Articles: back-pain.
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Individuals with nonspecific low back pain (NSLBP) show an impaired sensorimotor control. They need significantly more time to perform five consecutive sit-to-stand-to-sit (STSTS) movements compared with healthy controls. Optimal sensorimotor control depends on the coactivation of many brain regions, which have to operate as a coordinated network to achieve correct motor output. ⋯ However, local efficiency was significantly decreased in the patients with NSLBP compared with controls (p < 0.05, false discovery rate [FDR] corrected). Moreover, global efficiency was significantly correlated with the sensorimotor task performance within the NSLBP group (r = -0.73, p = 0.002). Our data show disrupted network organization of white matter networks in patients with NSLBP, which may contribute to their persistent pain and sensorimotor disabilities.
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Piriformis syndrome is an uncommon cause of buttock and leg pain. Some treatment options include the injection of piriformis muscle with local anesthetic and steroids. Various techniques for piriformis muscle injection have been described. ⋯ All 5 patients have improved their pain measured by numeric verbal scale. One patient had a sciatic after injection that improved in 10 days spontaneously. We describe an ultrasound-guided piriformis muscle injection that has the advantages of being effective, simple, and safe.
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Controlled Clinical Trial
Diagnosis of Neuropathic Components in Patients with Back Pain Before and After Surgery.
Background: The perception of back pain subjective is hard for physicians to measure. For this reason, questionnaires are an important instrument to evaluate the pain 1. The main point of this study was to verify differentiation of pain symptoms in patients with different pain mechanisms. ⋯ Conclusion: The preoperative pain characteristics of patients with vertebral compression fracture is different from those of patients with herniated disc or with spinal cord compression. 43 % of patients in group 2 exhibited a neuropathic pain component and in 30 % this could not be excluded. In contrast, in group 1 only 3 % of the patients exhibited a neuropathic pain component. Postoperatively, pain symptoms were significant reduced in both groups, so that the risk of chronic pain was considerably less.
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A 40-year-old woman consulted our ED for a 7-month history of left dorsal back pain and dyspnea. The pain was initially dull and mechanical. Her general practitioner started nonsteroidal antiinflammatory drugs and physiotherapy, which provided partial relief. ⋯ The patient was a healthy woman who lived in an urban area of Barcelona, Spain. She did not smoke or take drugs of abuse, and she worked as a butcher. During the initial evaluation, her blood pressure was 131/76 mm Hg, heart rate was 120 beats/min, temperature was 36.2°C, and ambient air pulse oximetry was 98%.
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The culture of current clinical practice calls for collaboration between therapists and patients, sharing power and responsibility. This paper reports on the findings of a qualitative study of exercise prescription for patients with NSCLBP, taking into account issues such as decision making and how this accords with patient preferences and experiences. ⋯ Shared decision making did not appear to happen in physiotherapy clinical practice, but equally may not be what every patient wants. The overall feeling of the patients was that the therapist was dominant in structuring the interactions, leaving the patients feeling disempowered to question and contribute to the decision making.