Articles: back-pain.
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Case Reports
Back pain in the emergency department: Pathological fracture following spinal manipulation.
Back pain is one of the most common presentations to the emergency department. Though case reports of patients presenting with increased back pain following chiropractic spinal manipulations are rare, we have identified a case rarely reported in the literature where a potential injury from chiropractic manipulation resulted in a diagnosis of multiple myeloma. We have reported a previously healthy 66-year-old male who presented with persistent lower back pain over 4 weeks. ⋯ Following initial presentation to the family physician, the patient underwent three treatments of spinal manipulation from his local chiropractor, which resulted in worsening lower back pain. A re-examination and new radiographs in the hospital revealed multiple compression fractures and an underlying diagnosis of multiple myeloma. We have explored current literature examining the prevalence of lower back pain, as well as the incidence of spinal fracture following chiropractic manipulation, and have highlighted a potential complication from chiropractic manipulation in a patient with an undiagnosed underlying neoplastic disorder.
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To standardize outcome reporting in clinical trials of patients with nonspecific low back pain, an international multidisciplinary panel recommended physical functioning, pain intensity, and health-related quality of life (HRQoL) as core outcome domains. Given the lack of a consensus on measurement instruments for these 3 domains in patients with low back pain, this study aimed to generate such consensus. The measurement properties of 17 patient-reported outcome measures for physical functioning, 3 for pain intensity, and 5 for HRQoL were appraised in 3 systematic reviews following the COSMIN methodology. ⋯ Various participants requested 1 free-to-use instrument per domain. Considering all issues together, recommendations on core instruments were formulated: Oswestry Disability Index version 2.1a or 24-item Roland-Morris Disability Questionnaire for physical functioning, NRS for pain intensity, and SF12 or 10-item PROMIS Global Health form for HRQoL. Further studies need to fill the evidence gaps on the measurement properties of these and other instruments.
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Wei et al. evaluated the global research in spine using scientometric methods based on a sample of 13,115 papers published in 5 spine journals from 2004 to 2013. This study builds on this pioneering study and provides up-to-date and thorough information on spine based on a sample of 166,962 papers for the stakeholders. ⋯ The optimal design of research sample made it possible to obtain nearly 13 times the size of the sample in Wei et al. as a true representation of the research in spine through the use of an optimal keyword set for the titles of both papers and 10 spine journals. However, despite the inefficient design of the incentive structures for the relevant stakeholders, the research in spine had expanded 6.8 times since 1980.
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Observational Study
Safety profile of intraoperative methadone for analgesia after major spine surgery: An observational study of 1,478 patients.
To investigate the incidence of perioperative adverse events in patients receiving intravenous methadone for major spine surgery. ⋯ Mild-moderate respiratory depression is observed following a one-time dose of intraoperative methadone, and monitoring in an appropriate postoperative setting is recommended.
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This study reports the results of a registry data collection project within a secondary care spinal osteopathy service. ⋯ The secondary care spinal osteopathy service demonstrated high satisfaction, few therapeutic complications and positive outcomes on all PROMs. Registry participation has facilitated robust clinical governance and the data support the use of osteopaths to deliver a conservative spinal service in this setting. Registry data collection is a significant administrative and clinical task which should be structured to minimise burden on patients and resources. These slides can be retrieved under Electronic Supplementary Material.