Articles: back-pain.
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Pediatric emergency care · Jun 2011
Case ReportsA case of autonomically mediated pain due to spinal epidural abscess in an adolescent female.
Spinal epidural abscess (SEA) is a rare disease in children without predisposing risk factors. Atypical presentations of SEA without the classic triad of fever, back pain, and neurological signs, have previously been described. We report an atypical presentation of an acute SEA in a previously healthy adolescent female. ⋯ Our experience adds to the literature a case that demonstrates the difficulty in diagnosis of atypical presentations of SEA in previously healthy children. In addition, referred or autonomically mediated pain should be considered in unusual pain presentations. Children with significant extremity or abdominal pain should be considered for the possibility of sympathetically mediated pain syndrome due to a thoracic-level spinal cord lesion such as a SEA.
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There is a high prevalence of mental health problems amongst adolescents. In addition there is a high prevalence of spinal pain in this population. Evidence suggests that these conditions are related. This study sought to extend earlier findings by examining the relationship between mental health problems as measured by the Child Behaviour Check List (CBCL) and the experience of back and neck pain in adolescents. ⋯ These findings strongly support the need to consider both psychological and pain symptoms when providing assessments and treatment for adolescents. Further research is required to inform causal models.
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Review
The influence of informal social support on risk and prognosis in spinal pain: a systematic review.
Spinal pain is very common and has considerable consequences for the individual (e.g. loss of employment, disability) as well as increased health care costs. It is now widely accepted that biological, psychological and social factors impact on spinal pain outcomes. The majority of research on social factors has been employment related, with little attention to the influence of informal social support (e.g. families, friends, social groups). ⋯ Evidence of social support as a factor for risk of occurrence was inconclusive with three studies reporting no significant associations with the remaining two studies reporting weak associations. Evidence of an effect of social support and prognosis revealed inconsistent findings. The variation in findings may reflect ongoing difficulties surrounding the conceptualisation and measurement of informal social support.
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This paper quantifies the relationship between early retirement due to back problems and wealth, and contributes to a more complete picture of the full costs associated with back problems. The output data set of the microsimulation model Health&WealthMOD was analysed. Health&WealthMOD was specifically designed to measure the economic impacts of ill health on Australian workers aged 45-64 years. ⋯ Of those who have retired early due to back problems who do have some wealth, on average the total value of this wealth is 87% less (95% CI: -90 to -84%) than the total value of wealth accumulated by those who have remained in full-time employment with no health condition controlling for age, sex and education. The financial burden placed on those retiring early due to back problems is likely to cause financial stress in the future, as not only have retired individuals lost an income stream from paid employment, but they also have little or no wealth to draw upon. Preventing early retirement due to back problems will increase the time individuals will have to amass savings to finance their retirement and to protect against financial shocks.
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Chronic back pain is commonly associated with physical and mental comorbidities, which create a considerable burden on the healthcare system. We examined the differences in comorbidity rates of 619 spinal surgery patients of employment age, and the impact of comorbidity rates on length of hospital stay and cost. The charts of patients aged >25 years and <65 years were reviewed retrospectively. ⋯ Multivariate analysis showed that a history of coronary artery bypass/stent procedure, chronic renal disease or preoperative opioid use had a significant impact on length of stay and hospital charges in unemployed spine surgery patients. Thus, unemployment in spinal surgery candidates is associated with higher comorbidity rates with a significant impact on healthcare cost. More research is needed into the relationship between unemployment and consumption of healthcare resources.