Articles: low-back-pain.
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Musculoskelet Sci Pract · Jun 2019
Longitudinal associations of kinematics and fear-avoidance beliefs with disability, work ability and pain intensity in persons with low back pain.
Impaired lumbar movement has cross-sectionally been associated with low back pain (LBP); however, the consequence of impaired movement on disability and pain in persons with LBP is poorly understood. Furthermore, fear-avoidance beliefs (FAB) may influence spinal movement, but the relation between fear-avoidance and kinematics is unclear. ⋯ Of the kinematic measures, only range-of-motion was related to disability. Higher FAB was weakly associated with all self-reported outcomes and with lower velocity only at the initial flexion phase. However, the magnitude of these associations suggest marginal clinical importance.
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J Orthop Sports Phys Ther · Jun 2019
Case ReportsSelective Fatty Replacement of Paraspinal Muscles in Facioscapulohumeral Muscular Dystrophy.
A 65-year-old man with a history of facioscapulohumeral muscular dystrophy presented to his physician with a complaint of new-onset low back pain, bilateral foot numbness, and left lower extremity radicular symptoms with foot drop. He subsequently underwent magnetic resonance imaging of the lumbar spine, which revealed complete fatty replacement of the erector spinae musculature throughout the lumbar spine. ⋯ The patient's lower extremity symptoms were consistent with left L5-S1 radiculopathy, and the magnetic resonance images indicated mild to moderate central canal stenosis at L2-L3 with severe bilateral L5-S1 foraminal narrowing. J Orthop Sports Phys Ther 2019;49(6):483. doi:10.2519/jospt.2019.8815.
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J Manipulative Physiol Ther · Jun 2019
Observational StudyResearching the Appropriateness of Care in the Complementary and Integrative Health Professions Part 3: Designing Instruments With Patient Input.
The purpose of this article is to describe how we designed patient survey instruments to ensure that patient data about preferences and experience could be included in appropriateness decisions. These actions were part of a project that examined the appropriateness of spinal manipulation and mobilization for chronic low back pain and chronic neck pain. ⋯ This article documents the challenges and the efforts involved in designing data collection tools to facilitate the inclusion of patient data into appropriateness decisions.
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Accumulating evidence has shown that complicated brain systems are involved in the development and maintenance of chronic low back pain (cLBP), but the association between brain functional changes and clinical outcomes remains unclear. Here, we used resting-state functional magnetic resonance imaging (fMRI) and multivariate pattern analysis to identify abnormal functional connectivity (FC) between the default mode, sensorimotor, salience, and central executive brain networks in cLBP and tested whether abnormal FCs are related to pain and comorbid symptoms. Fifty cLBP patients and 44 matched healthy controls (HCs) underwent an fMRI scan, from which brain networks were identified by independent component analysis. ⋯ Finally, we found that resting-state FC could discriminate cLBP patients from HCs with 91% accuracy in the first cohort and 78% accuracy in the validation cohort. Our findings suggest that the medial prefrontal cortex/rostral anterior cingulate cortex may be an important hub for linking the default mode network with the other 3 networks in cLBP patients. Elucidating the altered FCs and their association with clinical outcomes will enhance our understanding of the pathophysiology of cLBP and may facilitate the development of pain management approaches.
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Emergency department (ED) visits for dental pain and low back pain (LBP) are common. Many such patients have severe pain and receive opioids. Increased opioid-related deaths has led to efforts to reduce opioid prescriptions. We compared recent trends in use of analgesics and opioids in the ED and at discharge among patients with dental or LBP. ⋯ Prescription of opioids decreased for ED dental patients. While less likely to receive analgesics and opioids in the ED, patients with dental pain were more likely to be prescribed analgesics and opioids at the time of ED discharge than those with LBP.