Articles: low-back-pain.
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Associations between attention-deficit/hyperactivity disorder (ADHD) and chronic pain disorders, such as fibromyalgia, have been reported. However, associations between persistent chronic nonspecific low back pain (CNLBP) and ADHD have not yet been investigated. ⋯ Our findings revealed that the subscale scores on an ADHD scale were considerably high in patients with persistent CNLBP. As a previous study of our clinical experience indicates that persistent CNLBP can be substantially relieved by administering ADHD medications, ADHD screening is warranted in the treatment of persistent CNLBP.
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Observational Study
Lumbar Disc Herniation is a Nonnegligible Factor for the Degeneration of Sacroiliac Joints.
Sacroiliac joint (SIJ) abnormality is a potential source of low back pain (LBP), therefore numerous patients receive various treatments because of the degenerative changes of SIJ. However, the outcome is unfavorable for patients because these morphologic alterations are common but not the origins of LBP. Previous studies revealed lumbar fusion and transitional vertebra increased the prevalence of degeneration of SIJ. Lumbar disc herniation (LDH) is one of the most common lumbar diseases, but there is no study regarding the relationship between LDH and SIJ degradation. ⋯ The SIJ degeneration in patients with LDH was more serious than in individuals without LDH. SIJ degeneration was more significant in patients with LDH with more pathological alterations, symptoms, and complications. Age and LDH relate to SIJ degeneration. Therefore the diagnosis and selection of treatment for SIJ changes should comprehensively consider the coexistence of LDH.
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In clinical practice, we have found that the pain caused by thoracolumbar osteoporotic vertebral compression fracture (OVCF) is sometimes not limited to the level of the fractured vertebrae but instead occurs in areas far away from the injured vertebrae, such as the lower back, area surrounding the iliac crest, or buttocks, and this type of pain is known as distant lumbosacral pain. The pathogenesis of pain in distant regions caused by thoracolumbar OVCF remains unclear. ⋯ Both PVP and PKP can effectively alleviate pain in the distant lumbosacral region caused by thoracolumbar OVCF, and distant lumbosacral pain associated with thoracolumbar OVCF may be considered vertebrogenic referred pain.
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Case Reports
Acute renal failure with severe loin pain and patchy renal ischemia after anaerobic exercise.
Acute renal failure with severe loin pain and patchy renal ischemia after anaerobic exercise (ALPE) is gradually gaining recognition. In this case series, we describe the presentation of ALPE in the emergency department setting and its clinical course. In Case 1, an 18-year-old man presented with acute-onset nausea, vomiting, and right flank pain after playing basketball, with a creatinine level of 6.42 mg/dL on initial presentation. ⋯ In both cases, severe loin pain began after anaerobic exercise, and acute kidney injury without myoglobinuria was observed. The findings of our case series suggest that emergency physicians should consider ALPE in the differential diagnosis of abdominal and loin pain accompanied by an elevated creatinine level in young patients because it can be treated conservatively and has a good prognosis. Moreover, watchful waiting is recommended for ALPE while also emphasizing the need to exclude potentially life threatening or treatable kidney diseases.