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Search Results for "low back pain"
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Displaying 1 - 4 of 4 in Online Learning Center
Low Back Pain
A collection of educational materials in the Online Learning Center.
Evidence-Based Treatment of Low Back Pain
In this episode of Annals On Call, Dr. Centor discusses evidence-based treatment of low back pain with Dr. Roger Chou. First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
ACP Pain Management Cases: Low Back Pain
This interactive training series consists of 7 core modules and 2 sets of case studies. ACP Pain Management Cases: Low Back Pain provides interactive training on assessment and treatment to improve pain, function, and mood for patients with low back pain. By the conclusion of these cases, the learner will be able to:
Back Pain: Get Your Patient Back in the Game
Obidiugwu Kenrik Duru, MD, MSHS, discusses the prevalence, assessment and treatment of acute and chronic low back pain. This session was originally presented at IMM 2019. The 2024 rerelease of ACP's modules within the Pain Management Learning Series includes updated information and provides additional learning and credit earning opportunity for learners who claimed credit for earlier versions. CME/MOC credit are free to ACP Members. Nonmembers may purchase access to claim CME/MOC credit for $25.
Displaying 1 - 10 of 448 in Policy Library
Displaying 1 - 2 of 2 in Performance Measures
Use of Imaging Studies for Low Back Pain
The percentage of patients with a primary diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of diagnosis
Displaying 1 - 10 of 1899 in Annals of Internal Medicine
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Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica: A Randomized Controlled Trial: Annals of Internal Medicine: Vol 174, No 1
Background: Few studies have examined primary care management for acute sciatica, including referral to physical therapy. Objective: To evaluate whether early referral to physical therapy reduced disability more than usual care (UC) alone for patients with acute sciatica. Design: Randomized controlled clinical trial. (ClinicalTrials.gov: NCT02391350) Setting: 2 health care systems in Salt Lake City, Utah. Patients: 220 adults aged 18 to 60 years with sciatica of less than 90 days' duration who were making an initial primary care consultation. Intervention: All participants received imaging and medication at the discretion of the primary care provider before enrollment. A total of 110 participants randomly assigned to UC were provided 1 session of education, and 110 participants randomly assigned to early physical therapy (EPT) were provided 1 education session and then referred for 4 weeks of physical therapy, including exercise and manual therapy. Measurements: The primary outcome was the Oswestry Disability Index (OSW) score after 6 months. Secondary outcomes were pain intensity, patient-reported treatment success, health care use, and missed workdays. Results: Participants in the EPT group had greater improvement from baseline to 6 months for the primary outcome (relative difference, −5.4 points [95% CI, −9.4 to −1.3 points]; P = 0.009). The OSW and several secondary outcomes favored EPT after 4 weeks. After 1 year, between-group differences favored EPT for the OSW (relative difference, −4.8 points [CI, −8.9 to −0.7 points]) and back pain intensity (relative difference, −1.0 points [CI, −1.6 to −0.4 points]). The EPT group was more likely to self-report treatment success after 1 year (45.2%) than the UC group (27.6%) (relative risk, 1.6 [CI, 1.1 to 2.4]). There were no significant differences in health care use or missed workdays. Limitation: The patients and providers were unblinded, and specific physical therapy interventions responsible for effects could not be determined. Conclusion: Referral from primary care to physical therapy for recent-onset sciatica improved disability and other outcomes compared with UC. Primary Funding Source: Agency for Healthcare Research and Quality.
Using Public Cost Information During Low Back Pain Visits: A Qualitative Study: Annals of Internal Medicine: Vol 170, No 9_Supplement
Background: Patients desire information about health care costs because they are increasingly responsible for these costs. Public Web sites that offer cost information could inform provider–patient discussions of costs at the point of care. Objective: To evaluate tools to facilitate the use of publicly available cost information during clinical visits for low back pain (LBP). Design: Qualitative study using individual and group interviews and surveys. Setting: 6 rural primary care practices in 2 health systems in Maine. Participants: Practice staff (n = 50) and adult patients with LBP (n = 72). Intervention: Participating health systems and practices were offered financial incentives, a series of trainings, and technical assistance to pilot tools for discussing costs of LBP care using CompareMaine.org, Maine's cost and quality transparency Web site. Measurements: Integration of tools into workflow, awareness and value to providers, and patient experience were identified through 11 group interviews with practice staff (n = 25) and health system leaders (n = 11), provider (n = 25), and patient (n = 47) surveys; patient interviews (n = 5); and administrative data. Results: The intervention increased provider and consumer awareness of CompareMaine.org, but minimally changed use in clinical discussions as a result of fewer-than-expected patients with LBP, limited system support, workflow barriers, and providers' reluctance to adopt the tools because of perceptions of limited value for their patients. In contrast, patients valued cost conversations and found the tools useful, and over one half reported intending to use CompareMaine.org during future care decisions. Limitations: Generalizability was limited by the small number of practices and participants. Lower-than-anticipated participation precluded examination of the effect of the tool on the frequency of cost-of-care conversations. Conclusion: This multicomponent intervention to introduce publicly reported cost information into LBP clinical discussions had low provider uptake. Whereas cost conversations and CompareMaine.org were perceived as useful by participating patients with LBP, providers were uncomfortable discussing cost variation at the point of care. Successful use of public cost information during clinical visits will require normalizing use to a broader group of patients and greater provider outreach and health system engagement. Primary Funding Source: Robert Wood Johnson Foundation.
Displaying 1 - 10 of 85 in Annals of Internal Medicine: Clinical Cases
Paraneoplastic Leukemoid Reaction in High-Grade Lung Adenocarcinoma Complicated by Triple Co-Mutations | Annals of Internal Medicine: Clinical Cases
Paraneoplastic leukemoid reaction occurs secondary to cytokine-secreting tumors or cancers with high tumor burden. We report a case of extreme leukocytosis in a 58-year-old man presenting with a clavicular mass. Biopsy revealed a high-grade, non–small cell carcinoma of unknown origin, and genetic studies identified a lung adenocarcinoma with triple mutations in STK11, KRAS, and TP53 along with programmed death-ligand 1 positivity. Leukocytosis persisted despite treatment, so the diagnosis of paraneoplastic leukemoid reaction was made. Treatment of underlying malignancy is imperative in management, but this case was complicated by tumor mutations that rendered the most optimal treatments less effective.
Hemorrhagic Adrenal Mass: A Rare Presentation of Primary Adrenal Choriocarcinoma | Annals of Internal Medicine: Clinical Cases
Choriocarcinoma comprises less than 5% of all germ cell tumors in men, and primary extragonadal manifestation in the adrenal glands is a subset of that low percentage. Primary adrenal choriocarcinoma is a rare yet devastating diagnosis, with few cases reported in men. Delays in diagnosis can lead to increased morbidity and mortality given choriocarcinoma's aggressive growth; therefore, clinicians must recognize this clinical entity and consider it part of the differential diagnosis of a mass in the adrenals, lung, gastrointestinal tract, or brain, and expedite treatment if index of suspicion is high.
Symptomatic Methemoglobinemia at Low Levels in a Patient With Obstructive Sleep Apnea | Annals of Internal Medicine: Clinical Cases
Previously reported cases of hypoxemia secondary to methemoglobinemia usually had measured methemoglobin percentages of around 20% or greater. We report an unusual case of methemoglobinemia secondary to dapsone use in a 66-year-old man with obstructive sleep apnea who presented with dyspnea and hypoxia with a methemoglobin percentage of less than 10%.
Nutcracker Syndrome in an Adult With Recurrent Gross Hematuria Successfully Managed With Conservative Therapy | Annals of Internal Medicine: Clinical Cases
A 27-year-old man with no medical history began passing blood clots in his urine after significant weight loss. Imaging revealed nutcracker syndrome, with compression of his left renal vein by his superior mesenteric artery and aorta. His symptoms resolved after an intensive weight gain regimen. Despite maintaining his weight, his hematuria recurred 2 years later after worsening lumbar lordosis. After a period of strength and flexibility training, his symptoms never returned. This case highlights the clinically diagnostic features of nutcracker syndrome and the elements of successful conservative management in an adult.
Aortitis in Extracranial Giant Cell Arteritis: Do Not Lose Sight of the Patient | Annals of Internal Medicine: Clinical Cases
Giant cell arteritis is the most common systemic vasculitis. This case highlights aortic dissection as a potentially life-threatening complication of giant cell arteritis, in most instances occurring as very late event years or even decades after initial diagnosis.
A Rare Complication of Silicone Breast Implant Rupture | Annals of Internal Medicine: Clinical Cases
Rupture of silicone breast implants is common with the time spent in situ but often goes undetected. We encountered a 55-year-old woman who presented with symptoms attributable to hypercalcemia after undergoing the removal of ruptured silicone breast implants. Investigations uncovered multiple enlarged intrathoracic lymph nodes accompanied by extensive granulomatous disease. Although systemic steroids helped to regulate her symptomatic hypercalcemia, it resurfaced on cessation of therapy. This patient's case underscores the necessity of monitoring silicone breast implants and being vigilant for complications that may arise from their rupture.
A Heterozygous Variant of TGFB3 in a Patient With an Atypical Presentation of Loeys–Dietz Syndrome: A Case Report | Annals of Internal Medicine: Clinical Cases
Loeys–Dietz syndrome (LDS) 5 is characterized by aortic aneurysms, hypertelorism, and cleft palate/bifid uvula. We describe a woman with a transforming growth factor beta3 (TGFβ3) mutation who displays a forme fruste phenotype of LDS5. A 43-year-old woman with joint pain and hypermobile joints underwent evaluation for hypermobile Ehlers–Danlos syndrome. Her features included pes planus, treated high-arched palate, and increased joint mobility. Genetic analysis identified a pathogenic TGFβ3 variant (c.427A>T, p.Arg143*), clarifying the diagnosis of LDS5. Comparing our patient with others with TGFB3 mutations illustrated the diversity of LDS5 features, often a milder forme fruste form, which warrants more investigation due to insufficient characterization.
Pancreatic Acinar Cell Carcinoma in the Setting of a BRCA1 Germline Mutation | Annals of Internal Medicine: Clinical Cases
Pancreatic acinar cell carcinoma (PACC) is a rare neoplasm of the exocrine pancreas. PACC’s molecular and genetic features are poorly elucidated compared with pancreatic ductal cell carcinoma. Here, we present the patient case of a woman in her late 60s, with a BRCA1 germline mutation and a medical history of breast and lung adenocarcinomas diagnosed with PACC. A literature search identified only 2 reported cases of PACC associated with a BRCA1 germline mutation.
A Case of Spontaneous Isolated Superior Mesenteric Artery Dissection in a Patient With Celiacomesenteric Trunk Anomaly | Annals of Internal Medicine: Clinical Cases
Celiacomesentric trunk (CMT) is a rare vascular anomaly with a common origin for the celiac artery and superior mesenteric artery. To our knowledge, this is the first case of superior mesenteric artery (SMA) dissection in patients with CMT. Here, we discuss a case of a 65-year-old male with acute-onset epigastric pain who was found to have SMA dissection with CMT. He was treated conservatively with symptomatic improvement. Diagnostic imaging studies include computed tomography (CT) scanning of the abdomen with or without contrast and CT angiography. Management options include a conservative approach, endovascular repair, and surgical management based on the classification/location of the dissection.
A Case Report of Spontaneous Coronary Artery Dissection | Annals of Internal Medicine: Clinical Cases
Atherothrombosis is the leading cause of acute coronary syndrome (ACS). Spontaneous coronary artery dissection (SCAD) refers to a nonatherosclerotic lesion involving the tearing and splitting of the coronary wall. The creation of a false lumen and blockage of the true lumen generates an oxygenation mismatch in the myocardial tissue. A middle-aged woman with unremarkable medical history developed chest pain. Uptrending cardiac enzymes and electrocardiogram changes prompted further testing. Coronary angiography showed a type 3 SCAD lesion in the left circumflex artery. SCAD lacks the average risk factors of ACS and its recognition can be delayed. On the other hand, it preserves the typical presentation of ACS.