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Rheumatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Low back pain can be caused by: Any component of the thoracolumbosacral area: vertebrae, intervertebral discs, apophyseal joints, ligaments and paraspinal and abdominal musclesAssociated structures: may be retroperitoneal (kidneys, uterus and associated structures), genitourinary (bladder, prostate) or vascular (aortic aneurysm)Systemic disease: sickle cell disease, infection
Answers
Published in Ken Addley, MCQs, MEQs and OSPEs in Occupational Medicine, 2023
Gait disturbance is a red flag. An appropriate history and physical examination directed towards uncovering signs that suggest a serious underlying cause of low back pain is very important. Red flags also include pain that lasts more than six weeks, pain in persons younger than 18 years or older than 50 years, pain that radiates below the knee, a history of major trauma, constitutional symptoms, atypical pain (e.g., that which occurs at night or that is unrelenting), the presence of a severe or rapidly progressive neurological deficit, urinary and/or faecal incontinence, poor rectal tone and a history of malignancy.
Orthopaedics
Published in Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol, Handbook of Aviation and Space Medicine, 2019
Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol
Low back pain: Back pain is common in the population.Factors that are thought to provoke back pain include vibration, posture and sudden maximal effort.A higher incidence of back pain has been reported in certain groups of workers, such as truck drivers, heavy manual workers and nurses; higher incidence of back pain also reported in aviators.Rotary-wing aircrew are at particular risk (see Chapter 2), but crews of all aircraft types report low back pain.
Fibromyalgia and Nutrition: An Updated Review
Published in Journal of the American College of Nutrition, 2021
Laura Tomaino, Lluís Serra-Majem, Stefania Martini, Maria Rosaria Ingenito, Paola Rossi, Carlo La Vecchia, Fabrizia Bamonti, Luisella Vigna
Musculoskeletal pain is one of the clinical manifestations of FM and a randomized controlled trial conducted on 21 FM female patients aimed to investigate the efficacy of physiotherapy combined with a lacto-vegetarian diet an low back pain and body composition (34). The rationale of this study is that FM is associated to low levels of functional and physical capacity. Thus, physical exercise would improve symptoms of low back pain. Moreover, the dietary and exercise intervention would contribute to a body composition change, with improved muscular mass in the lumbar district. Participants were randomized to three groups: group A was assigned to core stabilization exercises and a lacto-vegetarian diet, group B placebo (ultrasound rehabilitation with the device turned off) and lacto-vegetarian diet, and group C control (dietary recommendations only). Group A showed significant improvement in Visual Analogic Scale (VAS) of pain (basal 6.7 ± 1.1, post-intervention 3.0 ± 1.4, p-value < 0.05). Provided that all the patients presented a normal BMI (18.5–24.9 kg/m2) at baseline and at the end of the intervention, group A showed an improvement in terms of fat-free mass (kg and %), and a significant reduction of fat mass (kg and %) after the intervention, while group B did not show any significant differences, and group C showed improved fat mass (% and kg), and reduced muscular mass (kg). The authors conclude that this 4-week combined intervention program contributes to pain reduction and improved body composition in patients with FM and low back pain (34).
Paracetamol for low back pain: the state of the research field
Published in Expert Review of Clinical Pharmacology, 2020
Bart Koes, Marco Schreijenberg, Alexander Tkachev
In most people with low back pain, the precise cause of the pain is unknown. In only a small proportion (up to 5–10%) of patients presenting in primary care underlying pathologies, such as malignancies, fracture, infections can be identified. When specific pathologies explaining the back pain are not present, the complaints are labeled as being nonspecific. It hampers adequate treatment that in most cases no cause of the pain can be found, since no causal treatment can thus be applied. Consequently, many treatments for low back pain are focused on reduction of symptoms. There are many treatments available for people with back pain. This includes non-pharmacological treatments (patient education, exercises, manual therapies) and pharmacological treatments (mostly pain medications, including paracetamol) [16]. Some patients suffering from low back pain also receive surgery. Especially patients with persisting radicular pain (>6–8 weeks) in the leg due to a herniated disk are regarded as surgical candidates. At the same time, there is good evidence that recovery rates after 1 and 2 years follow up are more or less similar between patients receiving disc surgery or prolonged conservative care [17]
Anti-nerve growth factor antibodies for the treatment of low back pain
Published in Expert Review of Clinical Pharmacology, 2020
Falin Patel, Demere K. Hess, Dermot P. Maher
The treatment of low back pain is frequently a prolonged process yielding small changes in symptoms in only a fraction of patients. Current therapies carry relatively large risk, such as the risk of spine surgical mortality or opioid-induced respiratory arrest. While emerging data suggests that anti-NGF mAbs are a potentially useful strategy, optimal patient selection remains to be clarified. It is also not clear if the risk of treatment-related AEs with these medications will outweigh the well-described morbidity and mortality of other treatments of low back pain. In order to better determine the role of anti-NGF mAbs in treating cLBP, further studies focused on specific pathologies of cLBP in the setting of different comorbid conditions with demographic subgroup analyses should be conducted. In doing so, the potential interactions would be better understood between anti-NGF and other medications and the uses of anti-NGF for specific pathologies. However, the therapeutic potential of novel pharmacological agents as part of a multi-modal approach to low back pain is promising. More studies of the use of anti-NGF mAbs in LBP should include lower doses to better illustrate the risks, and differentiate the pathology of the low back pain to better define efficacy.