-
Best Practice & Research. Clinical... Sep 2023With back pain as one of the most common complaints in the population and with no single disease feature with sufficient sensitivity and specificity to diagnose axial... (Review)
Review
With back pain as one of the most common complaints in the population and with no single disease feature with sufficient sensitivity and specificity to diagnose axial spondyloarthritis (axSpA) on its own, diagnosing axSpA can be challenging. In this article, we discuss clinical, laboratory, and imaging spondyloarthritis features that can be used in diagnosis and explain the general principles underlying an axSpA diagnosis. Moreover, we discuss three pitfalls to avoid when diagnosing axSpA: i) using classification criteria as diagnostic criteria, ii) making a diagnosis by simple counting of spondyloarthritis features, and iii) over-reliance on imaging findings. Finally, we have some advice on how to build diagnostic skills and discuss new developments that may help facilitate the diagnosis of axSpA in the future.
Topics: Humans; Spondylarthritis; Back Pain; Axial Spondyloarthritis; Spondylitis, Ankylosing; Magnetic Resonance Imaging
PubMed: 37714776
DOI: 10.1016/j.berh.2023.101871 -
Journal of Physiotherapy Oct 2017
Topics: Disability Evaluation; Humans; Low Back Pain
PubMed: 28889949
DOI: 10.1016/j.jphys.2017.07.004 -
Ugeskrift For Laeger Apr 2019Scoliosis is a common frontal plane spinal deformity with pain as a commonly associated occurrence in approximately 38% of the cases. This review summarises the possible... (Review)
Review
Scoliosis is a common frontal plane spinal deformity with pain as a commonly associated occurrence in approximately 38% of the cases. This review summarises the possible treatments. Corrective treatment with bracing or surgery does not specifically target the pain problem. Other causes of back pain should be considered, before or meanwhile treatment is initiated. Injections with botulinum toxin in the paravertebral muscles do not have any corrective effects but may reduce localised muscle pain. Other options including peripherally acting pain medication and muscle strengthening by either exercise programmes or physiotherapy should be tried first.
Topics: Back Pain; Braces; Humans; Scoliosis
PubMed: 30990160
DOI: No ID Found -
Journal of Orthopaedic Research :... Feb 2022To provide an up-to-date description of knowledge and pitfalls related to the classification, definition and grading of Modic changes (MC) visualized on magnetic... (Review)
Review
To provide an up-to-date description of knowledge and pitfalls related to the classification, definition and grading of Modic changes (MC) visualized on magnetic resonance imaging (MRI). State-of-the-art review of current knowledge regarding the definition and grading of MC on MRI. MC on MRI have been reported to be associated with low back pain and disability. However, previous studies have shown heterogeneous results in regards to the impact of MC and its clinical relevance in patients with back pain. MC is a term used with considerable variation in the literature. No strict definition has been provided previously, this has contributed to varying diagnostic inclusion criteria, heterogeneous study populations, and discrepancy in results. A definition of MC and a proposal for grading is provided in this state-of-the-art review. MC are important, clinically relevant findings. However, issues with the nomenclature, definition and grading of these changes need to be addressed. Our current review highlights relevant issues related to MC, and provides a definition and grading score for the term MC that includes the Modic type and the extent of vertebral body involvement. Future studies should seek to validate the MC grading score in clinically relevant populations.
Topics: Back Pain; Humans; Intervertebral Disc Degeneration; Low Back Pain; Lumbar Vertebrae; Magnetic Resonance Imaging
PubMed: 34910328
DOI: 10.1002/jor.25240 -
Annals of the Royal College of Surgeons... May 2023Spinal infection (SI) is uncommon and patients present with varied clinical features. In this review, the presentation, investigation, treatment and outcome of patients... (Review)
Review
INTRODUCTION
Spinal infection (SI) is uncommon and patients present with varied clinical features. In this review, the presentation, investigation, treatment and outcome of patients with SI in the north-east of Scotland were assessed.
METHODS
Electronic medical records of adult patients with SI hospitalised at a health board in the north-east of Scotland between 2014 and 2018 were analysed retrospectively. Collected variables included demographics, presenting clinical features, risk factors, comorbidities, admission blood results, microbiological investigations, imaging, treatment and outcomes.
RESULTS
Seventy-two patients were included. Mean age (±sd) was 63.3 years (±14.5). The lumbar spine was the most commonly involved region (51.4%). Back pain (84.7%), altered mobility (33.3%) and fever (29.2%) were the most frequent presenting features. Thoracic spine involvement ( = 0.041), urinary symptoms ( = 0.033), cauda equina syndrome (CES) ( = 0.027) and limb weakness ( = 0.026) were associated with poorer outcome. A better outcome was associated with back pain at presentation ( = 0.03) and underlying malignancy ( = 0.045). Diabetes (15.3%), recent falls (15.3%) and immunosuppression (12.5%) were common. A likely causative organism was found in 54 patients (75.0%) and was isolated in 41.7% of patients. Penicillins were used in 56.3% of patients and 20.8% underwent surgery. Outcomes were full recovery (38.2%), residual symptoms or neurological deficits (50.0%), paraplegia (4.4%) and death (7.4%).
CONCLUSIONS
Poorer outcomes occurred in patients with thoracic disease, limb weakness, urinary symptoms or CES, whereas better outcomes were associated with the presence of back pain on presentation and malignancy. This analysis highlights the diagnostic and therapeutic challenges of SI, alerting clinicians to key factors associated with prognosis.
Topics: Adult; Humans; Middle Aged; Retrospective Studies; Treatment Outcome; Spine; Staphylococcal Infections; Back Pain; Scotland; Cauda Equina Syndrome
PubMed: 35904356
DOI: 10.1308/rcsann.2022.0062 -
European Spine Journal : Official... Jul 2022Risk factors for chronic back pain (CBP) may share underlying genetic factors, making them difficult to study using conventional methods. We conducted a bi-directional... (Meta-Analysis)
Meta-Analysis
PURPOSE
Risk factors for chronic back pain (CBP) may share underlying genetic factors, making them difficult to study using conventional methods. We conducted a bi-directional Mendelian randomisation (MR) study to examine the causal effects of risk factors (education, smoking, alcohol consumption, physical activity, sleep and depression) on CBP and the causal effect of CBP on the same risk factors.
METHODS
Genetic instruments for risk factors and CBP were obtained from the largest published genome-wide association studies (GWAS) of risk factor traits conducted in individuals of European ancestry. We used inverse weighted variance meta-analysis (IVW), Causal Analysis Using Summary Effect (CAUSE) and sensitivity analyses to examine evidence for causal associations. We interpreted exposure-outcome associations as being consistent with a causal relationship if results with IVW or CAUSE were statistically significant after accounting for multiple statistical testing (p < 0.003), and the direction and magnitude of effect estimates were concordant between IVW, CAUSE, and sensitivity analyses.
RESULTS
We found evidence for statistically significant causal associations between greater education (OR per 4.2 years of schooling = 0.54), ever smoking (OR = 1.27), greater alcohol consumption (OR = 1.29 per consumption category increase) and major depressive disorder (OR = 1.41) and risk of CBP. Conversely, we found evidence for significant causal associations between CBP and greater alcohol consumption (OR = 1.19) and between CBP and smoking (OR = 1.21). Other relationships did not meet our pre-defined criteria for causal association.
CONCLUSION
Fewer years of schooling, smoking, greater alcohol consumption, and major depressive disorder increase the risk of CBP. CBP increases the risk of greater alcohol consumption and smoking.
Topics: Alcohol Drinking; Back Pain; Depressive Disorder, Major; Genome-Wide Association Study; Humans; Mendelian Randomization Analysis; Polymorphism, Single Nucleotide
PubMed: 35662366
DOI: 10.1007/s00586-022-07263-2 -
Exercise and Sport Sciences Reviews Apr 2017Exercise is the most effective treatment for the management and prevention of spinal pain; yet on average, it delivers small to moderate treatment effects, which are... (Review)
Review
Exercise is the most effective treatment for the management and prevention of spinal pain; yet on average, it delivers small to moderate treatment effects, which are rarely long lasting. This review examines the hypothesis that outcome of exercise interventions can be optimized when targeted toward the right patients and when tailored to address the neuromuscular impairments of each individual.
Topics: Adaptation, Physiological; Back Pain; Chronic Pain; Exercise Therapy; Humans; Motor Neurons; Muscle, Skeletal; Sensory Receptor Cells; Treatment Outcome
PubMed: 28092298
DOI: 10.1249/JES.0000000000000103 -
Scandinavian Journal of Pain Jul 2019
Topics: Back Pain; Humans; Low Back Pain; Radiography; Radiology
PubMed: 31228862
DOI: 10.1515/sjpain-2019-2011 -
American Family Physician Sep 2017
Review
Topics: Analgesics; Anti-Inflammatory Agents; Back Pain; Humans; Hyperthermia, Induced; Neuromuscular Agents; Physical Therapy Modalities
PubMed: 28925652
DOI: No ID Found -
JMIR MHealth and UHealth Mar 2021Low back pain (LBP) is a frequent reason for emergency department (ED) presentations, with a global prevalence of 4.4%. Despite being common, the number of clinical... (Observational Study)
Observational Study
BACKGROUND
Low back pain (LBP) is a frequent reason for emergency department (ED) presentations, with a global prevalence of 4.4%. Despite being common, the number of clinical trials investigating LBP in the ED is low. Recruitment of patients in EDs can be challenging because of the fast-paced and demanding ED environment.
OBJECTIVE
The aim of this study is to describe the recruitment and response rates using an SMS text messaging and web-based survey system supplemented by telephone calls to recruit patients with LBP and collect health outcomes in the ED.
METHODS
An automated SMS text messaging system was integrated into Research Electronic Data Capture and used to collect patient-reported outcomes for an implementation trial in Sydney, Australia. We invited patients with nonserious LBP who presented to participating EDs at 1, 2, and 4 weeks after ED discharge. Patients who did not respond to the initial SMS text message invitation were sent a reminder SMS text message or contacted via telephone. The recruitment rate was measured as the proportion of patients who agreed to participate, and the response rate was measured as the proportion of participants completing the follow-up surveys at weeks 2 and 4. Regression analyses were used to explore factors associated with response rates.
RESULTS
In total, 807 patients with nonserious LBP were invited to participate and 425 (53.0%) agreed to participate. The week 1 survey was completed by 51.5% (416/807) of participants. At week 2, the response rate was 86.5% (360/416), and at week 4, it was 84.4% (351/416). Overall, 60% of the surveys were completed via SMS text messaging and on the web and 40% were completed via telephone. Younger participants and those from less socioeconomically disadvantaged areas were more likely to respond to the survey via the SMS text messaging and web-based system.
CONCLUSIONS
Using an SMS text messaging and web-based survey system supplemented by telephone calls is a viable method for recruiting patients with LBP and collecting health outcomes in the ED. This hybrid system could potentially reduce the costs of using traditional recruitment and data collection methods (eg, face-to-face, telephone calls only).
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
RR2-10.1136/bmjopen-2017-019052.
Topics: Australia; Emergency Service, Hospital; Humans; Internet; Low Back Pain; Text Messaging
PubMed: 33661125
DOI: 10.2196/22732