Articles: low-back-pain.
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Fatigue is frequently found in chronic pain patients (CPPs) and may be etiologically related to the presence of pain. Fishbain et al. have recently demonstrated that chronic low back pain (LBP) and chronic neck pain patients are more fatigued than controls. The purpose of this study was to determine whether chronic LBP- and chronic neck pain-associated fatigue responded to multidisciplinary multimodal treatment not specifically targeted to the treatment of fatigue. ⋯ Multidisciplinary multimodal pain facility treatment improves chronic LBP- and neck pain-associated fatigue. At the present time we cannot predict this improvement with significant accuracy.
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Lumbar discography has been widely used for evaluating discogenic low back pain (LBP). Comparison of pain responses from suspected symptomatic discs with pain responses from asymptomatic negative discs is routine. However, the ability of discography to distinguish asymptomatic morphologically abnormal discs from those that are symptomatic has been understudied. In addition, the discographic characteristics of negative discs in patients with chronic discogenic LBP have not been reported. Criteria for negative morphologically abnormal discs may be valuable for excluding discs from further treatment and examination. ⋯ Pain tolerance was significantly lower in patients relative to asymptomatic subjects. Negative patient discs and asymptomatic subject discs showed similar characteristics. Pressure-controlled manometric discography using strict criteria may distinguish asymptomatic discs among morphologically abnormal discs with Grade 3 annular tears in patients with suspected chronic discogenic LBP.
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Clay shoveler's fracture is a repetitive stress injury that affects the spinous process of the lower cervical and upper thoracic spine. In sports, deceleration forces caused by the pull of the trapezius, rhomboids, and the ligamentum nuchae on the neck probably exert repetitive traction on their attachment sites to the narrow spinous processes. The condition is known in manual laborers, but it is rare in athletes, as in this case of a volleyball player. Early recognition and treatment with rest, analgesics, and physical therapy are important to prevent debilitating chronic back pain.
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Low back pain is a common clinical problem that may be due to a variety of causes, including disc disease. Provocative discography is an imaging-guided procedure in which a contrast agent is injected into the nucleus pulposus of the disc. Despite its controversial history, it remains the only imaging technique that provides both anatomical and functional information about a diseased disc. ⋯ It should instead be reserved for carefully- selected patients whose painful symptoms cannot be explained by findings on non-invasive imaging modalities such as magnetic resonance imaging or CT, and who are not responsive to conservative measures. Discography is helpful in selection of patients and disc levels to be operated upon. Careful application of indications and meticulous technique are however required if a successful outcome is to be expected.