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Pain in pregnancy, childbirth, and the puerperium
Published in Pamela E Macintyre, Suellen M Walker, David J Rowbotham, Clinical Pain Management, 2008
Lumbar back pain is common during pregnancy, with an estimated incidence of greater than 50 percent during pregnancy.13, 14 Approximately 20 percent of pregnant women will report severe pain, and one-third of these will be disabled.15 The disability from back pain may continue after childbirth. The etiology of back pain in many women relates to the increased lordosis and tension placed on the lumbar spine during gestation. Furthermore, the forward tilt of the pelvis, which is necessary for ideal placement of the pelvis canal for passage of the fetus, causes significant lordosis. Sacroiliac joint dysfunction is also a common cause of pain. The risk factors for back pain during pregnancy include: younger or older age;previous history of backache;obesity;lack of physical exercise.
Treatment of Myofascial Pain Syndromes
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
Robert D. Gerwin, Jan Dommerholt
A distinction must be made between a true and an apparent leg length discrepancy. An apparent leg length discrepancy or functional shortening may be caused by a pseudo-scoliosis where the legs are actually of equal or nearly equal length, by hip adductor contractures, by hip capsule tightness, or by posterior innominate rotation, because the acetabulum is anterior to the iliosacral rotation axis (LeVeau, 1994; Mitchell, 1993; Reid, 1992). The cause must be identified and then corrected where possible. If the problem is an ilial rotation, the rotation should be corrected. If it is combined with a sacroiliac joint dysfunction, that should be corrected as well. Quadratus lumborum or iliopsoas muscles shortened by trigger points, a cause of pseudo-scoliosis, must be inactivated by stretching or by other means, such as MTrP injections. Placing a heel lift under an apparent shorter leg may increase the leg length discrepancy. Functional shortening, pseudo-scoliosis, and pelvic obliquity can be corrected via osteopathic mobilizations and muscle energy techniques (Fowler, 1994; Greenman, 1991).
Metabolic Approaches to the Treatment of Back Pain
Published in Kohlstadt Ingrid, Cintron Kenneth, Metabolic Therapies in Orthopedics, Second Edition, 2018
Carrie Diulus, Patrick Hanaway
Stress: Psychosocial stressors: Chronic and acute psychologic stress are linked with numerous pain syndromes. These can be focal such as migraine and back pain or more systemic such as symptom complexes that fall under the category of the diagnosis of fibromyalgia. The specific mechanisms of these associations have not yet been elucidated; however, stress plays a significant role in altering both hormones and neurotransmitters. Chronically elevated cortisol or chronic insufficiency of cortisol impacts the ability to heal an acute injury, resulting in an inflammatory cascade.Trauma/Acute injury: Orthopedic injuries are clear causes of acute low back pain. Spinal fracture, even when healed, can change the biomechanical stresses seen within the different spinal columns and segments and this can lead to prolonged pain or remote degenerative changes. Muscle-related injury and the resulting intramuscular scarring are also factors that can contribute to axial back pain and altered spinal biomechanics. Injury, however, does not have to be as dramatic as a fracture. Improper or repetitive lifting places abnormal stresses across spinal elements and can lead to injury. Sometimes this is a muscle-related injury; however, it can also involve the facet joints and the annulus of the intervertebral disc. Annular tears are associated with inflammatory markers and are associated with an increased incidence of back pain and degeneration. Patients will often not remember the moment the “trauma” occurred or report that the pain didn’t start for several days after the traumatic event. The mechanism of this delay is felt to be related to an inflammatory threshold. Patients will then report substantial muscle spasm which is intensely painful and can be debilitating. It is this muscle spasm that often causes patients to seek acute care. Under optimal conditions, acute spine-related injury goes through the acute inflammatory process, which leads to tissue healing and resolution of inflammation. There are, however, factors that can lead to impaired healing and prolonged inflammation, which can result in chronic low back pain.Hormonal factors: Estrogen seems to play a significant role in disc degeneration. Looking at age-matched controls, young men have higher rates of radiographically identified disc degeneration than pre-menopausal women [21–25]. Post-menopausal women, however, have a higher rate of developing severe degenerative disc changes than age-matched men. There is also a higher incidence of degenerative spondylolisthesis in women who have undergone oophorectomy compared with age-matched women with functioning ovaries [26, 27]. In addition to axial back pain from spine-related disorders, women are more frequently impacted by sacroiliac joint dysfunction in the absence of a history of trauma or instrumented lumbar fusion.
Six Month Interim Outcomes from SECURE: A Single arm, Multicenter, Prospective, Clinical Study on a Novel Minimally Invasive Posterior Sacroiliac Fusion Device
Published in Expert Review of Medical Devices, 2022
Aaron K. Calodney, Nomen Azeem, Patrick Buchanan, Ioannis Skaribas, Ajay Antony, Christopher Kim, George Girardi, Chau Vu, Christopher Bovinet, Rainer S. Vogel, Sean Li, Naveep Jassal, Youssef Josephson, Timothy R. Lubenow, Nicholas Girardi, Jason E. Pope
Sacroiliac joint dysfunction is a condition affecting the sacroiliac joint (SIJ) resulting in non-radicular low back and buttock pain. Patients with this condition often report referred pain in the posterior thigh, knee, or foot with the posterior thigh constituting up to 50% of patient reported referral patterns [1]. It can be due to primary joint disease from trauma or secondary to rheumatologic, infectious, drug-related, or oncologic diseases [2]. It has a become an increasingly recognized cause of low back pain, affecting 15–30% of people with chronic, non-radicular pain [3].