Fast Back Pain Cure
Several tests are useful in differentiating between organic and non-organic back pain (e.g. that caused by depression or complained of by a known malingerer). 2. The person with non-organic back pain will usually refuse on the grounds that it would cause great pain or that he or she might overbalance in the attempt. 2. This will cause no discomfort to (most) patients with organic back pain.
Low back pain accounts for at least 5 of general practice presentations. The most common cause is minor soft tissue injury, but patients with this do not usually seek medical help because the problem settles within a few days. Most back pain in patients presenting to general practitioners is due to dysfunction of elements of the mobile segment, namely the facet joint, the intervertebral joint (with its disc) and the ligamentous and muscular attachments. This problem, often referred to as mechanical pain or traumatic joint derangement, will be described as vertebral dysfunction a general term that, while covering radicular and non-radicular pain, includes dysfunction of the joints of the spine.
1 Cancer as a cause of back pain 2 Infection as a cause of back pain 3 Cauda equina syndrome as a cause of back pain (due to large central disc protrusion or other cause of lumbar canal stenosis) 4 Significant disc herniation as a cause of back pain 5 Abdominal aortic aneurysm as a cause of back pain Back pain 77
Thoracic back pain due to mechanical causes is not such a feature in the elderly although vertebral dysfunction still occurs quite regularly. However, when the elderly person presents with thoracic pain, a very careful search for organic disease is necessary. Special problems to consider are
The most common cause of thoracic back pain in children is 'postural backache', also known as 'TV backache', which is usually found in adolescent schoolgirls and is a diagnosis of exclusion. Important, although rare, problems in children include infections (tuberculosis, discitis and osteomyelitis) and tumours such as osteoid osteoma and malignant osteogenic sarcoma. Dysfunction of the joints of the thoracic spine in children and particularly in adolescents is very common and often related to trauma such as a heavy fall in sporting activities or falling from a height, e. g. off a horse. Fractures, of course, have to be excluded. Inflammatory disorders to consider are juvenile ankylosing spondylitis and spinal osteochondritis (Scheuermann's disorder), which may affect adolescent males in the lower thoracic spine (around T9) and thoracolumbar spine. The latter condition may be asymptomatic, but can be associated with back pain, especially as the patient grows older. It is the commonest...
RACGP Back Pain Course participant, Brisbane 1986 Thoracic (dorsal) back pain is common in people of all ages including children and adolescents. Dysfunction of the joints of the thoracic spine, with its unique costovertebral joints (which are an important source of back pain), is very commonly encountered in medical practice, especially in people whose lifestyle creates stresses and strains through poor posture and heavy lifting. Muscular and ligamentous strains may be common, but they rarely come to light in practice because they are self-limiting and not severe.
The common mechanical disorders of the intervertebral joints can cause back pain in children, which must always be taken seriously. Like abdominal pain and leg pain, it can be related to psychogenic factors, so this possibility should be considered by diplomatically evaluating problems at home, at school or with sport. Tumours causing back pain include the benign osteoid osteoma and the malignant osteogenic sarcoma. Osteoid osteoma is a very small tumour with a radiolucent nucleus that is sharply demarcated from the surrounding area of sclerotic bone. Although more common in the long bones of the leg, it can occur in the spine. In older children and adolescents the organic causes of back pain are more likely to be inflammatory,
Like headache, back pain is a symptom of an underlying functional, organic or psychological disorder. 5 Preoccupation with organic causation of symptoms may lead to serious errors in the assessment of patients with back pain. Any vulnerable aching area of the body is subject to aggravation by emotional factors.
Several double-blind studies have reported benefit with devil's claw in people with back pain. A double-blind study of 117 people with back pain reported decreased pain and improved mobility after 8 weeks' treatment with devil's claw extract LI 174, known commercially as Rivoltan (Laudahn & Walper 2001). Use of the same extract provided significant pain relief after 4 weeks in another randomised, double-blind placebo-controlled study of 63 subjects with muscle stiffness (Gobel et al 2001). Similar results were reported in two double-blind studies of 118 people (Chrubasik et al 1996) and 197 people (Chrubasik et al 1999) with chronic lower back pain. from that study who were all given devil's claw for 1 year found that it was well tolerated and improvements were sustained (Chrubasik et al 2005). In an open, prospective study, an unspecific lower back pain treatment with Harpagophytum extract and conventional therapy were found to be equally effective (Schmidt et al 2005). Devil's claw...
This usually presents with inflammatory back pain (sacroiliac joints and spine) and stiffness in young adults, and 20 present with peripheral joint involvement before the onset of back pain. It usually affects the girdle joints (hips and shoulders), knees or ankles. At some stage over 35 have joints other than the spine affected.
Recent studies have focused on the importance of disruption of the intervertebral disc in the cause of back pain. A very plausible theory has been advanced by Maigne 3 who proposes the existence, in the involved mobile segment, of a minor intervertebral derangement (MID). He defines it as 'isolated pain in one intervertebral segment, of a mild character, and due to minor mechanical cause'. It is independent of radiological and anatomical disturbances of the segment. The most common clinical situation occurs where a vertebral level is found to be painful and yet to have a normal static and radiological appearance. Fig. 33.2 Reflex activity from a MID in the intervertebral motion segment. Apart from the local effect caused by the disruption of the disc (A), interference can occur in the facet joint (B) and interspinous ligament (C) leading possibly to muscle spasm (D) and skin changes (E) via the posterior rami REPRODUCED FROM C. KENNA AND J. MURTAGH, BACK PAIN AND SPINAL MANIPULATION,...
The common presentation is back pain and radicular pain that follows the appropriate dermatome. However, disc lesions in the thoracic spine are prone to produce spinal cord compression, manifesting as sensory loss, bladder incontinence and signs of upper motor neurone lesion. The disc is relatively inaccessible to surgical intervention, but over the past decade there has been a significant improvement in the surgical treatment of thoracic disc protrusions, due to the transthoracic lateral approach.
It is important to consider malignant disease, especially in an older person. It is also essential to consider infection such as acute osteomyelitis and tuberculosis, which is often encountered in recent immigrants, especially those from Asia. These conditions are considered in more detail under thoracic back pain. For pain or anaesthesia of sudden onset, especially when accompanied by neurological changes in the legs, consider cauda equina compression due to a massive disc prolapse and also retroperitoneal haemorrhage. It is important to ask patients if they are taking anticoagulants.
A patient with low back pain following lifting at work poses a problem that causes considerable anguish to doctors, especially when the pain becomes chronic and complex. Chronic pain may be the last straw for patients who have been struggling to cope with personal problems their fragile equilibrium is upset by the back pain. Many patients who have been dismissed as malingerers turn out to have a genuine problem. The importance of a caring, competent practitioner with an insight into all facets of his or her patient's suffering, organic and functional, becomes obvious. The tests for non-organic back pain are very useful in this context.
The commonest cause of low back pain is vertebral dysfunction, which then has to be further analysed. Muscle or ligamentous tears or similar soft tissue injuries are uncommon causes of back pain alone they are generally associated with severe spinal disruption and severe trauma such as that following a motor vehicle accident.
The management of 'mechanical' back pain depends on the cause. Since most of the problems are mechanical and there is a tendency to natural resolution, conservative management is quite appropriate. The rule is 'if patients with uncomplicated back pain receive no treatment, one-third will get better within 1 week and by 3 weeks almost all the rest of the other two-thirds are better'. 13 Practitioners should have a clear-cut management plan with a firm, precise, reassuring and conservative clinical approach.
Severe back pain in an unwell patient with fluctuating temperature (fever) should be considered as infective until proved otherwise. Investigations should include blood cultures, serial X-rays and nuclear bone scanning. Biphasic bone scans using technetium with either indium or gallium scanning for white cell collections usually clinch this diagnosis.
Low back pain for 5 months, after sudden onset of left sciatica (now settled) and low back pain (see Fig. 11.1 ). Fig. 11.1 Mr JR site of low back pain and illustration of painful limitation of movement on direction of movement diagram Back pain analysis Haemorrhoidectomy, mild episodes of back pain, appendicectomy.
Patients in this category seem to be the most frequently encountered in family practice. They clearly have a spondyloarthropathy but fail to meet the criteria for any one of the individual entities within the group. A typical patient is a young male in his third decade with a painful knee or other joint, unilateral (or bilateral) back pain with one of the entheseal problems, e.g. plantar fasciitis. Investigations
This writer undertook many small studies on common everyday problems during 10 years in country practice to determine the most effective treatments for which no or minimal evidence in the literature could be found. Many of these recommendations for problems such as tennis elbow, cold sores, aphthous ulcers, ingrown toenails, hiccoughs, back pain, nightmares, temporomandibular dysfunction and warts appear in this text. Although the numbers were relatively small it was a useful study to compare treatments for about ten or twenty cases to test hypotheses and allow trends to emerge. The results from a large controlled trial would, of course, take precedence over these recommendations if they differed. However, the exercise, albeit limited, added immense interest to one's practice, which at times can be tedious without such scholarly challenges.
It is important to utilise a type of fail-safe mechanism to avoid missing the diagnosis of these disorders. Some practitioners refer to consultations that make their 'head spin' in confusion and bewilderment, with patients presenting with a 'shopping list' of problems. It is in these patients that a checklist is useful. Consider the apparently neurotic patient who presents with headache, lethargy, tiredness, constipation, anorexia, indigestion, shortness of breath on exertion, pruritus, flatulence, sore tongue and backache. In such a patient we must consider a diagnosis that links all these symptoms, especially if the physical examination is inconclusive this includes iron deficiency anaemia, depression, diabetes mellitus, hypothyroidism and drug abuse.
Table 34.2 Non-musculoskeletal causes of thoracic back pain The acute onset of pain can have sinister implications in the thoracic spine where various life-threatening cardiopulmonary and vascular events have to be kept in mind. The pulmonary causes of acute pain include spontaneous pneumothorax, pleurisy and pulmonary infarction. Thoracic back pain may be associated with infective endocarditis due to embolic phenomena. The ubiquitous myocardial infarction or acute coronary occlusion may, uncommonly, cause interscapular back pain, while the very painful dissecting or ruptured aortic aneurysm may cause back pain with hypotension. back pain occurring in an older person unrelenting back pain, unrelieved by rest (this includes night pain) rapidly increasing back pain
This is a real surgical emergency in an elderly person who presents with acute abdominal and perhaps back pain with associated circulatory collapse (Fig 30.8). The patient often collapses at toilet because they feel the need to defecate and the resultant Valsalva manoeuvre causes circulatory embarrassment.
The slump test is an excellent provocation test for lumbosacral pain and is more sensitive than the straight leg raising test. It is a screening test for a disc lesion and dural tethering. It should be performed on patients who have low back pain with pain extending into the leg, and especially for posterior thigh pain.
Fig. 33.16 Lumbar spinal mobilisation illustration of the effective forces involved REPRODUCED FROM C. KENNA AND J. MURTAGH, BACK PAIN AND SPINAL MANIPULATION, BUTTERWORTHS, SYDNEY, 1989, WITH PERMISSION Spinal manipulation is a high velocity thrust at the end range of the joint. It is generally more effective and produces a faster response but requires accurate diagnosis and greater skill. It is extremely effective for uncomplicated persistent dysfunctional low back pain (without radicular pain) and, REPRODUCED FROM C. KENNA AND J. MURTAGH, BACK PAIN AND SPINAL MANIPULATION, BUTTERWORTHS, SYDNEY, 1989, WITH PERMISSION
Patient educational materials have been shown to have a beneficial effect. Giving patients a handout about tetanus increased the rate of immunisation against tetanus among adults threefold. 7 An educational booklet on back pain for patients reduced the number of consultations made by patients over the following year and 84 said that they found it useful. 8 The provision of systematic patient education on cough significantly changed the behaviour of patients to follow practice guidelines and did not result in patients delaying consultation when they had a cough lasting longer than 3 weeks or one with 'serious' symptoms. 9 backache ( Fig 10.3 )
Also known as 'breakbone fever', dengue is an arthropod-borne viral disease found mainly in Asia and Africa (click here for further reference). The features are the acute onset of fever, headache, retrobulbar pain, severe backache and aching of muscles and joints. Lymphadenopathy, petechiae on
Patients suffering from long-term pain are a special problem, especially those with back pain who seem to be on a merry-go-round of failed multiple treatments and complex psychosocial problems. These patients are frequently treated in pain clinics. As family doctors we often observe an apparently normal, pleasant person transformed into a person who seems neurotic, pain-driven and doctor-dependent. The problem is very frustrating to the practitioner, often provoking feelings of suspicion, uncertainty and discomfort. The author finds the following account a most useful method of explaining perplexing continuing back pain or neuralgia to patients (where there is no evidence of a persisting organic lesion).
Characterized by dysesthesia, burning pain, low back pain, and aching in the lower extremities and buttocks. The etiology of these symptoms attributed to radicular irritation. The symptoms usually appear within 24 hours after complete recovery from spinal anesthesia and resolve within 7 days.
Pharmacotherapy assessment starts with the assessment for need, followed by information on patient comprehension and ability. Need is based on identifying the cause of the pain, the types of pain, and the optimal drug to use for the identified pain. If, for example, a patient has back pain exacerbated by abdominal distention secondary to constipation, more opioid to treat the pain should not be given laxatives should be given instead. The laxative is not an analgesic per se, but for this patient, it is indeed the treatment of choice for increased back pain. Therefore, the assessment of need is the most important first step in pharmaco-therapy selection and design.
The theory behind IDET is that heat can modify the collagen and coagulate the pain nociceptors in the annulus of a disc. The exact mechanism of action remains unknown. IDET is a 40-minute outpatient procedure used to treat chronic, discogenic low back pain in patients who failed to respond to noninvasive treatment. In IDET, heat is delivered to the annulus via a specially designed electrode positioned in the outer circumference of a disc adjacent to the annulus fibrosis (see Fig. 10).
Overall impact of cubozoans is much greater as stings are not always reported. Carukia barnesi is now recognized as the cause of Irukandji syndrome, which results in severe backache, muscle pains, chest and abdominal pains, headache, localized sweating, and piloerection, as well as nausea and reduced urine output. There is a box jelly antivenom that binds to both C. fleckeri and C. barnesi, and vinegar can inhibit unfired nematocysts from firing (although it stimulates nematocyst firing with other cnidarians).
There are several other complications associated with localized rupture. With progressive atherosclerosis, the abdominal aortic aneurysms often develop inflammation and fibrosis of the adventitia. The inflammatory response may induce the aorta to adhere to the surrounding tissues or organs, which include the intestine, vena cava, and vertebral column. The abdominal aorta is a retroperitoneal structure. It lies immediately posterior to the 3rd and 4th portions of the duodenum, proximal to the ligament of Treitz. The duodenum in this location crosses the aorta at the level of the aortic bifurcation into the iliac arteries. Accordingly, this site, which is the most prevalent for atherosclerotic aneurysms, is susceptible to the rupture of an aneurysm into the intestine. This is known as an aorto-enteric fistula. It is virtually always fatal, with exsanguinating gastrointestinal hemorrhage. Rarely, it may produce a slow leak, and be a cause of chronic anemia. If the aortic aneurysm becomes...
In 10 or more of cases, the presentation of testicular GCT is a result of symptoms derived from metastatic disease. In some cases, this is due to the presence of a small primary tumor but massive fast-growing metastases. The most common first site for the development of metastatic disease is within retroperitoneal lymph nodes. The sentinel nodes from right-sided tumors are in the aortocaval area those from left-sided tumors are in the para- and preaortic areas, most frequently on the ipsilateral side. Nodal enlargement may cause local symptoms such as backache and loin pain, which may be more extreme when there is obstruction of the ureter, leading to hydronephrosis (Figure 5-10) or invasion of the psoas muscle and or the spine (Figures 5-11 and 5-12).* Compression of nerve roots can lead to leg weakness and muscle wasting. Nodal enlargement from metastatic disease within the retroperitoneum can also cause compression of the inferior vena cava (Figure 5-13), which in turn promotes the...
Although low-back pain is a very common ailment among the general population, it is perhaps even more among persons with MS. This may be related to abnormal postures and gaits associated with weakness and spasticity. Radicular pain may occur occasionally in the absence of compressive pathology and, in one report, was the presenting complaint in 3.9 of patients with newly diagnosed MS (51).
This syndrome involves persistent severe pain that cannot be explained by a physical disorder. An example would be a patient who has had an operation for back pain, but still has severe pain, or a patient who has been in a minor road traffic accident and sustained whiplash injuries, but is still complaining of incapacitating neck pain years later.
The incubation period for Ebola virus is between 3 and 21 days and for Marburg virus between 3 and 9 days. In contrast to Lassa fever, the onset of VHF caused by these viruses is abrupt, with onset of a prodrome lasting less than 7 days. This comprises non-specific symptoms including fever, chills, severe headache, malaise, myalgia and a maculopapular rash (onset day 2 to 7 typically on the face, neck, trunk and arms). This is followed by a rapid and progressive deterioration with severe, watery diarrhoea, abdominal pain and cramps, nausea and vomiting. Patients typically have ghost-like, drawn features with deep-set eyes and an expressionless facies. This phase is characterised by extreme lethargy. Other clinical features include chest pain, sore throat, hiccups, conjunctivitis, haematemesis, cough, photophobia and back pain.
The initial observation of bone pain and pathologic fractures in a number of our patients led us to investigate bone mineral density in a cohort of 30 patients (36) 15 30 patients (50 ) showed evidence of osteopenia osteoporosis, and in 5 of these 15 patients osteoporosis became a clinical problem with either pathologic fractures or moderate back pain.
The diathesis-stress model explains how we each have a certain threshold of biological and psychological vulnerability that when surpassed will result in symptom expression (Monroe & Simons, 1991). For example, when the level of stress in some individuals reaches a certain level they may develop lower back pain, while others may be subject to gastrointestinal disturbance. The most vulnerable bio-psychological systems will be the channel for anxiety. These biopsychosocial systems are genetically determined to some degree. All people have a diathesis, or a genetically predisposed vulnerability, in one area or another. Some people have very hearty, euthymic temperaments, maintaining positive moods in bleak situations, while others tend more toward dysthymia. Some have a genetic predisposition to bipolar-affective or schizophrenic spectrum disorders. This model is very helpful in understanding and predicting how a schizophrenic illness may be precipitated in an individual, when stress and...
A painless testicular mass is pathognomonic of a primary testicular tumour, occurring in only a minority of patients. The majority presents with diffuse testicular pain, swelling, hardness, or some combination of these findings. Since infectious epididymitis or orchitis is more common than tumour, a trial of antibiotic therapy is often undertaken. If testicular discomfort does not abate or findings do not revert to normal within two to four weeks, a testicular ultrasound examination is indicated. Delays in patients seeking definitive treatment after recognition of the initial lesion are frequent (3-6 months) and correlate with development of metastases. Trauma to the testis can sometimes lead to confusion in diagnosis. Endocrine manifestations such as gynaeco-mastia (2-4 of patients) are sometimes seen in association with sex cord-stromal tumours. In 5-10 of patients symptoms result from metastasis, e.g., back pain.
My Life 3-1 Back Pain Sometimes I think of my back pain as a familiar companion. He may not be overly friendly, but he certainly has remained with me for a long time. Eventually, I resigned myself to the notion that my back pain was like the man who came to dinner and de cided to stay. But a funny thing hap pened on the road to despair. When I simply decided to quit worrying about the pain, when I learned to avoid situ ations in which the pain was intense and to stop immediately and relax when it came calling, it abated and was more tolerable. I gave up looking for a dra matic cure and learned, if not to love, at least to feel at home with a certain amount of pain.
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.
(NSGCTs) whereas older patients (more than 50 years of age) more commonly have lymphomas. Sarcomas of the spermatic cord and other uncommon tumors of the testis are rarely diagnosed preoperatively. At operation, the gross seminoma specimen is usually smooth and often homogeneous areas of necrosis and hemorrhage suggest the presence of nonseminomatous malignancy or the uncommon anaplastic seminoma. Stage for stage, an anaplastic seminoma has the same patient survival as a seminoma but often presents as higher than stage I. A detailed history and physical examination may indicate whether a tumor is likely to be clinically localized or to be more extensive. For example, the presence of back pain, abdominal pain, cough, or dyspnea may suggest the presence of more extensive disease. Careful staging should be implemented (see Chapter 5). In brief, for patients with seminoma, routine blood work and biochemistry analysis are usually normal, as are circulating levels of
Supporting body weight, hip pathology can often be identified in gait abnormalities 1 . An antalgic gait (one that involves a self-protecting limp caused by pain, characterized by a shortened stance phase on the painful side so as to minimize the duration of weight bearing) is an indication of hip, pelvis, or low back pain 33,34 . The gait should be observed so that the full stride length can be assessed from the front and side 30 . Common key points of evaluation should include stride length, stance phase, foot rotation (internal external progression angle), and the pelvic rotation in the X and Y axes 1,30,32 . It is recommended that the patient walk down the hall if the room is not big enough to give the physician a chance to observe six to eight full strides.
Diagnosing hip pain in athletes has been difficult for physicians in the past because of the parallel presenting symptoms shared with back pain, which may exist concomitantly or independently of hip problems 17 . Radiating pain below the knee, palpable pains in the hip and back, and weakness or sensory limitations blur the lines in appropriately differentiating between the hip and back 17-22 . Low back pathology involving the paravertebral muscles can lead to an abnormal soft tissue balance, causing an irregular tension absorbed by the hip joint, which leads to knee pain, groin pain, leg length discrepancies, and limited ranges of motion in the hip 23 . Muscle contractures of the hip flexors or extenders as well as leg length discrepancy have also been identified as factors that can cause hip and low back pain to present together 24-28 . Brown and colleagues 17 proposed that limited internal rotation associated with a limp and groin pain were the physical signs to make the distinction...
Once the static stabilizers of the hip including the iliofemoral ligament and labrum are injured, the hip must rely more on the dynamic stabilizers for stability. It is hypothesized that when capsular laxity is present, the psoas major, a dynamic stabilizer of the hip, contracts to provide hip stability. Over time, this condition can lead to stiffness, coxa saltans, or flexion contractures of the hip 14 . In addition, due to the origin of this muscle from the lumbar spine, a chronically contracted or tightened psoas major may be a major contributor to low back pain. Thus, hip instability or capsular laxity can trigger a whole spectrum of disorders that the physician must take into consideration when considering various treatment options.
UK, after back pain (Smith et al., 2000). In addition to the detrimental health effects on the individual, stress has a financial and economic impact on the employer through illness of their employees, poor productivity and so on. We have seen some of the causes of stress at work, through long hours, bullying, and harassment or through a one-off major disaster.
Orchialgia who is completely normal on examination should probably have at least one follow-up examination in 3 to 6 months to ensure that a small tumor was not missed. Because these cancers grow rapidly, there is little concern in regard to diagnosing subclinical tumors. Finally, a small percentage of patients present with symptoms of metastatic disease, such as a neck mass, back pain, hemoptysis, or gynecomastia. These patients may be unaware of the abnormality in the testis. Unless the physician considers testicular cancer in the differential diagnosis of these symptoms, the appropriate treatment may be unnecessarily delayed.
The third class of AEs observed initially in the first PV701 trial occurred during infusion, and consisted mainly of back pain, noncardiac chest pressure, and, less commonly, abdominal pain and hypertension. These were particularly noted on repeat dosing at the higher dose levels (particularly 96 BPFU m2) and were managed effectively by slowing the infusion rate. Indeed, in second PV701 trial (25), this class of AEs became rare when the infusion time beginning for cycle 3 was doubled AEs during infusion occurred with 1 of 62 doses when 120 BPFU m2 was administered over 1 h vs 12 of 44 doses when 120 BPFU m2 was administered over 30 min. Likewise, in the third trial with PV701, all of the doses were administered slowly (over at least 1 h) throughout the trial and again AEs during infusion were rare (with only one mild case observed among the 18 patients treated).
Symptoms of acute colic include back pain and flank pain as well as lower abdominal pain, which may radiate to the groin or testes. Hematuria may also occur. Evaluations should include a physical examination, urine and renal function tests. Ultrasound evaluation can exclude urinary obstruction but does not detect small indinavir stones.
Figure 10.2 The vicious cycle of pain. Once the experience of pain is initiated (shown here as starting from a physical irritation) and continues without appropriate treatment, it begins to encompass many different factors, including physical, muscular, psychological, sexual, and sexual relationship. The involvement of these different systems usually leads to increases in the amount of pain and distress experienced, and can explain pain maintenance in the absence of physical findings, as in most cases of dyspareunia and back pain. Although this figure indicates that the initiating symptom can evolve into a complex cycle, theoretically, the cycle can start at any point or at multiple points simultaneously. Figure 10.2 The vicious cycle of pain. Once the experience of pain is initiated (shown here as starting from a physical irritation) and continues without appropriate treatment, it begins to encompass many different factors, including physical, muscular, psychological, sexual, and...
The illness can be broken into five phases febrile, hypotensive, oliguric, diuretic, and convalescent. The febrile phase lasts 5 days. Fever, backache, facial flush, and con-junctival injection are present. Petechial hemorrhages and albuminuria will appear. In the 3-day hypotensive phase the temperature can return to normal however, nausea, vomiting, and abdominal pain will be present. Capillary leakage ensues, leading to an increased hematocrit along with severe proteinuria, leukocytosis, thrombocytopenia, and diminishing renal function. The 4-day oliguric phase is heralded by extravascular fluid resorption, resulting in hypervolemia, hypertension, metabolic acidosis, and renal failure. Pulmonary edema may also develop. Renal function may normalize in the diuretic phase, with the consequent fluid and electrolyte shifts and imbalances. The convalescent phase may last for months. Case fatality is less than 5 . After an incubation period of 3 to 9 (Marburg) or 3 to 18 (Ebola) days, an...
Metastatic malignant teratoma. The patient was a 29-year-old man with recurrent malignant teratoma in the retroperitoneum and lungs. He was originally treated with left orchiectomy and three cycles of bleomycin etoposide cisplatin (BEP) chemotherapy for a serum marker-negative high-risk stage I mixed nonseminomatous germ cell tumor of the right testis from August 1998. The orchiectomy specimen demonstrated elements of malignant teratoma. A computed tomography (CT) scan of the abdomen was normal at that time. The patient declined retroperitoneal lymph node dissection. Seventeen months later, the patient re-presented with abdominal and back pain as well as morning headaches and visual field changes. CT of the abdomen demonstrated a retroperitoneal mass 11 cm in maximal diameter. Chest radiography demonstrated as many as 100 small nodules consistent with metastases. Magnetic resonance imaging of the brain (A and B) demonstrated a single large metastasis. The patient was...
When used for treatment of whiplash, botulinum toxin relived pain significantly compared with a placebo treatment, but showed a nonsignificant trend in improving subjective functioning (71). In another study, 46 patients with coexisting chronic tension headaches and temporomandibular disorders reported a 50 or greater improvement in headache pain. A randomized, double-blind study found that 11 of 15 subjects who received botulinum toxin A injections for low back pain had more than 50 pain relief vs 4 of 16 who received saline injections (72). By 8 weeks, these figures were 9 of 15 and 2 of 16, respectively, and function had improved in the treatment group.
To ensure that malignant change has not occurred. When cryptorchid testes remain intra-abdominal, they may present late after undergoing malignant change, with lower abdominal or back pain and a palpable mass (Figure 5-2). These tumors can grow to a massive size (Figure 5-3) and can metastasize (Figure 5-4).6 Local invasion of adjacent pelvic structures may occur, leading to presentation with unexpected symptoms such as hematuria.7
Historical note The horse chestnut tree is commonly found in ornamental gardens throughout Europe, growing up to 35 metres in height. The seeds are not edible due to the presence of alkaloid saponins, but both the dried seeds and bark of the horse chestnut tree have been used medicinally since the 1 6th century. The seeds are also used for the children's game 'conkers' and were used to produce acetone during World Wars I and II. In modern times, a dry extract referred to as horse chestnut seed extract (HCSE) is standardised to contain 1 6-21 triterpene glycosides (anhydrous escin). HCSE has been extensively researched for its beneficial effects and is commonly used by general practitioners in Germany for the treatment of chronic venous insufficiency. Homoeopathic preparations of both the leaf and seed are also used for treating haemorrhoids, lower back pain, and varicose veins and the buds and flower are used to make the Bach flower remedies chestnut bud and white chestnut. The active...
The reality of the situation is that there are no empirically or theoretically valid guidelines to distinguish psychogenic vs. organic dyspareunia. The notion that these terms reflect easily diagnosable qualitative categories is questionable both on empirical and theoretical grounds. The typical presumption made by many health professionals and the general public is that there must be an underlying physical cause for the pain. In clinical practice, this typically results in numerous physical investigations ranging from standard gynecological examinations and tests for infections, to invasive procedures such as colposcopy and laparoscopy. If such investigations yield negative findings, the default is to assume a psychogenic causation ( it is all in your head ) and refer the patient to a mental health professional. Depending on the orientation of the mental health professional, dyspareunia may be attributed to factors ranging from inadequate arousal to childhood sexual abuse. Because...
Opioids can frequently cause constipation and postoperative ileus the elderly patient is at the highest risk of developing these symptoms. If left untreated, constipation frequently can exacerbate lower back pain and discomfort from abdominal distention. Therefore, constipation and ileus need to be managed concurrently with the use of opioid analgesics to avoid stool impaction. Early mobilization after an injury is an important therapy in the elderly population to prevent constipation and reduce the risk for developing venous thrombosis.
Among the symptoms of prolonged stress are persisting anxiety, depression, irritability, fatigue, loss of appetite, headache, and backache. Continuing stress can affect the course and severity of physical disorders such as peptic ulcers, migraine headaches, skin conditions, chronic backache, and bronchial asthma.
A second viremia results in fever, myalgias, headache, rigors, and backache. Rigors and vomiting are present in more than 50 of patients, and delirium in 15 . Ten percent of patients have a fleeting erythetamous exanthem before the typical cutaneous manifestations. Initial lesions often begin around the oral mucosa, spreading to the face, then forearms, hands, and eventually to the trunk and lower limbs. Lesions favor the ventral surfaces, sparing the axilla, palms, and soles.
Endemic to the Rocky Mountain area, Colorado tick fever (CTF) is an acute tickborne viral infection characterized by headache, back pain, biphasic febrile course, an occasional maculopapular rash (around 10 ), and leukopenia. The etiologic agent of CTF is an arbovirus in the genus Orbivirus. CTF occurs in altitudes from 4,000 to more than 10,000 feet, in the Canadian provinces of British Columbia and Alberta and the western parts of the United States. The tick vector is Dermacentor andersoni, the same vector as RMSF. It is important to contrast CTF and RMSF because the treatments are different. Even though RMSF was described in the Rockies, it is actually less common than CTF, which is twenty-fold more common in Colorado.
This 20 year old Caucasian woman, diagnosed at 8 years of age with systemic lupus erythematosus (SLE), presented to the hospital with a one month history of non-traumatic low back pain. She was significantly incapacitated and required crutches for ambulation. The pain had a sudden onset and woke her up from her sleep. There was no history of recent changes in her urinary or gastrointestinal functions. Prior to admission, she had been seen by a physician who prescribed ibuprofen (400 mg q6h), but with no relief. Other medications at the time of admission were prednisolone (60 mg day) and furosemide (20 mg QD). She had increased her steroid dose on her own because of worsening arthralgias. She had not visited her rheumatologist for a considerable period of time and admitted poor compliance regarding scheduled medical appointments. Her knowledge of her medical condition was limited. The initial presentation during childhood was that of epistaxis secondary to thrombocytopenia. She had...
The rapid onset of jaundice is the most frequent complaint of patients with pancreatic-head cancers. Patients with tumors originating in the body or tail of the pancreas may present with abdominal or back pain or with upper GI bleeding from splenic vein thrombosis and resultant gastric
Patients may have significant symptoms without radiographic evidence of bulky disease and still benefit from radiation. For example, patients with low back pain and leg weakness should be considered for radiation to the cauda equina, and those with cranial neuropathies should be offered whole-brain or base of skull radiotherapy 166 .
However the main group of patients considered to be candidates for SCS are those with a combination of neuropathic and nociceptive pain, a condition that is usually referred to as failed back surgery syndrome.'' Practical experience suggests that patients with predominantly radicular pain radiating to one or both legs respond better to SCS than those with predominantly axial low back pain.
Symptoms include fever, chills, chest pain, anxiety, back pain, dyspnea in anesthetized patients, the reaction is manifested by rise in temperature, unexplained tachycardia, hypotension, hemoglobinuria, and diffuse oozing from surgical site. Free hemoglobin in the plasma or urine is presumptive evidence of a hemolytic reaction.
Relaxation has been used to help women during childbirth and people with chronic pain. Relaxation has also been used to treat muscle tension, muscle spasms, neck and back pain, and to decrease perspiration and respiratory rates. Furthermore, relaxation can help with fatigue, depression, insomnia, irritable bowel syndrome, high blood pressure, mild phobias, and stuttering.
Bleeding is the major adverse effect of bivalirudin and occurs more commonly in patients with renal impairment. Injection site pain has been reported in individuals given sc bivalirudin (Fox et al., 1993). Mild headache, diarrhea, nausea, and abdominal cramps have also been reported (Fox et al., 1993). In the Hirulog Angioplasty Study (HAS) (now known as the Bivalirudin Angioplasty Trial BAT ), the most frequent adverse effects included back pain, nausea, hypotension, pain, and headache. Approximately 5-10 of patients reported insomnia, hypertension, vomiting, anxiety, dyspepsia, bradycardia, abdominal pain, fever, nervousness, pelvic pain, and pain at the injection site (Bittl et al., 1995 Sciulli and Mauro, 2002) (Table 3).
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Back Pain Revealed
Tired Having Back Pains All The Time, But You Choose To Ignore It? Every year millions of people see their lives and favorite activities limited by back pain. They forego activities they once loved because of it and in some cases may not even be able to perform their job as well as they once could due to back pain.