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Pain Management Clinic - Victoria Pain & Rehabilitation …

The nutrition of the disc is very precarious, requiring only a small reduction in the flow of nutrients to render it insufficient for the normal metabolism of the disc cells. Cigarette smoking can cause such a reduction because of its effect on the circulatory system outside the intervertebral disc. The transport of nutrients, such as oxygen, glucose or sulphate, into the disc is significantly reduced after only 20 to 30 minutes of smoking, which may explain the higher incidence of low-back pain in individuals who smoke compared to those who do not (Rydevik and Holm 1992).

The low-back pain in most people has mechanical causes, which include lumbosacral sprain/strain, degenerative disc disease, spondylolisthesis, spinal stenosis and fracture. Here only mechanical low-back pain is considered. Mechanical low-back pain is also called regional low-back pain, which may be local pain or pain radiating to one or both legs (sciatica). It is characteristic for mechanical low-back pain to occur episodically, and in most cases the natural course is favourable. In about half of acute cases low-back pain subsides in two weeks, and in about 90% within two months. About every tenth case is estimated to become chronic, and it is this group of low-back pain patients that accounts for the major proportion of the costs due to low-back disorders.

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Intervertebral Disc Disease (IVDD) - Fitzpatrick Referrals

Surgery with disc prosthesis versus rehabilitation in patients with low back pain and degenerative disc: two year follow-up of randomised study

The causes of thoracic back pain are multifactorial and often obscure. The symptoms in many cases arise from an overuse, an overstretching and/or usually mild ruptures of the soft tissues. There are, however, also many specific disorders that can lead to back pain, such as severe scoliosis (hunchback) or kyphosis of different aetiology, Morbus Sheuermann (osteochondritis of the thoracic spine, sometimes painful in adolescents but seldom in adults), and other deformities which may follow trauma or some neurologic and muscular diseases. Infection in the spine (spondylitis) is often localized to the thoracic region. Many kinds of microbes may cause spondylitis, such as tuberculosis. Thoracic back pain may occur in rheumatic diseases, especially in ankylosing spondylitis and in severe osteoporosis. Many other intraspinal, intrathoracal and intra-abdominal diseases, such as tumours, may also result in back symptoms. Generally, it is common that the pain may be felt in the thoracic spine (referred pain). Skeletal metastases of cancer from other sites are frequently localized to the thoracic spine; this is especially true of metastatic breast, kidney, lung and thyroid cancers. It is extremely rare for a thoracic disc to rupture, the incidence being 0.25 to 0.5% of all intervertebral disc ruptures.

In general, pre-employment selection of workers is not considered an appropriate measure for prevention of work-related low-back pain. History of previous back trouble, radiographs of the lumbar spine, general strength and fitness testing-none of these has shown good enough sensitivity and specificity in identifying persons with an increased risk for future low-back trouble. The use of these measures in pre-employment screening can lead to undue discrimination against certain groups of workers. There are, however, some special occupational groups (e.g., fire-fighters and police officers) in which pre-employment screening can be considered appropriate.

Spinal Surgery: Laminectomy and Fusion - Medical …

Height and overweight: Evidence for a relationship of low-back pain with body stature and overweight is contradictory. Evidence is, however, quite convincing for a relationship between sciatica or herniated disc and tallness. Tall people may have a nutritional disadvantage due to a greater disc volume, and they may also have ergonomic problems at the worksite.

Symptoms of spinal disc herniation appear as pain, weakness and numbness on the legs.

Interpretation of more recent imaging techniques in relation to disc pathology has not been completely established. For example, degenerated discs on magnetic resonance imaging (MRI) give an altered signal from that seen for "normal" discs. However, the correlation between a disc of "degenerate" appearance on MRI and clinical symptoms is poor, with 45% of MRI-degenerate discs being asymptomatic and 37% of patients with low-back pain having normal MRI of the spine.

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Dr. William Stevens, MD - Phoenix, AZ - Orthopedic …


Chronic Pain: Get the Facts on Management - MedicineNet

Degenerative disc disease: This is a term applied to an ill-defined group of patients who present with low-back pain. They may show changes in the x ray appearance, such as a decrease in disc height and possibly osteophyte formation at the rim of the vertebral bodies. This group of patients could represent the endstage of several pathological pathways. For example, untreated annular tears may eventually take on this form.

Medical CPB Periodic Reviews - Health Care …

The spinal cord terminates at the level of the highest lumbar vertebrae (L1-L2). The lumbar spinal canal is filled by the extension of the spinal cord, cauda equina, which is composed of the spinal nerve roots. The nerve roots exit the spinal canal pairwise through intervertebral openings (foramina). A branch innervating the tissues in the back departs from each of the spinal nerve roots. There are nerve endings transmitting pain sensations (nociceptive endings) in muscles, ligaments and joints. In a healthy intervertebral disc there are no such nerve endings except for the outermost parts of the annulus. Yet, the disc is considered the most important source of low-back pain. Annular ruptures are known to be painful. As a sequel of disc degeneration a herniation of the semigelatinous inner part of the intervertebral disc, the nucleus, can occur into the spinal canal and lead to compression and/or inflammation of a spinal nerve along with symptoms and signs of sciatica, as shown in .

Coverage Policy - BlueAdvantage Administrators of Arkansas



Anticipated CPB Review Date: June 8

0556 - Bio-Surgery: Medicinal Leech Therapy and Medical Maggots
0557 - Cancer Vaccines
0558 - Percutaneous Transluminal Septal Myocardial Ablation (PTSMA)
0559 - Pulsed Dye Laser Treatment
0560 - Voice Prosthesis for Voice Rehabilitation Following Total Laryngectomy
0561 - Celiac Disease Laboratory Testing
0562 - Biochemical Markers of Bone Remodeling
0563 - Retinopathy Telescreening Systems
0564 - Electrocochleogram and Perilymphatic Pressure Measurement
0565 - Ankle Orthoses, Ankle-Foot Orthoses (AFOs), and Knee-Ankle-Foot Orthoses (KAFOs)
0566 - Strabismus Repair in Adults
0567 - Actinic Keratoses Treatment
0568 - AngioJet Rheolytic Thrombectomy System
0569 - Lumbar Traction Devices
0570 - Chemotherapy Inpatient
0571 - Dehydration Testing for Endolymphatic Hydrops (Meniere's Disease)
0572 - Home/Ambulatory Spirometry
0574 - Female Sexual Dysfunction (FSD)
0575 - Intravenous Iron Therapy
0576 - Laminoplasty
0577 - Laser Treatment for Psoriasis and Other Selected Skin Conditions
0578 - Lower Limb Prostheses
0579 - T-Wave Alternans
0580 - Low Vision Programs
0581 - Lung Imaging Fluorescence Endoscopy (LIFE)
0582 - Titanium Rib
0583 - Eye Movement Desensitization and Reprocessing (EMDR) Therapy
0584 - Mammography
0585 - Cardioverter-Defibrillators
0586 - Heart Transplantation
0587 - Pancreas Kidney Transplantation
0588 - Capsule Endoscopy
0590 - Intensity Modulated Radiation Therapy
0591 - Intervertebral Disc Prostheses
0592 - Radiofrequency Ablation of Hypertrophied Nasal Turbinates
0593 - Aerosolized or Irrigated Anti-infectives for Sinusitis
0594 - Visudyne (Verteporfin) Photodynamic Therapy
0595 - Kineret (Anakinra)
0596 - Liver Transplantation
0597 - Heart-Lung Transplant

Providers - BlueAdvantage Administrators of Arkansas

The prevalence estimates of low-back pain vary depending on the definitions used in different surveys. The prevalence rates of low-back pain syndromes in the Finnish general population over 30 years of age are given in . Three in four people have experienced low-back pain (and one in three, sciatic pain) during their lifetime. Every month one in five people suffers from low-back or sciatic pain, and at any point in time, one in six people has a clinically verifiable low-back pain syndrome. Sciatica or herniated intervertebral disc is less prevalent and afflicts 4% of the population. About half of those with a low-back pain syndrome have functional impairment, and the impairment is severe in 5%. Sciatica is more common among men than among women, but other low-back disorders are equally common. Low-back pain is relatively uncommon before the age of 20, but then there is a steady increase in the prevalence until the age of 65, after which there is a decline.

Attorneys for CIGNA Disability Claims



Anticipated CPB Review Date: February 23

0208 - Deep Brain Stimulation
0210 - Phonophoresis
0211 - Abdominoplasty, Suction Lipectomy, and Ventral Hernia Repair
0212 - Skeletal Analysis Systems
0213 - Gastroesophageal Reflux Disease (GERD): Treatment Devices
0214 - Cognitive Rehabilitation
0215 - Lyme Disease and other Tick-Borne Diseases
0218 - Home Health Aides
0220 - Distraction Osteosynthesis
0221 - Quantitative EEG (Brain Mapping)
0223 - Urinary Incontinence Treatments
0225 - Maze Procedure
0226 - Hospitalization for the Initiation of Ketogenic Diet for the Treatment of Intractable Seizures
0227 - BRCA Testing, Prophylactic Mastectomy, and Prophylactic Oophorectomy
0228 - Cardiac CT, Coronary CT Angiography and Calcium Scoring
0229 - Iontophoresis
0231 - Grenz Ray Therapy for Skin Disorders
0232 - Back Pain - Non Invasive Treatments
0234 - Chelation Therapy
0235 - Plantar Fasciitis Treatments
0236 - Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) of the Spine
0237 - Chronic Pain Programs
0238 - Chronic Vertigo
0240 - Antineoplaston Therapy and Sodium Phenylbutyrate
0241 - Extracorporeal Photochemotherapy (Photopheresis)
0243 - Speech Therapy
0244 - Wound Care
0245 - Tumor Chemosensitivity Assays
0247 - Autologous Chondrocyte Implantation
0248 - Fiberoptic Endoscopic Evaluation of Swallowing (FEES)/Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST)
0249 - Inflammatory Bowel Disease: Serologic Markers and Pharmacogenomic and Metabolic Assessment of Thiopurine Therapy
0250 - Occupational Therapy Services
0251 - Dermabrasion, Chemical Peels, and Acne Surgery
0253 - Vocal Cord Paralysis/Insufficiency Treatments
0255 - Inpatient Admission Prior to Surgery (Preop Days)
0256 - Sensory and Auditory Integration Therapy
0259 - Transjugular Intrahepatic Portosystemic Shunt (TIPSS)
0262 - External Counterpulsation (ECP)
0263 - Gait Analysis and Electrodynogram
0264 - Multiple Sclerosis

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