Articles: back-pain.
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The Permanente journal · Jan 2013
Preoperative pain intensity and chronicity and postoperative analgesia markers of length of stay in patients undergoing spinal fusion.
Pain medication use is enormous in those looking for relief of chronic back pain. The impact of long-term analgesia use might serve as a marker for prolonged hospitalization due to undertreating postoperative pain, which could ultimately result in higher health care costs. ⋯ Postoperative pain management continues to be a challenge because of the need to balance satisfactory analgesia in patients with the fear of adverse effects due to overdosing. This challenge is even greater in patients with long-term narcotic use. Anecdotally, patients undergoing spinal fusion show an inverse relationship between LOS and amount of use of postoperative pain medication. A more extensive scientific review of current postoperative pain control protocols is warranted in patients undergoing spinal fusion.
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Back and neck pain are common conditions that have a high burden of disease. Changes in somatosensory function in the periphery, the spinal cord and the brain have been well documented at the time when these conditions have become chronic. It is unknown, however, how early these changes occur, what the timecourse is of sensory dysfunction and what the specific nature of these changes are in the first 12 weeks after onset of pain. In this paper, we describe the protocol for a systematic review of the literature on somatosensory dysfunction in the first 12 weeks after pain onset. ⋯ Currently, there is a gap in our knowledge about the timing of somatosensory changes in back and neck pain. The systematic review outlined in this protocol aims to address this knowledge gap and inform developments in diagnostic tools and pain mechanism-based treatments.
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Solitary vertebral chordoma presents as an intra- and extraosseous tumour with typical bright signal on T2-weighted images and moderate inhomogeneous enhancement on T1 postcontrast images. The diffusion weighted imaging (DWI) characteristics of this histologically proven third lumbar vertebra chordoma are reported for the first time. The DWI hyperintensity with increased apparent diffusion coefficient (ADC) values strongly supports the preoperative diagnosis of a vertebral chordoma, allows for careful preoperative planning of the surgical procedure, and helps to narrow the differential diagnosis.
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To determine whether a difference exists between patients' self-ratings of amount of change and their self-ratings of importance of change. ⋯ Assessing the amount of change is not the same as assessing the importance of change. When the goal is to estimate important change, the reference standard should direct patients to judge the importance of the change.