J Am Board Fam Med
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Chronic back pain is among the most common patient complaints. Its prevalence and impact have spawned a rapidly expanding range of tests and treatments. ⋯ The limited studies available suggest that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates. We suggest a need for a better understanding of the basic science of pain mechanisms, more rigorous and independent trials of many treatments, a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronic pain, and a chronic disease model for managing chronic back pain.
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Review Case Reports
Improvement of chronic back pain or failed back surgery with vitamin D repletion: a case series.
This article reviews 6 selected cases of improvement/resolution of chronic back pain or failed back surgery after vitamin D repletion in a Canadian family practice setting. Pub Med was searched for articles on chronic back pain, failed back surgery, and vitamin D deficiency. Chronic low back pain and failed back surgery may improve with repletion of vitamin D from a state of deficiency/insufficiency to sufficiency. Vitamin D insufficiency is common; repletion of vitamin D to normal levels in patients who have chronic low back pain or have had failed back surgery may improve quality of life or, in some cases, result in complete resolution of symptoms.
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Lemierre syndrome is a potentially fatal complication of oropharyngeal infections that is characterized by jugular vein thrombosis and septic emboli. Fusobacterium spp. are the causative organisms. Patients typically present with high fevers, neck pain, and pulmonary symptoms. ⋯ Anticoagulation for this syndrome is controversial. We present 3 cases within a 12-month period of young, family practice patients seen with oropharyngeal infections who developed Lemierre syndrome. The incidence of Lemierre syndrome may be increasing and primary care physicians should be aware of this rare though serious condition.