Articles: back-pain.
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Case Reports
A potentially underrecognized and treatable cause of chronic back pain: entrapment neuropathy of the cluneal nerves.
We describe a case of longstanding low back pain related to entrapment neuropathy of the L1-L2 dorsal ramus over the iliac crest. As 3 local anesthetic pain blocks (at the trigger point, 7 cm left of the L5 spine process and just above the iliac crest) were successful for 3 weeks each, a surgical procedure was performed. This corrected patient stricture of a voluminous dorsal ramus within a rigid osteofibrous orifice between the upper rim of the iliac crest and the thoracolumbar fascia. Pain decreased dramatically the same day and disappeared completely within less than a week.
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Case Reports
Patterns of ordering diagnostic tests for patients with acute low back pain. The North Carolina Back Pain Project.
Low back pain is a common reason for visiting a physician. Authors of guidelines and insurance payers are currently scrutinizing use of radiography and computed tomography (CT) or magnetic resonance imaging (MRI). ⋯ Radiography is commonly used as a diagnostic test for patients with acute back pain. Clinical factors and provider specialty are major correlates of the use of imaging studies.
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Our purpose was to study the relationship between serum relaxin levels and back pain during pregnancy. ⋯ Relaxin is known to remodel pelvic connective tissue in several mammalian species during pregnancy. The current data suggest that relaxin might be involved in the development of pelvic pain in pregnant women.
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Case Reports
Painful adult thoracic Scheuermann's disease. Diagnosis by discography and treatment by combined arthrodesis.
This is the case report of a 42-year-old woman with chronic thoracic pain, nonradicular and refractory to all nonoperative treatment. Radiographs showed the classic findings of Scheuermann's disease, but without abnormal kyphosis. Magnetic resonance imaging scans showed multilevel thoracic disc degeneration typical of long-term Scheuermann's disease. ⋯ Treatment consisted of an anterior fusion, T5-11, and posterior fusion of T3 through L1, with Cotrel-Dubousset instrumentation. At follow-up, she was pain free and able to work full time and had been able to return to golf, her favorite recreation. Discography of the thoracic spine, as of the lumbar spine, can reveal the true source of pain and thus lead to precise and effective treatment.
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There is a great need to expand current knowledge of the various functional capacity measurements used in the rehabilitation of chronic low back pain (CLBP) patients. The literature on these patients reports that mobility, endurance, trunk strength and lifting capacity decrease during the process of chronicity. Chronically disabled patients appear to have lower functional capacity than asymptomatic persons. ⋯ Study results showed that physical capacity in disabled patients with low back pain is substantially reduced in comparison to persons who do not suffer from back pain. The only exception was in trunk flexor strength and endurance, in which measurements did not differ between the patients and the control group. However, even CLBP- patients with long-term pain and severe physical illness can successfully improve their physical condition by participating in an active treatment program. Back extensor muscle training has to be included in physical therapy. Because of loss of condition during the time after treatment, regular monitoring of patients and their home training programs is necessary. Overall, treatment of CLBP has to include physical training and psychosocial treatment to achieve satisfactory results.