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The divorce was finalized in 1996."When my daughter was born things kind of took a turn for the worst," she said.Ms. Winne's daughter, now 13, had been in contact with Mr. Diab over the phone and online until about two weeks before "this whole episode" took place, she said."Things came out online maybe a week after I was spoken to," Ms.
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Low back pain has been the leading cause of years lost to disability over the past several decades,1 with a lifetime prevalence that ranges between 50% and 90%.2 3 The economic cost is estimated to exceed $100bn a year in the United States (67bn, 93bn), over half of which can be attributed to lost productivity.3 4 Efforts to deal with the worldwide burden posed by low back pain have become an international priority.The classification of back pain is perhaps the most important distinction for clinicians to make as it influences investigation and treatment decisions at all levels of care.5 Since the development of validated instruments to categorize low back pain,6 7 studies have determined that the proportion of chronic cases that are predominantly neuropathic (that is, sciatica, radicular pain from a herniated disc, or neurogenic claudication from spinal stenosis) ranges between 17% and 55%,7 8 9 10 11 with one review finding a median prevalence rate of 41%.12 Whereas the presence of neuropathic symptoms portends a more negative prognosis for acute episodes,13 lumbosacral radicular pain might be more responsive to procedural interventions than non specific back pain.12 14Epidural steroid injections are the most commonly performed procedure for pain relief in the world,15 being more commonly used and more effective for radicular pain than mechanical spine pain.12 16 Although mixed, most controlled studies have also found pharmacotherapy with gabapentinoids can be effective for lumbosacral radicular pain.17 18 19 20 21Numerous controlled trials have been performed to evaluate epidural steroid injections and drug treatment in people with low back pain, with review articles generally reporting modest effects.12 22 Yet for clinicians, the more relevant question is not whether a real treatment is better than a sham treatment, but which treatment is more effective.23Several small randomized open label studies have looked at epidural steroid injections compared with drug treatment. One study showed superiority for a single epidural steroid injection at one month but not later follow up compared with tramadol and a muscle relaxant.24 A second study showed that a single caudal epidural steroid injection provided better pain relief than non steroidal anti inflammatory drugs through three months.25 Neither study evaluated first line adjuvant treatments (such as gabapentin) as a comparison group. A more recent three armed multicenter study was performed in 169 patients with cervical radiculopathy.
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