Articles: back-pain.
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Case Reports
An Uncommon Cause of Acute Back Pain: Spinal Subarachnoid Hemorrhage Progressing to Spinal Cord Compression.
Spinal subarachnoid hemorrhage (SSH) is an uncommon occurrence responsible for <1% of all cases of subarachnoid hemorrhage (SAH). ⋯ We present the case of a 53-year-old man who presented to the emergency department (ED) with acute onset of "tearing" back pain that began during activity, and who was diagnosed with an SSH that ultimately progressed to spinal cord compression. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although uncommon, the consequences of SSH are potentially devastating, yet reversible, making awareness of this condition critical. Several rare yet potentially devastating causes of acute back pain are deserving of consideration when approaching back pain in the ED setting; SSH is among them. Pain that is described as "tearing" or that is unresponsive to ordinary analgesic dosages should prompt strong consideration of vascular or other serious pathology, including arterial dissection or spinal cord compression.
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A retrospective review ⋯ TLIF may induce uneven changes in foraminal morphometry. Cage position may be the major determinant of this result.
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Observational Study
Association of early imaging for back pain with clinical outcomes in older adults.
In contrast to the recommendations for younger adults, many guidelines allow for older adults with back pain to undergo imaging without waiting 4 to 6 weeks. However, early imaging may precipitate interventions that do not improve outcomes. ⋯ Among older adults with a new primary care visit for back pain, early imaging was not associated with better 1-year outcomes. The value of early diagnostic imaging in older adults for back pain without radiculopathy is uncertain.
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Bmc Musculoskel Dis · Mar 2015
Multicenter Study Observational StudyPsychological predictors of recovery from low back pain: a prospective study.
Recovery from low back pain (LBP) is an important outcome for patients and clinicians. Psychological factors are known to impact the course of LBP but have not been extensively investigated for predicting recovery. The purposes of this study were to: 1) describe LBP recovery rates at 6 months following 4 weeks of physical therapy; 2) identify psychological factors predictive of 6 month recovery status; and 3) identify psychological factors that co-occur with 6 month recovery status. ⋯ Our findings indicated that psychological risk status, depressive symptoms, and pain intensity were predictive of 6 month recovery status. Furthermore elevated fear-avoidance, kinesiophobia, and depressive symptoms co-occurred with non-recovery at 6 months. Future studies should investigate whether stratified psychologically informed treatment options have the potential to improve recovery rates for those most at risk for non-recovery.
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Pain as a consequence of nerve root compression may not be easy to diagnose. Degenerative changes causing nerve root compression on magnetic resonance imaging (MRI) are common but not necessarily symptomatic while the distribution of pain attributable to a particular nerve root is variable. Selective dorsal root ganglion blocks (DRGBs) have been used in these situations to aid the diagnostic process, although their use remains controversial. ⋯ In patients with diagnostic doubt, a positive DRGB is a good predictor of a positive outcome after surgery to decompress that nerve root. However, the negative predictive value is poor. This result could almost certainly be improved if there was a better definition of what constitutes a positive, and more importantly a negative, DRGB result. In the meantime, DRGBs are a useful adjunct in predicting the outcome of decompressive surgery in people with pain as a consequence of potential lumbosacral nerve root compression.