Articles: low-back-pain.
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Spondylolysis in the athletic adolescent and preadolescent is common enough that primary care practitioners should be familiar with its frequency and its progression from pars interarticularis stress fracture to spondylolysis and to spondylolisthesis. One-half of all pediatric back pain in athletic patients is related to disturbances of the posterior elements including spondylolysis, which presents as low back pain aggravated by activity, frequently with minimal physical findings. Failure to suspect, hence to diagnosis, a pars stress fracture or early spondylolysis is common and a misdiagnosis of lumbosacral strain is often made. ⋯ We present three adolescent and preadolescent athletes with low back pain in whom a high index of suspicion led to the early diagnosis of pars stress fracture or spondylolysis. All three had different stages of spondylolysis, and one illustrates the clinical utility of the one-legged hyperextension test. The ease with which early disease may be treated further supports efforts by primary care practitioners to suspect and diagnose pars stress fracture and early spondylolysis.
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Arch Phys Med Rehabil · May 1998
Randomized Controlled Trial Clinical TrialCombined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial.
To assess the effect of a combined exercise and motivation program on the compliance and level of disability of patients with chronic and recurrent low back pain. ⋯ The combined exercise and motivation program increased the rate of attendance at scheduled physical therapy sessions, ie, short-term compliance, and reduced disability and pain levels by the 12-month follow-up. However, there was no difference between the motivation and control groups with regard to long-term exercise compliance.
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Disregarding pain resulting from vitamin deficiency, an analgesic effect seems to be exerted only by vitamin B1 (thiamine), vitamin B6 (pyridoxines), and vitamin B12 (cobalamine), particularly when the three are given in combination. The analgesic effect is attributed to an increased availability and/or effectiveness of noradrenaline and 5-hydroxytryptamine acting as inhibitory transmitters in the nociceptive system. In animal experiments, high doses of these vitamins administered alone or in combination inhibited nociceptive behavior and depressed the nociceptive activity evoked in single neurons of the dorsal horn of the spinal cord and in the thalamus. ⋯ The use of high doses of vitamin B6 may be limited by a neurotoxic effect. The effectiveness of B vitamins in depressing chronic pain has not been established. It would be interesting to know if the B vitamins are of use as adjuvants in the treatment of tumor pain.
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J. Clin. Gastroenterol. · Apr 1998
Letter Case ReportsPseudomembranous colitis induced by diclofenac.
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A survey of a random sample of 1002 members of the Royal Canadian Mounted Police to determine their experience with low back pain. ⋯ The prevalence of low back pain in this police force is comparable with that in the general population, and driving a patrol car or wearing the duty belt does not appear to influence the prevalence rate in this population.