Clinical Information Search
Search Results for "low back pain"
- Online Learning Center (4)
- Policy Library (448)
- Performance Measures (2)
- Annals of Internal Medicine (1899)
- Annals of Internal Medicine: Clinical Cases (85)
- IM Matters (105)
- ACP Hospitalist (289)
- ACP Diabetes Monthly (27)
- ACP Gastroenterology Monthly (31)
Displaying 21 - 30 of 448 in Policy Library
Displaying 21 - 30 of 1899 in Annals of Internal Medicine
These Annals of Internal Medicine results only contain recent articles.
- Visit annals.org to search all content back to 1927.
- View Annals of Internal Medicine CME by topic here.
In acute or subacute LBP at risk for chronicity, supported self-management reduced disability vs. medical care over 1 y
Clinical Impact Ratings GIM/FP/GP: 5 out of 7 Phys Med & Rehab: 6 out of 7
Effectiveness of Nonpharmacologic Treatments for Chronic Low Back Pain: A Sequential, Multiple-Assignment, Randomized Trial: Annals of Internal Medicine: Vol 0, No 0
Background: Many treatments are recommended for chronic low back pain (cLBP), but comparative effectiveness and adaptive interventions have not been adequately studied. Objective: To compare the effectiveness of physical therapy (PT) and cognitive behavioral therapy (CBT) as first-stage treatment and switching treatments versus mindfulness as second-stage treatment. Design: Multisite sequential, multiple-assignment, randomized trial with 52-week follow-up. (ClinicalTrials.gov: NCT03859713) Setting: Three health care systems. Participants: Adults with cLBP. Intervention: Eight weeks of PT or CBT in stage I. Nonresponders were randomly assigned again to 8 weeks of stage II treatment. Measurements: Co-primary outcomes were function measured with the Oswestry Disability Index (ODI; range, 0 to 100) and pain intensity (range, 0 to 10) at 10 (stage I), 26, and 52 (stage II) weeks. Results: The sample comprised 749 participants. After 10 weeks, there was greater improvement in function in the PT group (adjusted mean ODI difference, 2.8 [96% CI, 0.38 to 5.1]) and no difference in pain intensity (adjusted mean difference, 0.32 [99% CI, −0.07 to 0.71]). The mean difference in ODI was below the minimum important difference of 6. After 52 weeks, there were no differences in stage II treatments for nonresponders for either function (adjusted mean ODI difference, 0.43 [96% CI, −0.29 to 2.4]) or pain intensity (adjusted mean difference, −0.05 [96% CI, −0.58 to 0.48]). Limitations: Treatment initiation was lower than expected, particularly for CBT and for nonresponders. Participants were not blinded. Sample size was reduced due to the COVID-19 pandemic. Conclusion: Patients with cLBP may benefit from PT as first-line treatment. Among nonresponders, there were no differences in second-stage treatment with mindfulness or switching. Primary Funding Source: Patient-Centered Outcomes Research Institute (PCORI).
In moderate-to-severe sciatica, pregabalin did not reduce leg pain intensity or improve quality of life
Source Citation Mathieson S, Maher CG, McLachlan AJ, et al. Trial of pregabalin for acute and chronic sciatica. N Engl J Med. 2017;376:1111-20. 28328324
Guideline: In low back pain, nonpharmacologic treatments are recommended
Source Citation Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166:514-30. 28192789
In acute low back pain, adding oxycodone/acetaminophen or cyclobenzaprine to naproxen did not improve pain or function
Source Citation Friedman BW, Dym AA, Davitt M, et al. Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: a randomized clinical trial. JAMA. 2015;314:1572-80. 26501533
In persistent sciatica and lumbar disk herniation, surgery vs. conservative care reduced leg pain at 6 mo
Source Citation Bailey CS, Rasoulinejad P, Taylor D, et al. Surgery versus conservative care for persistent sciatica lasting 4 to 12 months. N Engl J Med. 2020;382:1093-102. 32187469
Long-Term Effects of Individualized Acupuncture for Chronic Neck Pain: A Randomized Controlled Trial: Annals of Internal Medicine: Vol 177, No 10
Background: Long-term effects of individualized acupuncture in persons with chronic neck pain (CNP) remain unknown. Objective: To evaluate the efficacy and safety of pressure pain, sensory-based individualized acupuncture for relieving CNP. Design: A 24-week multicenter randomized controlled clinical trial. (ChiCTR1800016371) Setting: Outpatient settings at 4 clinical centers in China from May 2018 to March 2020. Participants: 716 participants with CNP. Intervention: Participants were randomly assigned to a waiting list (WL) group or to 1 of 3 interventions, which consisted of 10 sessions over 4 weeks: higher sensitive acupoints (HSA), lower sensitive acupoints (LSA), and sham acupoints (SA) acupuncture groups. Measurements: The primary outcome was the change in the visual analogue scale (VAS) score for neck pain (range, 0 to 100) from baseline to 4 weeks, with a difference of 10 points considered the minimum clinically important threshold. The VAS was also assessed every 4 weeks through 24 weeks. Results: The modified intention-to-treat population included 683 participants. The mean baseline VAS was 50.36, 50.10, 49.24, and 49.16 for HSA, LSA, SA, and WL, respectively. Compared with a mean baseline to week 4 change of −12.16 in the HSA group, the mean changes were −10.19 in the LSA group (net difference [ND], −1.97 [95% CI, −5.03 to 1.09]), −6.11 in the SA group (ND, −6.05 [CI, −9.10 to −3.00]), and −2.24 in the WL group (ND, −9.93 [CI, −12.95 to −6.90]). The intervention effects persisted at 24-week follow-up. Limitation: Lack of complete blinding and limited generalizability. Conclusion: Individualized acupuncture interventions using high- or low-sensitivity acupuncture points were more effective in reducing CNP than SA and WL control groups sustained through 24 weeks, but the magnitude of relative improvement did not reach a minimal clinically important difference. Primary Funding Source: National Natural Science Foundation of China.
Displaying 21 - 30 of 85 in Annals of Internal Medicine: Clinical Cases
Mpox-Associated Pneumonia: A Case Report | Annals of Internal Medicine: Clinical Cases
Mpox classically presents with a prodrome of fevers and chills followed by a characteristic rash 3 to 4 days later, and self resolves within 2 to 4 weeks. We present a patient case of atypical mpox complicated by left lower lobe pneumonia, severe headaches, and photophobia in addition to the classic rash. These atypical features could play a role in guiding treatment with antiviral drugs such as tecovirimat.
A Case of Bilateral Subclavian Artery Stenosis Presenting as Refractory Hypotension | Annals of Internal Medicine: Clinical Cases
A 72-year-old woman presented with epigastric pain, hypotension, and tachycardia. Laboratory studies revealed anemia and lactic acidosis. Endoscopy showed gastric cancer without active bleeding. Although the tachycardia and lactic acidosis resolved shortly after a blood transfusion, her blood pressure (BP) remained low. BP measured in both her upper and lower extremities confirmed a discrepancy. Computed tomography revealed findings suggestive of bilateral subclavian artery stenosis. Bilateral subclavian artery stenosis should be suspected in a patient who presents with prolonged unexplained asymptomatic low BP measured in both upper extremities, noting the importance of also measuring the BP in all extremities.
Kikuchi–Fujimoto Disease Presenting With Mesenteric Lymphadenopathy and Partial Hemophagocytic Lymphohistiocytosis in a Young Black Man | Annals of Internal Medicine: Clinical Cases
Kikuchi–Fujimoto disease (KFD) is a rare, self-limited inflammatory condition that typically presents with cervical lymphadenopathy and constitutional symptoms, classically described in young Asian women. We report an atypical presentation in an 18-year-old Black man with weight loss, fevers, and isolated mesenteric lymphadenopathy, ultimately diagnosed with KFD by excisional biopsy. His presentation was also notable for mild secondary hemophagocytic lymphohistiocytosis (HLH). This case highlights an association between isolated mesenteric KFD and hemophagocytic lymphohistiocytosis, suggesting a spectrum of disease that links these syndromes.
Concurrent Phenylalanine Hydroxylase–Related Disorder and Celiac: A Rare Co-occurrence With Implications for Clinical Management | Annals of Internal Medicine: Clinical Cases
Comorbid nutritional disorders can present with clinical management challenges. Phenylalanine hydroxylase (PAH) deficiency and celiac disease are both associated with dietary protein intolerance, yet they are different disorders. Phenylalanine hydroxylase deficiency is a rare genetic disorder that results in elevated levels of phenylalanine (Phe) in the blood. It causes multisystemic abnormalities, including neurologic findings, seizures, episodic tremor, ataxia, and cognitive and sensory disturbances. In contrast, celiac disease is a common nutritional disorder that arises from immune-mediated enteropathy against dietary gluten. Herein, we describe the clinical findings in an adult with PAH deficiency and celiac disease to showcase some opportunities for improved personalized nutritional management.
Unexpected Therapeutic Effect of GLP-1 Receptor Agonists in Patients With Refractory IBS-D: A Case Series | Annals of Internal Medicine: Clinical Cases
Irritable bowel syndrome with diarrhea (IBS-D) is a common functional gastrointestinal disorder. It is primarily caused by increased intestinal transit. GLP-1 receptor agonists (GLP-1 RAs) are widely used for obesity and diabetes management. They have been shown to decrease intestinal motility as a side effect. We present a 67-year-old woman and a 23-year-old woman, both with long-standing, debilitating IBS-D. Both achieved a 22.7-kg weight loss with GLP-1 RA use. They also reported resolution of diarrhea and improved quality of life. This case series suggests potential therapeutic benefits of GLP-1 RA use in hypermotility associated with IBS-D.
When Sarcoidosis Looks Like Myeloma: A Diagnostic Pitfall | Annals of Internal Medicine: Clinical Cases
Multiple myeloma (MM) is a plasma cell malignant disorder with variable clinical presentations. Because MM is the most prevalent hematologic malignancy among Black patients, a high index of suspicion is often applied in this population. However, premature diagnostic closure may occur when initial findings appear consistent with MM, while conflicting information is overlooked. This case describes a 46-year-old Black man initially diagnosed with active MM but ultimately found to have active sarcoidosis and smoldering myeloma. This case illustrates the importance of recognizing cognitive bias and considering granulomatous disease in the differential diagnosis of hypercalcemia, lytic lesions, and systemic abnormalities.
A Rare Case of Ocular Syphilis With Bilateral Central Visual Loss in a Young Man Who Was Negative for HIV | Annals of Internal Medicine: Clinical Cases
Syphilis is an ancient disease that has been resurging in the 21st century. This report describes a rare case of bilateral ocular syphilis with neurosyphilis in an immunocompetent young adult who was negative for HIV. The patient presented with a black spot in the left eye and was found to have bilateral chorioretinitis and vitritis. The diagnosis was initially thought to be X-linked juvenile retinoschisis, but the results of laboratory testing revealed elevated serum rapid plasma regain and a positive cerebrospinal fluid venereal disease research laboratory test. The patient was treated with intravenous benzylpenicillin, resulting in clinical and serologic improvement. The case highlights the importance of considering ocular syphilis in younger sexually active patients.
A Young Patient With Lupus Nephritis and Cryptococcemia Lacking Central Nervous System Involvement | Annals of Internal Medicine: Clinical Cases
There has been a recent increase in the prevalence of cryptococcal infections worldwide due to increased prevalence of immunosuppressed individuals secondary to AIDS, autoimmune disease, or neoplastic disease. Cryptococcus neoformans infection typically presents as a meningoencephalitis; however, there is low incidence of cryptococcemia in the absence of central nervous system and other organ involvement. Here we present a case of a 26-year-old female patient with lupus nephritis on immunosuppressants found to have asymptomatic cryptococcemia in the absence of meningoencephalitis and other organ involvement.
Euglycemic Diabetic Ketoacidosis Related to SGLT2 Inhibitor Use in a Patient With Cobalamin C Deficiency and Diabetes | Annals of Internal Medicine: Clinical Cases
A 24-year-old woman with cobalamin C deficiency (CblCD), autoimmune thyroiditis, and recently diagnosed diabetes mellitus presented with weight loss, emesis, and abdominal pain. She had been placed on sodium-glucose cotransporter inhibitor (SGLT2i) therapy because of metformin intolerance, with the addition of a dipeptidyl peptidase-4 inhibitor. Biochemical analyses demonstrated severe acidosis, initially attributed to CblC-associated metabolic decompensation. Subsequent evaluation led to the diagnosis of SGLT2i-induced euglycemic diabetic ketoacidosis in a patient with type 1 diabetes mellitus. This case highlights the importance of assessing for insulin deficiency when evaluating acidosis and the management challenges of common diseases in adults with inherited metabolic disorders.
A Case of Steroid-Responsive Multisystem Inflammatory Syndrome in Adults With SARS-CoV-2 | Annals of Internal Medicine: Clinical Cases
While the COVID-19 pandemic continues to evolve, different phenotypic variants of the disease are being recognized. Multisystem inflammatory syndrome in adults is an emerging entity that has yet to be fully characterized. The syndrome involves extrapulmonary multiorgan failure with hyperinflammation that typically affects young healthy males, approximately 2 to 12 weeks after infection with SARS-CoV-2. There are no formal guidelines for management, although the syndrome appears responsive to immunomodulators and supportive care. Clinicians should be aware of this unusual and severe clinical entity and the general principles of its management.