Articles: back-pain.
-
Vertebral Fragility Fractures (VFF) are common and lead to pain, long term disability and increased mortality. Most patients will have mild to moderate pain symptoms and can be managed conservatively. However, patients with severe pain who have minimal or no pain relief with potent analgesia, or who only achieve adequate pain relief with high doses of morphine based analgesia which results in significant adverse events, should be considered for vertebral augmentation. ⋯ The Cardiovascular and Interventional Radiological Society of Europe (CIRSE) recommends Percutaneous Vertebroplasty as the first line surgical augmentation technique for VFF in older people, which has been shown to improve pain symptoms, allow early restoration of functional mobility and may reduce the risk of further vertebral collapse. CIRSE recommends percutaneous Balloon Kyphoplasty as second line treatment in VFF, although the optimal indication is for acute traumatic vertebral fractures (less than 7-10 days) in younger people. Assessment and treatment of underlying osteoporosis is important to reduce the risk of further fractures in older people with VFF.
-
Lumbar back pain and the high risk of chronic complaints is not only an important health concern in the general population but also in high performance athletes. In contrast to non-athletes, there is a lack of research into psychosocial risk factors in athletes. Moreover, the development of psychosocial screening questionnaires that would be qualified to detect athletes with a high risk of chronicity is in the early stages. The purpose of this review is to give an overview of research into psychosocial risk factors in both populations and to evaluate the performance of screening instruments in non-athletes. ⋯ Psychosocial risk factors of chronic back pain, such as chronic stress, depressive mood, and maladaptive pain processing are becoming increasingly more recognized in competitive sports. Screening instruments that have been shown to be predictive in the general population are currently being tested for suitability in the German MiSpEx research consortium.
-
Exposure therapy is an economical and promising psychological method for the treatment of chronic back pain, although little research has been done and its evidence needs further clarification. Exposure therapy has so far been little used in practice, which is partly due to the few published studies on this topic and partly to the uncertainty of the practitioners as to whether exposure therapy can be carried out without risk. Exposure therapy can be classified as a "tailored treatment" approach, in which patients with certain profiles (here: increased fear of movement) receive specific treatments. ⋯ Subsequently, possibilities for the identification of those patients suitable for exposure treatment are explained. The practical procedure is presented using a case study. The four randomized controlled trials available to date are described in detail and discussed.
-
The BackPEI questionnaire was developed and validated just exclusively to evaluate children. ⋯ The BackPEI-A is a reproducible, valid, and reliable instrument for use in the evaluation of back and neck pain and their associated risk factors. The instrument also facilitates the evaluation of postural habits in activities of daily living in adults.
-
Baastrup disease is a condition where spinous processes form painful pseudoarticulations. We present a patient with midline axial back pain consistent with Baastrup disease confirmed by computed tomography, which revealed degenerative changes along the opposing surfaces of the spinous processes at L1-2 and L2-3. ⋯ She underwent successful interspinous radiofrequency lesioning, which has not been previously described in the literature. At 4 months follow-up, she reported complete pain relief.