed for diagnosis lumbar pain of facet origin was made. Phase 3, the list of signs and symptoms found was submitted to a committee of experts to discriminate the most significant signs and symptoms, these were linked to general sociodemographic variables to develop an evaluation questionnaire; Phase 4, the evaluation questionnaire was applied, including those selected signs and symptoms to a group of patients with clinical diagnosis of facet disease lumbar pain and who underwent a selective facet block. Phase 5, under standard technique selective facet block and subsequent postoperative clinical control at 1 month. Phase 6, given pre and postsurgical results associated with signs present in the patients we propose a clinical scale of diagnosis scale. Descriptive statistics and Stata 12.0 were used as statistical software. RESULTS A total of 36 signs and symptoms were found for the diagnosis of lumbar facet syndrome that were submitted to the group of experts, where a total of 12 (8 symptoms and 4 signs) were included for the final survey. 31 patients underwent selective lumbar facet blockade, mostly women, with an average of 60±11.5 years, analogous visual scale of preoperative pain of 8/10, postoperative of 1.7/10, the signs and symptoms most frequently found included in a diagnostic scale were: 3 symptoms 1) axial or bilateral axial lumbar pain, 2) improvement with rest, 3) absence of root pattern, may have pseudoradicular pattern, however, the pain is greater lumbar than pain in the leg and 3 clinical signs 1) Kemp sign, 2) pain induced in joint or transverse process, 3) facet stress sign or Acevedo sign. CONCLUSION The clinical diagnosis of lumbar facet pain is still debated. Few diagnostic scales have been postulated, with little or no external validity, so the present study proposes a diagnostic scale consisting of 3 symptoms and 3 clinical signs.
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Affiliation(s)
- Juan Carlos Gómez Vega
- Departamento de Neurociencias, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - Juan Carlos Acevedo-González
- Departamento de Neurociencias, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
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Clinical classification criteria for nonspecific low back pain: A Delphi-survey of clinical experts. Musculoskelet Sci Pract 2018; 34:66-76. [PMID: 29367122 DOI: 10.1016/j.msksp.2018.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/14/2017] [Accepted: 01/05/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Nonspecific low back pain (NSLBP) is a common problem. Attempts have been made to classify NSLBP patients into homogenous subgroups. Classification systems based on identifying the underlying mechanism(s) driving the disorder are clinically useful to guide specific interventions. OBJECTIVE To establish consensus among experts regarding clinical criteria suggestive of a dominance of 'articular', 'myofascial', 'neural', 'central', and 'sensorimotor control' dysfunction patterns (DPs) in NSLBP patients. STUDY DESIGN A 2-phase sequential design of a focus group and Delphi-study. METHODS A focus group with 10 academic experts was organized to elaborate on the different DPs discernible in LBP patients. Consecutively, a 3-round online Delphi-survey was designed to obtain consensual symptoms and physical examination findings for the 5 DPs resulting from the focus group. RESULTS Fifteen musculoskeletal physical therapists from Belgium and the Netherlands experienced in assessing and treating LBP patients completed the Delphi-survey. Respectively, 34 (response rate, 100.0%), 20 (58.8%) and 15 (44.12%) respondents replied to rounds 1, 2 and 3. Twenty-two 'articular', 20 'myofascial', 21 'neural', 18 'central' and 11 'sensorimotor control' criteria reached a predefined ≥80% consensus level. For example, after round 2, 85.0% of the Delphi-experts agreed to identify 'referred pain below the knee' as a subjective examination criterion suggestive for a predominant 'neural DP'. CONCLUSION These indicators suggestive of a clinical dominance of the proposed DPs could help clinicians to assess and diagnose NSLBP patients. Future reliability and validity testing is needed to determine how these criteria may help to improve physical therapy outcome for NSLBP patients.
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Berjano P, Villafañe JH, Vanacker G, Cecchinato R, Ismael M, Gunzburg R, Marruzzo D, Lamartina C. The effect of case-based discussion of topics with experts on learners' opinions: implications for spinal education and training. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:2-7. [PMID: 29255928 DOI: 10.1007/s00586-017-5418-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 10/11/2016] [Accepted: 11/01/2016] [Indexed: 10/18/2022]
Abstract
PURPOSE This investigation aimed to examine the extent to which case-based discussion with experts could influence the audience's opinions on the treatment of patients during a continuing medical education event for spine surgeons. METHODS We conducted a prospective controlled crossover study of 90 surgeons. During a continuing medical education activity using case-based discussion, quiz questions were used which asked participants (attendants and faculty group) their opinions on the best choices about diagnosis and treatment in a number of cases. No answer was considered correct, but we evaluated the number of participants choosing each specific answer among a number of valid options. Quiz questions were collected with an automated response system at the entry and at the end of each case discussion. Change in participant's opinions was estimated from the change in the preferred answers between the entry and exit quizzes. Chi-square analysis was performed to determine significance. RESULTS Sixty-two attendants out of eighty three (75%) and six faculties out of twelve (50%) responded to the survey. After the case discussion, 68.2% (p < 0.04, Chi-square test) of the attendants changed their opinion on the appropriate treatment. The faculty answers, however, showed no significant change in opinions regarding the identification of the appropriate treatment. CONCLUSIONS On the basis of our results, case-based discussion driven by experts, as a form of teaching, has a measurable effect in terms of changes in the learners' opinions.
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Affiliation(s)
| | | | | | | | | | | | - Daniele Marruzzo
- Department of Neurosurgery, San Cammilo-Forlanini Hospital, Rome, Italy
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Berjano P, Villafañe JH, Vanacker G, Cecchinato R, Ismael M, Gunzburg R, Marruzzo D, Lamartina C. The effect of case-based discussion of topics with experts on learners' opinions: implications for spinal education and training. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:2660-2665. [PMID: 27844232 DOI: 10.1007/s00586-016-4860-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 10/11/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE This investigation aimed to examine the extent to which case-based discussion with experts could influence the audience's opinions on the treatment of patients during a continuing medical education event for spine surgeons. METHODS We conducted a prospective controlled crossover study of 90 surgeons. During a continuing medical education activity using case-based discussion, quiz questions were used which asked participants (attendants and faculty group) their opinions on the best choices about diagnosis and treatment in a number of cases. No answer was considered correct, but we evaluated the number of participants choosing each specific answer among a number of valid options. Quiz questions were collected with an automated response system at the entry and at the end of each case discussion. Change in participant's opinions was estimated from the change in the preferred answers between the entry and exit quizzes. Chi-square analysis was performed to determine significance. RESULTS Sixty-two attendants out of eighty three (75%) and six faculties out of twelve (50%) responded to the survey. After the case discussion, 68.2% (p < 0.04, Chi-square test) of the attendants changed their opinion on the appropriate treatment. The faculty answers, however, showed no significant change in opinions regarding the identification of the appropriate treatment. CONCLUSIONS On the basis of our results, case-based discussion driven by experts, as a form of teaching, has a measurable effect in terms of changes in the learners' opinions.
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Affiliation(s)
| | | | | | | | | | | | - Daniele Marruzzo
- Department of Neurosurgery, San Cammilo-Forlanini Hospital, Rome, Italy
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Geurts JW. Classification and management of low back pain: Is this the right direction? Eur J Pain 2015; 19:293-4. [DOI: 10.1002/ejp.647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 11/10/2022]
Affiliation(s)
- José W. Geurts
- Department of Anaesthesiology and Pain Medicine Maastricht University Medical Centre Maastricht The Netherlands
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