Pain medicine : the official journal of the American Academy of Pain Medicine
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Several research groups established functional tests to obtain performance data for mobility-related activities in patients with low back pain (LBP). In our study we aimed to assess the construct validity and associations with other measures of a battery of functional tests in relationship to physical performance on the one hand and physical capacity and variables of pain, disability and psychological variables on the other. ⋯ In contrast to the past and present literature, our results suggest that physical performance tests have an inherent problem to sharply differentiate patients with back pain from healthy controls and problems with inter-rater reliability. Physical performance seems to be more a matter of patients' perception of generalized disability than of restricted function.
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Posttraumatic stress disorder (PTSD) treatment is often complicated in veterans by co-occurring conditions including pain, insomnia, brain injury, and other mental disorders. Pharmacologic approaches to these conditions can produce an accumulation of sedating medications with potential for safety concerns. ⋯ Important trends in polysedative use among veterans with PTSD illustrate the complexity of treating an intersecting cluster of symptoms managed by sedative medications. As the VA seeks to improve care by focusing on non-pharmacologic options, our findings emphasize the need for a comprehensive approach that encompasses overlapping conditions of relevance to veterans with PTSD.
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To identify and categorize anatomical anomalies of the vertebral artery and determine the relationship of these unexpected variations to the site for cervical transforaminal epidural steroid injections (CTESI). ⋯ CTESI have become a mainstay in the treatment algorithm for painful cervical radiculopathy. Described techniques take extreme care to avoid cannulation of the vertebral artery during this procedure. Unexpected deviation of the artery, or an arterial segment, into the posterior neural foramen, the target zone for CTESI, increases the risk of intraarterial cannulation during injection. Accordingly, the practitioner must be aware of variant anatomy of the vertebral artery and take all precautions to avoid potential complications that may arise as a consequence.