Licina low back pain
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This document discusses acute versus chronic low back pain. Acute low back pain results from tissue trauma and is self-limiting, usually resolving with staying active. Chronic low back pain lasts a long time and may be caused by segmental instability, discogenic pain, facetogenic pain, soft tissue problems, or unknown causes. It often requires a multidisciplinary treatment approach using non-operative treatments that are generally ineffective. The decision to operate for chronic low back pain is difficult as surgery is not always effective and degeneration does not necessarily cause pain.
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Surgery for low back pain
This document discusses spinal fusion surgery for low back pain. It begins by noting that fusion has caused "more tragic human wreckage" when performed incorrectly. It then outlines specific diagnoses that may warrant fusion, including facetogenic pain, discogenic pain, and spondylolisthesis. The document describes suitable and unsuitable surgery candidates. It details common fusion techniques like posterolateral fusion and interbody fusion. Finally, it states that fusion is appropriate when there is a clear diagnosis, identified pain source, suitable patient without psychosocial issues, and the technique matches the pathology.
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Surgery for back pain
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Patient cases
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Sometimes called a slipped disc, a herniated disk most often occurs in your lower back. It is one of the most common causes of low back pain, as well as leg pain (sciatica).
Herniated Disc symptoms: sharp, burning or stabbing pain in back, may also run down leg; onset is often sudden.
Condition and Causes
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Dr Adrian Nowitzke — Neurosurgeon
Event:
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Pharmacotherapy for pain involves the use of medications to alleviate or manage pain. The choice of pharmacological agents depends on the type, severity, and duration of pain, as well as individual patient factors such as age, comorbidities, and medication tolerances. Here is a comprehensive description of pharmacotherapy for pain, considering various classes of medications:
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- Excessive use, however, can lead to liver damage, so dosing recommendations should be followed carefully.
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4. **Adjuvant Medications:**
- Certain medications originally developed for other purposes, such as anticonvulsants (e.g., gabapentin, pregabalin) and antidepressants (e.g., amitriptyline, duloxetine), can be used as adjuvants in pain management.
- These medications can help manage neuropathic pain and may enhance the effects of other analgesics.
5. **Corticosteroids:**
- Corticosteroids, such as prednisone, may be used for short-term relief of pain and inflammation, particularly in conditions like rheumatoid arthritis or certain inflammatory disorders.
- Prolonged use is generally avoided due to the risk of side effects.
6. **Topical Analgesics:**
- Topical formulations, including creams, patches, and gels, containing analgesic agents like NSAIDs, lidocaine, or capsaicin, can be applied directly to the affected area for localized pain relief.
7. **Muscle Relaxants:**
- Muscle relaxants, such as cyclobenzaprine or baclofen, may be prescribed to alleviate pain associated with muscle spasms or tension.
It's important for healthcare professionals to conduct a thorough assessment of the patient's pain and medical history to tailor the pharmacotherapy approach. The goal is to achieve adequate pain control while minimizing the risk of side effects and considering the overall well-being of the patient. Regular monitoring and communication.
Diagnosis and evaluation
This document provides an overview of failed back surgery syndrome (FBSS), including its diagnosis, evaluation, and treatment. It defines FBSS as continued back and/or extremity pain following one or more spinal surgeries. Common causes of FBSS include deconditioning, psychosocial factors, and surgical complications. The evaluation of FBSS involves a detailed pain history, physical exam, imaging, and may include diagnostic blocks. Treatment is multidisciplinary and aims to improve function through physical therapy, psychological treatments, and pain management with medications, injections, or devices.
Low back pain (lumbago)
Low back pain is a common condition that affects 60-80% of people at some point in their lives. It is caused by injuries or strains to the muscles, ligaments or discs in the lower spine. Common symptoms include pain in the lower back that may radiate to the buttocks or thighs. Prolonged sitting, obesity, poor posture, heavy lifting and repetitive bending or twisting can contribute to back pain. Diagnosis is typically based on symptoms and physical exam rather than tests. Treatment involves medications, physical therapy, injections or surgery in severe cases. Maintaining a healthy lifestyle and proper lifting technique can help prevent back pain.
Chronic pain Managment
Trauma or injury causes the release of chemicals that stimulate nerve fibers, leading to pain signals being sent to the brain. The integration of these pain signals with cognitive, emotional, and environmental factors results in the perception of pain. When this balance is disturbed, chronic pain can develop. Chronic pain is defined as pain lasting beyond normal tissue healing time, typically three months. A multidisciplinary approach is often needed to treat chronic pain through non-pharmacological and pharmacological methods.
Pain
Chronic pains are highly prevalent conditions that are often linked through metaflammation and lifestyle factors. When pain becomes chronic, it undergoes pathological changes including sensitization of the peripheral and central nervous system. Effective management of chronic pains requires a multimodal approach that addresses both the source of pain and pain control through non-invasive and minimally invasive methods before considering more aggressive options.
Chronic Pains, Dr Rohitha Jayamaha MD FIPP
Chronic pains are highly prevalent conditions that are often linked through metaflammation and lifestyle factors. When pain becomes chronic, it undergoes pathological changes including sensitization of the peripheral and central nervous system. Effective management of chronic pains requires a multimodal approach that addresses both the source of pain and pain control through non-invasive and minimally invasive methods before considering more aggressive options.
Acute and chronic pain management principals.pptx
This document provides an overview of pain classification and terminology. It discusses the differences between acute and chronic pain, and outlines various pain assessment tools including numerical rating scales, the McGill Pain Questionnaire, and screening tools for neuropathic pain. A variety of pain terminology is defined, including allodynia, dysesthesia, hyperalgesia, hyperesthesia, neuralgia, and neuropathic pain. Factors to consider in a comprehensive pain assessment are highlighted such as pain description, location, onset, duration, relieving/worsening factors, and impact on daily activities.
approach to Syncope patient in ED
Syncope, or fainting, is defined as a transient loss of consciousness associated with loss of postural tone that resolves spontaneously. It accounts for 0.8% of ED visits and has a prevalence of 19% in the general population. Common causes include vasovagal, cardiac, orthostatic, and medication-related reactions. A thorough history and physical exam can suggest a diagnosis in 45% of cases and help determine appropriate disposition, whether inpatient for high-risk patients or outpatient follow up for low-risk cases.
Cancer pain dr. varun
Proton pump inhibitors or H2 blockers
Ibuprofen, naproxen, diclofenac, celecoxib
Contraindicated in renal impairment, peptic ulcer
disease, bleeding disorders, heart failure
Max dose: Ibuprofen 2400 mg/day, naproxen 1500
mg/day, diclofenac 150 mg/day
Short term use only due to GI toxicity
Step 2: Weak Opioids
Codeine, tramadol
Equianalgesic dose: Codeine 30-60 mg
Frozen shoulder
Frozen shoulder, also known as adhesive capsulitis, is an inflammation condition of the shoulder characterized by progressive pain and stiffness leading to loss of motion. It affects 2-5% of the population between ages 40-65, more commonly in women. The condition involves three stages - a freezing phase with pain and loss of motion, a frozen phase with more stiffness, and a thawing phase where motion gradually returns over 1-3 years. Diagnosis is based on the clinical presentation of pain and reduced range of motion on physical exam. Treatment involves physical therapy, injections, medications and possibly surgery if conservative treatments fail to provide relief after 4 months.
Recognition and diagnosis of pseudoneurological syndromes
This document provides an overview of pseudoneurological syndromes and functional neurological disorders. It defines conversion disorder and somatic symptom disorder, and discusses their epidemiology, risk factors, pathophysiology, diagnostics, treatment, and differential diagnosis. Pseudoneurological disorders are psychiatric conditions where physical symptoms are not fully explained by medical issues. They affect daily functioning and cause significant distress. Diagnosis involves ruling out medical causes through history, exam, and testing. Treatment focuses on managing perpetuating factors through therapy and avoiding unnecessary medical interventions.
Approach to Failed back surgery syndrome (FBSS ) Agrasen hospital gondia vida...
Approach to Failed back surgery syndrome (FBSS ) Agrasen hospital gondia vida...AGRASEN Fracture Arthritis Hospital, Ganesh Nagar,Gondia,Maharashtra,INDIA
Failed Back and Neck Surgery Syndromes happen when a surgery to correct pain completely fails to alleviate the pain and in some cases makes the pain worse.
There are many reasons why a surgery could fail to provide results, both related to the patient and the surgeon.
How is it that a patient could cause a surgery to fail. A great example of this would be that a patient has undergone a spinal fusion to correct spinal instability in the lower back. The surgeon has advised the patient that smoking cigarettes which could severely reduce the healing chances and effect the fusion process. The patient ignores the doctor and continues to smoke and the fusion doesn’t heal. This is an example of the patient being at fault.
In what ways could a surgeon be at fault? There are many times that there is fault before the surgery is even performed. If there is an inaccurate diagnoses the surgery will be performed in the wrong area, and possibly the wrong surgery will be done. It is important to seek a second opinion of a specialist before proceeding with surgery of any kind. If two heads can agree on what and where the problem is, it is likely that there will be an accurate diagnosis.
One of the most common reasons for Failed Back and Neck Surgery Syndrome is that the surgeon is just not experienced enough in the technique being performed and he/she doesn’t perform it properly. This is why it is important to ask the right questions to the surgeon before moving forward with the surgery. How long have you been performing back surgeries? How long have you been performing this specific surgical procedure? and how many times a year do you perform this surgery.
Back and neck surgeries are procedures meant to be a permanent fix for a specific problem and correcting failed back or neck surgery is difficult.
Human spine is a complex structure that provides both mobility (so to bend and twist) and stability (so to remain upright). The normal curvature of spine has an “s”- like curve when looked at from the side. This curvature allows even distribution of weight and with stand stress.Atypical facial pain
Atypical facial pain is a chronic facial discomfort or pain of unknown cause that typically affects middle-aged or older women. It is characterized by a dull, burning pain of ill-defined location with no objective signs or positive test results. The pathogenesis is unclear but may involve extreme stress, enhanced cerebral activity, and cell damage. Diagnosis involves ruling out other conditions through medical history, examination, and negative imaging and blood tests. Treatment can be challenging as the condition often does not respond well to interventions.
Low Back Pain lecture with associated causes
1) Low back pain is a common condition that has many potential causes, including muscle strains, arthritis, herniated discs, and fractures.
2) Risk factors include obesity, smoking, heavy lifting, prolonged sitting or standing, and age.
3) Common causes are muscle strains (70%), degenerative changes like arthritis (10%), herniated discs (4%), and compression fractures (4%).
4) Treatment depends on the underlying cause but may include medications, physical therapy, exercises, injections, and sometimes surgery.
History of Low back-pain
This document discusses the common causes and clinical presentation of low back pain in different age groups. It outlines various pathologies that can cause low back pain such as degenerative spondylosis, spondylolisthesis, trauma, infection, and metastases. The document differentiates between disc prolapse and spinal stenosis. It identifies red flag features that suggest a serious underlying condition and yellow flag psychosocial factors associated with chronic pain. Clinical assessment of low back pain includes history of present illness, review of systems, physical examination, and consideration of psychosocial factors.
Access ce - 2016 02 pain management total presentation
This document provides an overview of pain management for pre-hospital care providers. It defines pain and discusses pain physiology, assessment tools like the numeric pain scale and OPQRST method. It covers types of pain like acute, chronic, referred, somatic and neuropathic. Factors that influence pain tolerance like gender, culture and psychological states are addressed. Guidelines for treating pain to a goal of zero whenever possible are provided, with exceptions for some cases. Non-pharmacological and pharmacological pain management options are outlined.
pain mangement Lecture for 3rd year MBBS
This document provides an overview of pain control and postoperative analgesia. It begins with defining different types of pain such as nociceptive and neuropathic pain. It then discusses factors that influence pain and the physiological and psychological effects of uncontrolled pain. The document outlines principles of pain assessment and various pain assessment tools. It discusses pharmacological and non-pharmacological pain control strategies including the WHO analgesic ladder and principles of multimodal analgesia. The document provides details on specific drug classes and routes of administration for pain management. It concludes with discussing a multidisciplinary approach to pain management.
Interventional Pain Management
This document discusses interventional pain management (IPM) as a specialty focused on diagnosing and treating pain through minimally invasive procedures. It provides an overview of common IPM procedures like diagnostic nerve blocks, radiofrequency ablation, vertebroplasty, and percutaneous discectomy. The document also presents four case studies where IPM procedures like epidurolysis, percutaneous discectomy, vertebroplasty, and radiofrequency rhizotomy successfully treated chronic pain when other options had failed. It concludes that contrary to common beliefs, over 85% of spinal pain causes can be accurately diagnosed through IPM procedures and that IPM can provide long-term relief when pharmacologic treatments and surgery are not suitable options.
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Low Back Pain abc A review of anatomy and treatment options for low back pain.
Low Back Pain abc A review of anatomy and treatment options for low back pain.
Recognition and diagnosis of pseudoneurological syndromes
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Approach to Failed back surgery syndrome (FBSS ) Agrasen hospital gondia vida...
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Access ce - 2016 02 pain management total presentation
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Some WorkCover fusions work
- The study examined outcomes of 42 WorkCover fusion patients compared to 465 privately insured patients over 10 years
- WorkCover patients showed less improvement in ODI and VAS scores postoperatively, especially those with significant back pain preoperatively
- However, WorkCover patients with dominant leg pain preoperatively had similar outcomes to privately insured patients with leg pain
- The presence of leg pain may predict better outcomes for WorkCover fusion patients than significant back pain
Pain management
This document discusses interventional procedures for chronic pain, specifically in the lumbar back region. It describes common origins of lumbar pain such as degenerative discs and stenosis. Invasive treatment options are then outlined, including various injection procedures like epidural, facet joint, and medial branch nerve ablation using radiofrequency. The document provides details on how these procedures are performed and their goals in potentially providing temporary pain relief and allowing rehabilitation. Maximum recommended opioid doses and conversions between opioids are also presented.
Imaging for back pain
This document discusses several issues related to spine imaging. It covers the importance of radiation exposure from various imaging modalities like CT and highlights strategies to reduce radiation dose. Guidelines for imaging low back pain recommend no imaging for non-specific back pain but imaging if neurological deficits are present or specific causes are suspected. The document reviews imaging modalities like X-ray, bone scan, CT and MRI and what each shows. It provides details on MRI sequences and appearances of common spine findings.
Non-operative management for common back conditions
Lumbar disc herniation and stenosis are common causes of low back pain that often improve without surgery. Post-surgery rehabilitation focuses on education, low-impact exercises, and a gradual return to normal activities. Key goals include reducing pain and improving function to allow patients to return to work and daily life. Appropriate exercises target the lumbar spine, hips, and core muscles while avoiding positions that increase pain. Outcomes are best with a multidisciplinary approach including exercise prescription managed by a physiotherapist or exercise physiologist.
Surgery for common lumbar conditions
This document discusses common degenerative conditions of the lumbar spine, including disc herniation, spinal stenosis, and spondylolisthesis. It provides details on symptoms, treatments like steroid injections or surgery, and outcomes. It aims to dispel misconceptions about spinal fusion surgery, noting that while risks exist, severe damage is rare and fusion is usually successful when performed for the right reasons. Fusion may not necessarily lead to more problems at adjacent levels in the future. The document includes examples of patients who had good outcomes from fusion surgery for conditions like isthmic spondylolisthesis and post-discectomy.
Pain management
This document discusses interventional pain procedures for chronic pain, including epidural injections, facet joint injections, medial branch blocks, and radiofrequency nerve ablation. It provides details on how each procedure is performed, when they are appropriate, and their potential benefits which include temporary pain relief and allowing patients to progress in rehabilitation. It also covers guidelines for opioid prescribing for chronic pain, including maximum recommended doses, conversion between opioid medications, requirements for authorities to prescribe, and factors to consider in opioid trials and maintenance therapy.
Common conditions of the lumbar spine
Common conditions of the lumbar spine include:
1. Degenerative disc disease, which occurs in nearly everyone over 50 due to disc degeneration and affects the lower lumbar spine the most.
2. Disc herniations, where a tear in the disc allows the nucleus to migrate and press on nerves, commonly causing leg pain.
3. Spinal stenosis, a narrowing of the spinal canal from bone spurs or thickened ligaments that compresses nerves and causes leg symptoms improved by sitting or bending forward.
4. Spondylolisthesis, the slipping of one vertebra over another, most often affecting L4 on L5 due to degeneration.
Case Presentation
Dave, a 38-year old factory worker, sees a doctor for worsening back pain that radiates down his left leg. Imaging reveals chronic pars defects, grade 1 spondylolisthesis, and disc degeneration. He is referred to specialists, prescribed medications, and advised to file a workers compensation claim to receive treatment including epidural injections and physical rehabilitation with the goal of a gradual return to work.
Lumbar Stretching
The document describes an exercise program for lumbar stretching rehabilitation. It includes 18 different stretching exercises targeting the lower back and hips. The exercises involve movements such as rolling the knees from side to side, bringing the bent knee towards the chest, tightening stomach muscles to lift the bottom, rocking backwards on hands and knees, and rotating the leg outwards while pulling it towards the chest. Each exercise provides instructions on body position, movement, and number of repetitions.
Lumbar Stabilisation
The document outlines an exercise program for lumbar stabilization rehabilitation. It provides 15 different exercises that involve contracting the transversus abdominis muscle to stabilize the spine. Each exercise lists instructions on positioning, muscle activation, and repetitions. The goal is to perform the full series of exercises while maintaining control of the lower back and pelvis.
Discectomy Activity Guide
Presented by:
Stephen Boyd — Physiotherapist
Event:
GP Education Day - 2013
6 week discectomy
The document provides instructions for a 6-week lumbar rehabilitation exercise program following back surgery. It includes over 20 different exercises targeting the lower back, core, and legs. Exercises should be done 2-3 times per day and include stretches, strengthening moves using balls, bands, and body weight as well as exercises done in standing, kneeling, and various positions on the floor or ball. The full range of motion and correct form are emphasized to protect the back during rehabilitation.
3 week discectomy
This exercise program outlines rehabilitation exercises over 3 weeks following a lumbar discectomy surgery. The goals by 6 weeks include exercising 2-3 times per day, increasing walking, and lifting up to 10kg. The document provides detailed instructions for 20 different core-focused exercises involving positions like lying on the back or side, kneeling, and standing. Each exercise describes muscle activation and movements to help recovery while avoiding movements that could cause pain.
Initial Discectomy
This document outlines an exercise program for patients who have undergone a lumbar discectomy. The goals within 3 weeks are to do 2-3 exercise sessions per day, walk for a total of 5km split into two sessions, and lift weights up to 5kg. The program focuses on core stabilization exercises using a ball and includes exercises to do lying down, kneeling, sitting, and standing to strengthen the back and abdomen. Proper form is emphasized by engaging the transversus abdominis muscle and maintaining a neutral spine alignment throughout. Exercises are to be done in sets of 10-15 repetitions and held for 3-10 seconds, progressing to weight added as tolerated.
Pain diagram and questionnaire
The document contains a pain diagram and questionnaire for a patient to report their back pain. The pain diagram has the patient mark areas of pain and tingling. Two pain scales have the patient rate their average back and leg pain in the past week from 0 to 10. The back pain questionnaire has 10 sections for the patient to select the statement that best describes how their back pain affects daily activities like personal care, lifting, walking, sitting, standing, sleeping, social and work life, and traveling.
Rehabilitation for back pain
This document provides guidance on rehabilitation for non-operative and operative back pain. It discusses assessing abnormalities and treating to correct them. For severe back pain, it recommends reducing pain and inflammation through comfort positions, movement, medications, modalities, and exercise away from aggravation. For sub-acute back pain, it recommends manual therapy, restoring range of motion and flexibility/strength training. Post-episode, it recommends modifying activities, correcting biomechanical abnormalities, and implementing a home exercise regime. Core stability and stabilization exercises are emphasized for retraining deep muscles to maintain functional stability. Post-operative rehabilitation focuses on early mobility, exercises in neutral spine, and functional control prior to discharge with a home program.
Interventional Procedures and Opioids
Presented by:
Dr Brendan Moore — Pain Medicine Specialist Physician
Event:
GP Education Day - 2013
This Unbearable Pain
Presented by:
Dr Brendan Moore — Pain Medicine Specialist Physician
Event:
GP Education Day - 2013
Appropriate imaging for back pain
1) The document discusses appropriate imaging for back pain, describing different imaging modalities like X-rays, CT scans, bone scans, and MRI.
2) It categorizes back pain into 3 groups: nonspecific low back pain, back pain associated with radiculopathy, and back pain associated with a specific cause needing prompt evaluation.
3) Guidelines recommend triaging patients into these 3 categories and only imaging those with red flags, severe/progressive neurological symptoms, or if considering surgery/injections. Imaging is not recommended for nonspecific back pain.
What else could it be?
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Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
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Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
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Combination Therapies
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Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
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Licina low back pain
- 1. acute LBP ≠ chronic LBP LOW BACK PAIN • acute tissue trauma • self-limiting • stay active, be positive • dysfunction in nervous system • long-lasting • multidisciplinary interventions genetic psychosocial
- 6. USUAL NONOPERATIVE TREATMENTS GENERALLY INEFFECTIVE CHRONIC LOW BACK PAIN multidisciplinary approach
- 10. • 38 year old female • 18/12 of worsening low back pain • Conservative treatment for past year • Simple analgesics • Flares of back pain becoming more frequent • Fit, active lifestyle • Recently ceased running and regular sport • Working but with difficulty • No WorkCover/legal claim • Mild restriction of forward flexion • Normal neurological examination
- 15. • 76 y.o. retired farmer • Long history of mild backache • Recent change with sharp, catching left- sided back pain • Vague leg discomfort causing no functional limitations • Tender left low back • Pain on hyperextension • No neurological deficit
- 22. • 32 year old manual worker • Sudden back pain with repetitive lifting • Off work since injury, 9 months ago • WorkCoverclaim, considering litigation • High narcotic intake • Spends majority of time in bed, resting • Very restricted ROM in all directions • Marked abnormal illness behaviour