How I Healed my Lower Back Pain
Due to almost epidemic proportions of patients presenting to general practitioners, general orthopaedic clinics, and accident and emergency departments, a working knowledge of the assessment of the patient presenting with back pain, as well as an idea of the possible causes and their treatment is essential. The vast majority of patients presenting with back pain of a musculoskeletal origin will have symptoms secondary to degenerative spinal disease. Other conditions can occur such as trauma, infections and inflammatory spondyloarthropathies. Visceral causes can also represent with very symptoms that mimic back pain.
The differential diagnoses for abdominal aneurysms include the causes of syncope, abdominal pain, back pain, and shock. The presentation of syncope with back pain or shock should strongly suggest aortic disease. However, the diagnosis will be difficult to make in shock or syncope without a significant complaint of pain. Other cardiac, abdominal, and retroperitoneal diseases need to be considered, including renal disorders, hepatobiliary disorders, and pancreatic disease. Unfortunately, some patients may appear well enough to receive benign diagnoses such as musculoskeletal back pain or enteritis and be discharged from the emergency department (ED).
Known diagnosis of an abdominal aortic aneurysm presents with abdominal pain, ruling out rupture should always be considered. Without prior diagnosis, an aneurysm with the possibility of rupture should also be considered in patients with high-risk factors who present with a sudden drop in hema-tocrit and hemodynamic instability that transiently improves with fluid resuscitation. Patients will often present complaining of abdominal or back pain. A pulsatile abdominal mass can sometimes be palpated, depending on the girth of the patient. Mortality rates are at least 50 percent if the patient presents with rupture.
Multiparous women (Kroovand 1992 Stothers and Lee 1992). The calculi are essentially composed of calcium carbonitee and more rarely of struvite (Meria et al. 1993 Saidi et al. 2005 Stothers and Lee 1992). The revealing symptom is most often lower back pain (89 ) followed by microscopic hematuria, sometimes macroscopic hematuria (95 ) (Leaphart et al. 1997 McAleer and Loughlin 2004 Stothers and Lee 1992). Symptoms can be deceptive, bringing to mind cholecystitis or right-sided appendicitis, left-sided sigmoiditis, an occlusion, adnexal pathology, or placental detachment (Biyani and Joyce 2002a Evans and Wollin 2001 McA-leer and Loughlin 2004). Elsewhere, the calculus is discovered by signs in the lower urinary structures, abortion, the threat of premature delivery (Biyani and Joyce 2002a Loughlin 1994), atypical abdominal pain, or nausea or vomiting (Evans and Wollin 2001). More rarely, lithiasis presents as an infectious complication or anuria (Carringer et al. 1996 Meria et al. 1993...
Vaginal cuff cellulitis is a common complication following both abdominal and vaginal hysterectomy. Symptoms and signs usually present between postoperative days 3 and 5, and may begin in the hospital, or just after discharge. Patients often complain of lower abdominal pain, pelvic pain, back pain, fever, and abnormal vaginal discharge. Induration, tenderness of the vaginal cuff, and possibly a purulent discharge or labial edema or erythema are prominent during the pelvic examination. The white blood cell count is usually elevated.
Second, determine what symptoms accompany the vomiting. Is the patient febrile Fever could point toward an infectious or inflammatory source, or it could represent a toxicologic cause, such as salicylate intoxication. Is there associated abdominal pain, back pain, headache, or chest pain that may point to a specific cause Pancreatitis, cholecystitis, peptic ulcer disease, appendicitis, and pelvic inflammatory disease typically cause abdominal pain. Back pain usually accompanies aortic dissections, rupturing aortic aneurysms, pyelonephritis, and renal colic. Vomiting is one of the signs of increased intracranial or intraocular pressure and may be a foreboding sign in patients complaining of headache. Finally, the complaint of vomiting associated with chest or epigastric pain might suggest a diagnosis of myocardial ischemia. In female patients, obstetric and gynecologic causes of vomiting should always be considered. In a pregnant woman, epigastric pain and vomiting accompanying...
The first two parts of this text provide a comprehensive overview and foundational knowledge of the early development (Part One) and continuing growth and development (Part Two) of the e-health field. Part Three begins by examining how various e-health domains and applications are interrelated. Chapter Seven highlights e-health domains as part of e-health landscapes and relates it to various e-health care services, providing an overview as well as a set of concepts that are explored in the other chapters of Part Three. Chapters Eight through Eleven focus on e-medicine, e-home care, e-diagnosis support systems (especially for back pain) and e-health intelligence through data mining and clustering.
Would you argue that the SOAP scheme recommended for lower back pain diagnosis could be used for other types of chronic ailments If so, give instances and discuss how this scheme would assist in guiding the therapists. How can e-technology be applied in automating such a scheme 5. Imagine that this e-DSS for lower back pain is available to an occupational therapist in your workplace. How might people who may have LBP problems benefit from such a system Please discuss its socioeconomic value.
Aortic dissections will commonly present ( 90 percent) with an abrupt and severe pain in the chest or between the scapulae. Patients often describe the pain as tearing or ripping. Pain in anterior chest is often associated with involvement of the ascending aorta. Back pain may indicate involvement of the descending aorta. Dissection often presents with dynamic pathology therefore, pain patterns often change as the anatomic injury migrates.10
Vomiting, night sweats, and weight loss. The clinical course is usually insidious, and the initial symptoms are so nonspecific that the correct diagnosis is usually not considered. Constitutional symptoms may be present for weeks to months before localizing signs develop. With pressure on the extraperitoneal nerves, pain may be referred to the groin, hip, thigh, or knee, with little or no complaint of abdominal or back pain. Urologic symptoms are rare, even with perirenal abscess.
DYSMENORRHEA AND MITTELSCHMERZ Primary dysmenorrhea is defined as painful menstruation during ovulatory periods, in the absence of pelvic disease. This significant problem, which may cause 5 to 10 percent of women to miss school or work, occurs shortly after menarche and is most severe in young, nulliparous women. The crampy lower abdominal midline pain of primary dysmenorrhea is secondary to progesterone-mediated myometrial contractions and arteriolar vasospasm. The pain precedes menstrual flow by 12 to 24 h and subsides after menses begins. In severe cases, cramps may be associated with nausea, vomiting, back pain, headache, and irritability. Dysmenorrhea can be relieved with antiprostaglandin therapy (NSAIDs). The OCP should be used as a second-line therapy. Pelvic ultrasound or laparoscopy may be helpful in the assessment of patients with uncertain diagnoses or with pain that does not respond to therapy. Secondary or acquired dysmenorrhea occurs later in life and is associated...
Upper motor neuron dysfunction causes limb spasticity, hyperreflexia (including Babinski's sign and a brisk jaw-jerk reflex), and emotional lability. Lower motor neuron dysfunction causes limb muscle weakness, atrophy, cramps, and fasiculations, as well as dysarthria, dysphagia, and difficulty in mastication. At the time of initial presentation, extremity cramping, fatigue, and weakness are seen, as well as muscle fasciculations and atrophy. 5 These symptoms are more prominent in the upper extremities, with asymmetric weakness seen commonly. Regardless of the initial symptomatology, widespread motor and respiratory dysfunction progresses within weeks to months. Atrophic, fasciculating, hyperreflexic extremities are seen, as well as foot drop and claw deformity of the hand. Patients also may present with an atrophic fasciculating tongue and monotonous speech, with relative sparing of facial and eye movements. Patients with fALS more often present with isolated lower extremity weakness...
Back pain or anaesthesia caudal to the thoracolumbar region is due most often to a lesion at that site. Depressed or absent spinal reflexes and muscle atrophy of the limbs localise lesions to the spinal cord segments and nerves of the lumbosacral plexus which supply those reflexes and muscles. Hyperactive hindlimb spinal reflexes and a crossed extensor reflex suggest a lesion of the cerebrum, diencephalon, midbrain, pons and medulla oblongata, and cervical, thoracic and lumbar (Ll-3) spinal cord segments.
On the medical side, e-medicine, videoconferencing and Web services can decrease the number of nurses' and nurse's aides' visits required in home health care settings, thus effectively reducing labor costs. Virtual visits can be prescheduled on a regular basis, for example, to ensure that the patient suffering from a chronic illness such as lower back pain will follow-up on instructions pertaining to pain medication and other therapeutic procedures (for example, regular stretching exercises and healthy lifestyle behaviors).
Dissection of the aorta and major branches (e.g., renal artery) has been described (293,294,297-300). Dissection can occur in any segment of the aorta. Intimal disruption of atherosclerotic plaque may be the initiating event (301). The determination of whether an aortic dissection occurred prior to or resulted from a traumatic incident depends on the circumstances and pathological findings. Chest or back pain prior to the incident and evidence of aortic degeneration (cystic medionecrosis) favor a spontaneous dissection.
The causes of lumbosacral pain are as diverse and as complex as are the interrelated anatomic structures of the lumbar spine itself. Any innervated structure in the region can be a pain generator. The specific pain generator is rarely identified. Deep somatic pain due to mechanical irritation, inflammation, or even increased vascular pressure can emanate from the vertebral column, surrounding muscles, tendons, ligaments, or fascia. Discomfort of articular origin, either lumbar zygapophyseal or sacroiliac joints, can also be recognized by known sclerotome patterns of pain referral. 8 Pain due to nerve irritation can be perceived locally and distally. Nonspinal causes of low back pain must also be considered. One rational approach to the diagnosis and treatment of low back pain or sciatica is predicated on an understanding of the process of spinal degeneration as described by Kirkaldy-Willis and Farfan.9 Initially beginning with an alteration in the hydroscopic quality of the nucleus...
Signs and symptoms include vaginal bleeding (unless concealed), abdominal pain, back pain, uterine tenderness, and uterine irritability. Fetal distress, hypotension, and disseminated intravascular coagulation can develop. Abruptio placentae is frequently misdiagnosed as preterm labor. Complications include fetal death, maternal death from hemorrhage or disseminated intravascular coagulation, fetomaternal transfusion, and amniotic fluid embolism. Laboratory tests that should be ordered include CBC, type and crossmatch, coagulation profile, and renal function studies. Crystalloids should be given to maintain maternal volume status. Emergency obstetrical consultation is necessary whenever abruption is suspected. Cardiotocodynamometry and ultrasound studies are used to monitor fetal well-being, and emergency delivery may be necessary. Some centers may elect to treat small abruptions expectantly. Tocolytics should not be given by the emergency physician in the presence of suspected...
In summary, CBT has strong empirical support as an effective treatment for chronic pain clients. More research is needed to explore whether cognitive therapy or behavior therapy is superior with chronic pain clients in general and for what types of problems or outcomes. In addition, the benefits of adding CBT to active treatments for chronic pain clients, especially low back pain clients, demand further exploration.
BACK PAIN Risk factors for chronic back pain following an acute episode include male gender, advanced age, evidence of nonorganic disease, leg pain, prolonged initial episode, and significant disability at onset. 10 Chronic back pain symptoms and causes can be divided into myofascial or muscular, articular, and neurogenic types. Myofascial back pain is characterized by constant dull and occasional shooting pain that does not follow a classic nerve distribution. Pain may or may not be exacerbated by movement. Usually trigger points can be found at the site of greatest pain, and muscle atrophy is not found. Range of motion of the involved muscle is reduced, but there is no actual muscle weakness. Previous recommendations for bed rest in the treatment of back pain have proven counterproductive. 11 Exercise programs have been found to be helpful in chronic low back pain.12 Articular back pain is characterized by constant or sharp pain that is exacerbated by movement and associated with...
Rarities (a) A cystic hygroma is a rare swelling it is loculated and very soft. Usually the fluid can be pressed from one part of it to another. (b) A psoas abscess is a soft swelling frequently associated with backache. It loses its tension if the patient is laid flat. It is classically lateral to the femoral artery. (c) A hydrocoele of the femoral canal is a rarity reported from West Africa. In reality it is the end stage of an untreated strangulated femoral epiplocoele. The strangulated portion of omentum is slowly reabsorbed, the neck of the femoral sac remains occluded by viable omentum, while the distal sac becomes progressively more and more distended by protein-rich transudate.
The key management issue is recognition of the disorder and identification and discontinuation of the offending drug. Care also must be taken to avoid overtreatment of symptoms such as pain and seizures with medications that may exacerbate the illness. Other treatment modalities include supportive care, glucose infusions to prevent heme biosynthesis, vitamin B6, and hematin (4 mg kg daily for 1 to 2 weeks). The differential diagnosis includes other disorders that cause pain and lower extremity weakness. Spinal cord compression causes back pain, which frequently radiates around the trunk and is followed by lower extremity weakness, but reflexes in this situation are brisk with upgoing toes (positive Babinski's reflex). An aortic aneurysm or dissection also can cause abdominal pain and lower extremity weakness if spinal arteries are occluded by the expanding aneurysm.
Intrathecal injection Intravascular injection Neurological Backache Pressure areas 5) Backache Epidural analgesia in labour has developed a reputation for causing low grade but persistent backache after delivery which is probably related not to epidural analgesia itself but to the management of the back in labour. In the absence of pain sensation, proprioception and muscle tone to protect the joints and ligaments of the back there is a possibility of musculo-skeletal strain.
Spinal cord compression can result from bleeding, infection, or fracture. It may be the first sign of a neoplasm or can complicate pre-existing metastatic disease. The incidence is estimated at greater than 5 percent, and repeated occurrences in the same patient have been reported. Spinal cord compression occurs most commonly as a complication of breast or lung carcinoma and lymphoma. In at least 95 percent of patients, a long history of back pain, often several weeks to several months, elapses prior to diagnosis. The pain is progressive in severity and duration, typically continuous, and requires analgesics. It may be radicular, and when affecting the thoracic spine, radicular pain is characteristically bilateral. Symptoms and signs of myelopathy are late findings. Once neurologic deficits from spinal cord compression are present, the tempo of deterioration increases dramatically, with some patients progressing from weakness to complete paralysis in a matter of hours. Once ambulatory...
Endometriosis should be considered in any woman of reproductive age who has pelvic pain. The most common symptoms are dysmenorrhea, dyspareunia, and low back pain that worsens during menses. Rectal pain and painful defecation may also occur. Other causes of secondary dysmenorrhea and chronic pelvic pain (eg, upper genital tract infections, adenomyosis, adhesions) may produce similar symptoms.
The zygapophyseal (facet) joints are true synovial joints innervated by the medial branches of the dorsal rami. It has been estimated that 15 to 40 percent of chronic back pain is due to the zygapophyseal joints. The clinical presentation overlaps considerably with low back pain of other etiologies. The diagnosis remains one of exclusion and confirmation by analgesic injection.11
Biofeedback or applied psychophysiology (AP) has been most frequently used to assist in the attainment of a relaxed physiological and psychological state. Schwartz has labeled the many procedures aimed at accomplishing this task as cultivated low arousal.'' The paradigm driving these applications is based on the assumption that many disorders (often called functional disorders) in modern medicine are the result of the sympathetic nervous system and the hypotha-lamic-pituitary-adrenaline (HPA) system being driven to excessive levels over a long period of time. Disorders included in this list are many hypertension, headache, irritable bowel syndrome, back pain, asthma, noncardiac chest pain, fibromyalgia, chronic fatigue syndrome, temporomandibular disorder, and perhaps the somatic symptoms of anxiety disorders. Whereas the evidence related to etiology is mixed with regard to most of these disorders, the treatment protocols described next have been fairly successful in reducing or...
Approximately 40 percent of patients with multiple myeloma will have hypercalcemia, often accompanying the clinical triad of back pain, anemia, and lethargy. Hypercalcemia from any cause may produce nausea, vomiting, anorexia, and constipation. Altered mental status, confusion, and coma are consistent with rapid and or high levels of hypercalcemia. Elevated ionized calcium is responsible for neuromuscular dysfunction, and therefore, serum calcium levels should be interpreted in conjunction with serum phosphorus, albumin, and blood pH determinations. The QT interval of the electrocardiogram may shorten as the serum calcium rises.
Clinically, a transfusion reaction should be suspected when the patient complains of fever, chills, low back pain, breathlessness, or a burning sensation at the site of infusion. If the reaction progresses, the patient may develop hypotension, bleeding, respiratory failure, and acute tubular necrosis. More severe reactions occur in anesthesized or unconscious patients because of their inability to alert the staff that something is amiss. The management of a patient with a possible transfusion reaction begins with the immediate discontinuation of the transfusion. While the transfusion workup is in progress, the patient should be aggressively hydrated in order to maintain a brisk diuresis (at least 100 mL h) for at least 24 h. Furosemide may be required to maintain the diuresis. Cardiorespiratory support may be needed. The laboratory evaluation of a possible hemolytic transfusion reaction includes the finding of hemoglobinemia (elevated plasma free hemoglobin) and hemoglobinuria. Other...
The patient who embellishes a medical history, exaggerates pain perception, or provides responses on physical examination inconsistent with known physiology can be particularly challenging.15 This condition can be objectified in the physical exam with the use of Waddell's nonorganic physical signs. 20 Tests can be included in the flow of the general physical exam for the back. Testing includes tenderness to superficial skin rolling report of low back pain with axial loading or when the whole body is rotated as one the flip test, in which the patient does not report pain with seated straight leg raise (often using distraction of manual muscle testing the quadriceps or ankle dorsiflexors) but reports pain at a low angle on the supine SLR weakness or sensory loss in a nonanatomic distribution and overreaction with pain behaviors. If three or more of these signs are present, it represents increased psychological distress on the part of the patient to their condition. While it can be...
Pain is classically described as acute, severe, unrelenting and diffuse reported in the chest, neck and abdomen and with radiation to the back and shoulders. Back pain may be the predominant symptom. Pain is often exacerbated by swallowing. Dysphagia, dyspnea, hematemesis, and cyanosis can be present as well. Less acute and atypical presentations are also described. Esophageal perforation is often ascribed to acute myocardial infarction (MI), pulmonary embolus, peptic ulcer disease, aortic catastrophe, or acute abdomen, resulting in critical delays in diagnosis, the most important factor in determining morbidity and mortality outcome.
Trauma to the genitourinary (GU) tract should be considered in all children with multiple trauma, a pelvic fracture, or injury to the flank, back, or groin. GU injuries are uncommon in children, occurring in only 10 percent of trauma patients. Symptoms and physical findings are often nonspecific, including back pain, abdominal pain, hypotension, and abdominal wall trauma. Pelvic fractures, particularly anterior ring fractures, are associated with urethral and bladder injury. Children are less likely to die of hemorrhage from a pelvic fracture than are adults. Often, other coexisting injuries mask the signs and symptoms of GU trauma in a multiply-injured child.
Backache and neck pain can occur from poor patient positioning and as a result of stretched ligaments and relaxed skeletal muscle. Arms and legs can slip off operating tables or trolleys, if inadequately secured, with the potential for ligament and bony injuries. Nerve injuries have been extensively reported and are a result of direct compression or stretching of the nerve. Correct patient positioning and extensive padding of exposed sites are mandatory. The brachial plexus can be damaged if there is excessive abduction of the arm ( 90 degrees) with the humeral head impinging on the axillary neurovascular bundle. The radial nerve, as it runs down the lateral border of the arm 3-5 cm above the lateral epicondyle, is at risk of being damaged by a blood pressure cuff. Radial nerve palsy is associated with wrist drop, weakness of finger extension, and loss of sensation in the first web space. The ulnar nerve is exposed at the elbow and can be damaged by direct trauma or the blood pressure...
Mechanical dysfunction can occur within the sacroiliac (SI) joints. Sacroiliac joint pain is commonly referred to the inguinal and anterolateral thigh, as well as the lower abdominal quadrants, often simulating an acute appendicitis or ovarian cyst. Inflammatory processes can involve the SI joints, as in the seronegative spondyloarthropathies. Early in this process there may be little or no correlation between symptom severity and radiographic evidence of joint involvement. The pain is usually experienced over the joints themselves, radiating to the anterior lateral or posterior thighs. Usually worse at night, the pain may be bilateral, alternating from side to side. Prolonged standing or sitting, especially on long car trips, exacerbates the discomfort. Weakness or stiffness, primarily in the morning, is also a predominant symptom of sacroiliitis. When in young men, stiffness may be associated with new-onset rheumatoid spondylitis the earliest complaint may be that of chest pain and...
Fibrin thrombi formation in the mucosa of the small intestine considerable autolysis of autopsy specimen. This individual died of septic shock due to Staphylococcus aureus sepsis as a consequence of an intragluteal injection of diclofenac for treatment of lumbago. Fig. 3.31. Fibrin thrombi formation in the mucosa of the small intestine considerable autolysis of autopsy specimen. This individual died of septic shock due to Staphylococcus aureus sepsis as a consequence of an intragluteal injection of diclofenac for treatment of lumbago.
The differential diagnosis of biliary colic includes other conditions associated with upper abdominal pain, including gastritis, gastroesophagal reflux, pancreatitis, hepatitis, and peptic ulcer disease. Atypical myocardial infarction should be considered in older patients. Acute renal colic can be associated with upper abdominal and upper back pain. Both conditions can also be associated with flank tenderness, nausea, and vomiting. Renal colic does not have a circadian rhythm, and the pain is colicky, not continuous, as in biliary colic. Nonetheless, it can be difficult to distinguish biliary from renal colic, and definitive imaging studies may be needed to make the correct diagnosis. Acute pyelonephritis, like cholecystitis, can be associated with flank and upper quadrant pain, but pyuria confirms the former diagnosis. Appendicitis can sometimes be associated with RUQ pain, especially in pregnancy or in patients with a retrocecal or redundant appendix. In women of childbearing age,...
Because of the spectrum of drug-seeking patients, the history given may be factual or fraudulent. Drug seekers may be demanding, intimidating, or flattering. In one ED study, the most common complaints of patients who were drug seeking were (in decreasing order) back pain, headache, extremity pain, and dental pain. 23 Patients may complain of panic disorder or drug withdrawal symptoms and request benzodiazepines. Additional fraudulent techniques are listed in Iab e,3.4-4 In some cases, observations of vital signs and physical examination findings will help the physician identify factitious illness, but even experienced clinicians are frequently misled.23
Evolutionary medicine has proposed explanations for an array of modern ailments ranging from obesity to lower back pain, asthma, otitis media, depression, and addictions. Allergies, for example, are thought to be related to originally adaptive responses to parasitic infections (Nesse & Williams, 1994). Even more problematic are evolutionary explanations for current behavioral aberrations, such as homicidal assault, sexual abuse and incest, depression, and infanticide. Intellectually it may be satisfying to link contemporary ills to past conditions, but the extent of genetic determinism is problematic.
Haemolytic shock phase - this may start within minutes after a few millilitres of blood have been transfused or may take 1-2 h after the end of the transfusion to develop. Symptoms include urticaria, lower backache, flushing, headache, shortness of breath, precordial pain and hypotension. These symptoms may be difficult to identify in the anaesthetized patient or the unconscious intensive therapy unit (ITU) patient. Laboratory examinations will reveal evidence of blood cell destruction, jaundice and disseminated intravascular coagulation. Urinalysis will demonstrate haemoglobinuria.
Additionally, pain of remote origin, even outside the spine itself, can present as lumbar pain. Lesions within the central nervous system, and in the spinal cord at or above the lumbar area, can also produce both low back pain and radicular leg discomfort. Parasagittal brain tumors and thoracic root lesions, including neurofibromata, can simulate lumbar root syndromes. Based on their shared segmental innervation, pain from visceral disorders, including those of kidney, pancreas, and gallbladder duodenal ulcers colonic diverticulitis expanding abdominal aortic aneurysm epidural hematoma or abscess and endometriosis, can all mimic primary low back disorders. Pain from a leaking abdominal aortic aneurysm is constant and aching and may be referred to the lower abdomen and inguinal areas as well as the low back. In the evaluation of low back pain in the elderly, an abdominal aortic aneurysm must always be considered in the differential diagnosis. Costovertebral angle percussion pain is...
Complete eradication of pain is not a reasonable end point in most cases. Rather, the goal of therapy is pain reduction and return to functional status. Chronic pain syndromes discussed in this chapter include myofascial headaches, transformed migraine headaches, fibromyalgia, myofascial chest pain, back pain, complex regional pain types I and II, postherpetic neuralgia, and phantom limb pain. Drug-seeking patients are also covered.
Overall, it appears that the cognitive-behavioral approach has a positive additive effect to active treatments (e.g., medications, physical therapy, and medical treatments) for chronic pain clients (in treating pain, cognitive appraisals, and pain behavior problems see meta-analysis study by Morley et al., 1999). However, for chronic low back pain clients, this did not appear to be the case (see meta-analysis by van Tulder et al., 2000).
On examination of these patients, it is imperative to perform a full neurological examination paying specific attention to the sacral dermatomes and myotomes and their associated reflexes. Assessment of anal tone and sensation can be performed at the same time as DRE. In patients with symptoms suggestive of cauda equina compression, such as back pain and saddle anesthesia, urgent magnetic resonance imaging (MRI) scanning should be performed with a view to urgent neurosurgical intervention where appropriate. Some patients in this group may have known metastatic bone disease, in which case MRI followed by urgent radiotherapy may be required. Both of these events will not effect the immediate management of AUR, i.e., cathe-terization. If treated early, normal neurological function should return after a period of time, but any delays to treatment are associated with worse long-term recovery.
A 47-year-old man presents to the emergency room with a 1-week history of fever, malaise, and back pain. The patient's symptoms began insidiously, but have been severe enough to keep him home from work for the past 2 days. The patient was previously healthy, but reports having been told he had a heart murmur caused by mitral valve prolapse. He has no significant family history of medical illness. Further questioning reveals that the patient had a tooth extracted 5 weeks prior to presentation. He does not recall having taken antibiotics prior to the extraction (or at any time during the past 2 months). He denies having ever used intravenous drugs.
Other applications of EMG biofeedback are to reduce specific muscle activity in the treatment of tension headaches, back pain associated with skeletal muscle hyperactivity, and other conditions of inappropriate muscle activity such as writer's cramps. EMG biofeedback is also used to recruit muscle activity, to aid in the rehabilitation of muscle paresis resulting from injuries such as strokes.
Interdisciplinary Issue The Spine and Low-Back Pain One of the most common complaints is low-back pain.The medical literature would say that the etiology (origin) of these problems is most often idiopatic (of unknown origin). The diagnostic accuracy of advanced imaging techniques like magnetic resonance imaging (MRI) for identifying spinal abnormalities (e.g., disk herniation) that correlate with function and symptoms of low-back pain is poor (Beattie & Meyers, l998).The causes of low-back pain are complicated and elusive. Biomechanics can contribute clues that may help solve this mystery. Mechanically, the spine is like a stack of blocks separated by small cushions (McGill, 2001). Stability of the spine is primarily a function of the ligaments and muscles, which act like the guy wires that stabilize a tower or the mast of a boat.These muscles are short and long and often must simultaneously stabilize and move the spine.Total spine motion is a summation of the small motions at each...
The incubation period is not well established, but is in the range of 1-4 weeks. 1,2 The majority of infections are asymptomatic or nonspecific. Very few cases of non-encephalitic illness have been described, as it is likely that most are undiagnosed or unreported. Two cases were identified during an epidemic in Western Australia (WA) in 2000. The illness consisted of headache, myalgia, and backache with or without recorded fever. 3 Both had a spontaneous recovery.
Placental production of the hormone relaxin stimulates generalized ligamentous relaxation. This results in widening of the pubic symphysis, increased mobility of the sacroiliac, sacrococcygeal and pubic joints. As the uterus enlarges, lumbar lordosis is enhanced to maintain the woman's centre of gravity over the lower extremity. As a result, most pregnant women experience low back pain.
Occasionally, the tumour spreads to para-aortic lymph nodes, lungs, liver and brain. These may present with backache, haemoptysis, jaundice or neurological events. Testicular tumours occur in relatively young men, late teens to early 30s. Teratoma tends to occur in the younger age range and semi-noma in the slightly older group.
Lumbarplexopathy, or diabetic amyotrophy, occurs in diabetic patients and presents with back pain followed by weakness. Patients report the acute onset of ipsilateral back pain, followed within days by progressive leg weakness. Sensory findings are absent. The examination reveals decreased leg power in a variety of patterns reflecting impairment of plexus function with relatively symmetric sensation. There may be muscle wasting in affected limbs in long-standing disease. Deep tendon reflexes may be diminished on the affected side. Bowel and bladder functions are not affected.
The prehospital treatment of patients with spinal cord injury involves recognition of patients at risk, proper triage, and early care. All patients who have complaints of neck or back pain or who have tenderness on prehospital assessment must be presumed to have a spine injury until proven otherwise. Traditionally, all patients with significant injury above the clavicle are also presumed to have cervical spine injury regardless of related complaints. All patients with neurologic complaints must be presumed to have a spinal cord injury. Sometimes this is obvious, as in a patient with flaccid paraplegia. More often, symptoms are much more subtle (numbness or tingling in an extremity). Appropriate triage is imperative, as the results of the treatment for spinal cord injury are somewhat time-related. Therefore, initial triage to a center that is capable of rapid diagnostics and therapeutics is essential to optimize outcome following spinal cord injury. NEUROLOGIC EXAMINATION Once patients...
In general, an x-ray of the cervical spine is part of the standard triage for blunt trauma. The utility of plain films of the cervical spine over the clinical examination to identify injury in patients who are alert, oriented, and have no neck or back pain is questionable. 1819 Many centers have abandoned use of cervical spine x-rays in such patients. There is a substantial difference, however, in patients who are not alert and awake. The frequency of cervical spine injury in association with blunt head trauma is about 2 to 5 percent. However, it increases to almost 9 percent in patients with significant head injury, defined as a Glasgow Coma Scale score
There are remnants of these primitive notions of disease in today's lay language. For example, in English slang menstruation is sometimes called the curse the German word for lumbago, Hexenschuss, means witch's wound. To what extent one can observe these assumptions about sickness and health, and the social structures that correspond to them, among the primitive peoples of today is hard to say. Modern civilization and medicine have left their impact in every part of the world. Primitive peoples, too, change over time.
CT of the spine, particularly of the lumbar spine, following administration of intrathecal contrast material is occasionally performed for the evaluation of back pain. This procedure, CT myelography, has been essentially replaced by MRI, which provides significantly better visualization of the spinal cord, nerve roots, and intervertebral disks. CT myelography should only be performed in special cases, such as preoperative evaluation and planning.
While melena or unexplained hematomas may be obvious signs of warfarin complications, less obvious presentations should also prompt investigation. Subtle confusion in an elderly patient on warfarin may suggest a subdural hematoma, and tachycardia with back pain may occur with retroperitoneal bleeding. An episode of gastrointestinal bleeding or hematuria may be a marker for underlying pathology and mandates further investigation.
The last documented case of endemic smallpox occurred in Somalia in 1977. While repositories of the virus currently are held by the United States and Russia, it is possible that others exist. An outbreak of smallpox would be an international emergency, given the high rate of person-to-person transmission and the termination of public vaccination programs that has rendered civilian and military populations now susceptible. Desirable properties of this virus in terms of weaponization are its relative ease of cultivation and stability on freeze-drying. Mortality of variola major is 3 to 30 percent depending on immune status. Following an incubation period averaging 12 days, abrupt onset of fever, rigors, vomiting, headache, backache, and in severe cases, delirium occurs. Two to three days later, an enanthem appears, along with a centrifugal rash on the face, hands, and forearms. The lower extremities and trunk become involved over the next week as lesions progress from macules to papules...
The degree of symptomatology is quite variable. The most common complaint is a feeling of heaviness or fullness in the pelvis. Others may describe something falling out. More diffuse complaints include backache, pelvic discomfort, and discomfort or straining with defecation or urination. Cystocele may present with frequency, urgency, incontinence, or ultimately, retention (especially if displacement causes kinking of the ureter), whereas rectocele may present with difficulty evacuating the rectal vault.1 A characteristic not to be overlooked is the worsening of symptoms with prolonged standing followed by alleviation when lying down. Women may become extremely tolerant of prolapse symptoms and present with advanced complications such as infection of the prolapsed segment, decubitus ulceration, bleeding, and carcinoma of the cervix.
The adipose fat cell is not only a passive storage site but an endocrinologically active secretor of many substances like leptin, adiponectin, and cyto-kines, which participate in an inflammatory response and may mediate a host of adverse consequences, including insulin resistance and diabetes. Obesity is related to an increased risk of developing type 2 insulin-resistance diabetes mellitus, hyper-lipidemia, heart disease, obstructive sleep apnea, asthma and other respiratory problems, back pain and orthopedic problems, fatty liver (nonalcoholic steato-hepatitis or NASH), gallstones, and depression. The increasing incidence of type 2 diabetes in obese adolescents is already being noticed, with estimates of 200 000 diabetics under age 20 years in the US predicted to rise to a lifetime risk of developing diabetes of 33-39 for those born in the year 2000.
Gaining too much weight can make pregnancy an uncomfortable experience, causing backache, leg pain, and varicose veins. Varicose veins can occur anywhere there is increased pressure in a vein close to the skin, but they are most common in the legs and ankles. Varicose veins do not usually cause any symptoms, but when there are symptoms, they are often worse after prolonged sitting or standing, or late in the day.
Adenocarcinoma in the head of the pancreas accounts for 80-90 of pancreatic cancer. Pancreatic cancer is a devastating disease because it is rapidly fatal the case fatality ratio is 0.99, median survival is 6 months or less, 1-year survival is approximately 20-30 , and 5-year survival is less than 5 . There is no effective screening modality for pancreatic cancer. The disease is difficult to diagnose and detect because the disease process is either silent or present with nonspecific symptoms, such as unexplained weight loss, back pain, nausea, jaundice, and altered intestine habits. In approximately 80-90 of cases, the cancer is diagnosed at a nonresectable stage when even small tumors have metastasized to other organs, most commonly the liver. Patients undergo cachexia, a complex metabolic syndrome clinically presenting with progressive weight loss and depletion of reserves of adipose tissue and skeletal muscle. Pancreatic cancer cells are particularly resistant to radiotherapy and...
N Engl J Med 328 291, 1988. 4. Deyo RA, Tsui-Wu YJ Descriptive epidemiology of low back pain and its related medical care in the United States. Spine 12 264, 1987. 5. Andersson GBJ, Svensson H-O, Oden A The intensity of work recovery in low back pain. Spine 8 880, 1983. 6. Carey TS, Garrett J, Jackman A, et al The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. Spine 14 913, 1995. 7. Nachemson AL Newest knowledge of low back pain A critical look. Clin Orthop 279 8, 1992. 11. Dreyer SJ, Dreyfuss PH Low back pain and the zygapophysial (facet) joints. Arch Phys Med Rehabil 77 290, 1996. 13. Kuslich SD, Ulstrom CL, Michael CJ The tissue origin of low back pain and sciatica A report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. Orthop Clin North Am 22(2) 181, 1991. 15. Bigos S, Bowyer O, Braen G, et al Acute...
Another aspect of empowerment is the ability of e-consumers to learn on their own or from one another, accessing current and relevant e-health information resources about treatments and medical procedures available for particular illnesses. Best practices can be easily shared. The increased ability of e-consumers to search, retrieve, store, learn about, and transmit specific health information regarding a certain disease group both for themselves and for others will make an appreciable difference in the management and control of these illnesses. Problems related to management of chronic ailments, such as diabetes and lower back pain, are especially amenable to this approach.
Another extremely useful book from the authors of 'Be Your Own Doctor With Acupressure', Be Your Own Doctor With Magnet Therapy'''From Fat to Fit') Prevent Heart Disease and Prolong Life', 'Vision Training Programme To Improve Eyesight', 'Backache Prevention And Cure', 'Diabetes High Blood Pressure Without Any Fear' and other popular works.
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Dealing With Back Pain
Deal With Your Pain, Lead A Wonderful Life An Live Like A 'Normal' Person. Before I really start telling you anything about me or finding out anything about you, I want you to know that I sympathize with you. Not only is it one of the most painful experiences to have backpain. Not only is it the number one excuse for employees not coming into work. But perhaps just as significantly, it is something that I suffered from for years.