Search Results for: "low back pain"

Background: Mindfulness-based stress reduction (MBSR) is frequently used to treat pain-related conditions, but its effects on low back pain are uncertain. Purpose: To assess the efficacy and safety of MBSR in patients with low back pain. Data Sources: Searches of MEDLINE/PubMed, Scopus, the Cochrane Library, and PsycINFO to 15 June 2016. Study Selection: Randomized controlled trials (RCTs) that compared MBSR with usual care or an active comparator and assessed pain intensity or pain-related disability as a primary outcome in patients with low back pain. Data Extraction: Two reviewers independently extracted data on study characteristics, patients, interventions, outcome measures, and results at short- and long-term follow-up. Risk of bias was assessed using the Cochrane risk-of-bias tool. Data Synthesis: Seven RCTs involving 864 patients with low back pain were eligible for review. Compared with usual care, MBSR was associated with short-term improvements in pain intensity (4 RCTs; mean difference [MD], −0.96 point on a numerical rating scale [95% CI, −1.64 to −0.34 point]; standardized mean difference [SMD], −0.48 point [CI, −0.82 to −0.14 point]) and physical functioning (2 RCTs; MD, 2.50 [CI, 0.90 to 4.10 point]; SMD, 0.25 [CI, 0.09 to 0.41 point]) that were not sustained in the long term. Between-group differences in disability, mental health, pain acceptance, and mindfulness were not significant at short- or long-term follow-up. Compared with an active comparator, MBSR was not associated with significant differences in short- or long-term outcomes. No serious adverse events were reported. Limitation: The number of eligible RCTs was limited; only 3 evaluated MBSR against an active comparator. Conclusion: Mindfulness-based stress reduction may be associated with short-term effects on pain intensity and physical functioning. Long-term RCTs that compare MBSR versus active treatments are needed in order to best understand the role of MBSR in the management of low back pain. Primary Funding Source: None.

Intradiscal Glucocorticoid Injection for Patients With Chronic Low Back Pain Associated With Active Discopathy: A Randomized Trial: Annals of Internal Medicine: Vol 166, No 8

Background: Active discopathy is associated with a specific phenotype of chronic low back pain (LBP). Local inflammation has a role in active discopathy–associated symptoms. Objective: To assess the efficacy of a single glucocorticoid intradiscal injection (GC IDI) in patients with chronic LBP with active discopathy. Design: Prospective, parallel-group, double-blind, randomized, controlled study. (ClinicalTrials.gov: NCT00804531) Setting: 3 tertiary care centers in France. Patients: 135 patients with chronic LBP with active discopathy on magnetic resonance imaging (MRI). Intervention: A single GC IDI (25 mg prednisolone acetate) during discography (n = 67) or discography alone (n = 68). Measurements: The primary outcome was the percentage of patients with LBP intensity less than 40 on an 11-point numerical rating scale (0 [no pain] to 100 [maximum pain] in 10-point increments) in the previous 48 hours at 1 month after the intervention. The main secondary outcomes were LBP intensity and persistent active discopathy on MRI at 12 months and spine-specific limitations in activities, health-related quality of life, anxiety and depression, employment status, and use of analgesics and nonsteroidal anti-inflammatory drugs at 1 and 12 months. Results: All randomly assigned patients were included in the primary efficacy analysis. At 1 month after the intervention, the percentage of responders (LBP intensity <40) was higher in the GC IDI group (36 of 65 [55.4%]) than the control group (21 of 63 [33.3%]) (absolute risk difference, 22.1 percentage points [95% CI, 5.5 to 38.7 percentage points]; P = 0.009). The groups did not differ in LBP intensity at 12 months and in most secondary outcomes at 1 and 12 months. Limitation: Tertiary care setting. Conclusion: In chronic LBP associated with active discopathy, a single GC IDI reduces LBP at 1 month but not at 12 months. Primary Funding Source: French Ministry of Health.

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain

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Displaying 11 - 20 of 85 in Annals of Internal Medicine: Clinical Cases

A Rare Cause of Severe Hypoglycemia in Intracranial Hemangiopericytoma Associated With Non-Islet Cell Tumor Hypoglycemia | Annals of Internal Medicine: Clinical Cases

A 60-year-old man with a history of metastatic intracranial hemangiopericytoma and type 2 diabetes mellitus presented with acute episodes of confusion and dizziness. A magnetic resonance imaging scan of the brain showed progressing calvarial metastasis without intracranial abnormality. He was found to have severe persistent hypoglycemia. The initial hypoglycemia work-up revealed low serum insulin and C-peptide level and negative panel for oral hypoglycemic agents. Further laboratory testing revealed an elevated insulin-like growth factor II (IGF II):IGF-I ratio and low β-hydroxybutyrate, consistent with nonislet cell tumor hypoglycemia. The patient received prednisone and his hypoglycemia improved.

Rifampin-Induced Loss of Glucocorticosteroid Therapeutic Effect | Annals of Internal Medicine: Clinical Cases

Drug–drug interactions between rifampin and glucocorticosteroids are uncommonly reported in the literature but can have significant impact on patient management. We report a case in which this drug–drug interaction complicated the management of a patient with active lupus arthritis flare on prednisone changing to biological therapy with concurrent rifampin given for latent tuberculous infection. Lack of therapeutic response to prednisone with subsequent control of her flare was finally achieved by discontinuing rifampin and changing to methylprednisolone and rituximab given that use of B-cell–directed biological therapy does not require concomitant latent tuberculosis treatment. This case underscores the importance of conducting a thorough evaluation of medications for any potential drug–drug interactions in immunosuppressed individuals.

Tremors and Memory Loss From Hypomagnesemia and Hypocalcemia Secondary to Long-Term Proton Pump Inhibitor Use | Annals of Internal Medicine: Clinical Cases

Proton pump inhibitors (PPIs) are commonly prescribed for short-term use but are often taken chronically, including through over-the-counter (OTC) access. Long-term use has been linked to hypomagnesemia and hypocalcemia, which may cause serious complications. A 47-year-old man on PPIs for 5 years presented with cramps, spasms, tremors, disorientation, and amnesia. Tests showed low magnesium and calcium, with other causes excluded. Proton pump inhibitor treatment was discontinued and supplementation initiated, leading to marked recovery. Chronic PPI use should be considered in unexplained electrolyte abnormalities, even in patients not at high risk, highlighting the need for cautious prescribing, periodic monitoring, and reassessment of OTC availability.

Infectious Proctitis From Cytomegalovirus in an Immunocompetent Patient | Annals of Internal Medicine: Clinical Cases

Cytomegalovirus colitis typically causes immunocompromised patients to present with hematochezia, abdominal pain, fever, or diarrhea and rarely as perforation. Here we report an 83-year-old woman with no other traditional immunocompromising risk factors who presented with cytomegalovirus proctitis. Providers should be aware of the potential for this severity of presentation even in immunocompetent patients.

Blastic Plasmacytoid Dendritic Cell Neoplasm Mimicking Erythema Nodosum: A Case Report | Annals of Internal Medicine: Clinical Cases

Blastic plasmacytoid dendritic cell neoplasm (BPDCN), previously known as blastic natural killer cell lymphoma, is a rare, difficult-to-diagnose, and aggressive hematologic malignancy. Skin lesions are the initial presentation of BPDCN in 64% to 77% of cases, characterized by brown to purple nodular or bruised macular lesions in solitary or multiple locations. Here, we report the case of a 57-year-old man who initially presented with refractory erythema nodosum symptoms, including fever, arthritis, and painful erythema, and was finally diagnosed with BPDCN after a second skin biopsy. This case illustrates that skin lesions caused by BPDCN mimic ordinary erythema nodosum.

A Rare Case of Bivalvular Infective Endocarditis and Mural Vegetation Caused by Bartonella quintana | Annals of Internal Medicine: Clinical Cases

Bartonella quintana is a rare but increasingly recognized cause of culture-negative infective endocarditis. We report a patient who presented with features of congestive heart failure without associated fever or detectable bacteremia. Diagnostic work-up revealed infective endocarditis due to B. quintana causing a large right atrial mural vegetation along with severe mitral regurgitation and severe aortic regurgitation, for which the patient had surgical valve replacements. The case highlights the indolent nature of the disease, leading to late presentation and challenging management, especially in a vulnerable patient population.

Severe Retiform Purpura Associated With COVID-19 Infection | Annals of Internal Medicine: Clinical Cases

A healthy, unvaccinated 44-year-old woman developed a severe, diffusely spread, and intensely painful purpuric rash following mild COVID-19 infection. A punch skin biopsy revealed small vessel inflammation and intravascular thrombi consistent with thrombotic leukocytoclastic vasculitis. She was successfully managed with therapeutic anticoagulation, high-dose steroids, intravenous immunoglobulin, and aggressive analgesia. This case highlights an atypical and severe presentation of an uncommon cutaneous manifestation of COVID-19 that has been linked with significant morbidity and mortality.

Chronic Eosinophilic Pneumonia as the Initial Manifestation of Rheumatoid Arthritis: A Case Report | Annals of Internal Medicine: Clinical Cases

Chronic eosinophilic pneumonia (CEP) is a rare disorder characterized by peripheral blood eosinophilia, increased eosinophils in bronchoalveolar lavage fluid, and eosinophilic infiltration of lung alveoli and interstitia. While only a handful of cases of CEP have been reported in rheumatoid arthritis (RA), CEP as the initial presenting manifestation of RA is extremely rare. We report a 28-year-old woman who was diagnosed with CEP in association with newly diagnosed RA, who responded to corticosteroid therapy but relapsed on steroid taper. She was later treated with mepolizumab as a steroid-sparing agent while being tapered off steroids.

Pituitary Apoplexy as a Mimicker of Infectious Meningitis in an Adolescent Female Patient | Annals of Internal Medicine: Clinical Cases

Pituitary apoplexy can cause a chemical meningitis, and its mimicry in presentation with infectious meningitis poses a diagnostic challenge. Here we report an 18-year-old woman who presented with acute headache, altered mental status, and cerebral spinal fluid (CSF) pleocytosis and clinically improved with antibiotics and steroids. Despite an unremarkable computed tomography (CT) scan of the head, brain magnetic resonance imaging showed a pituitary macroadenoma with apoplexy. To our knowledge, this is one of the first reports of an adolescent with pituitary apoplexy masquerading as infectious meningitis and underscores the importance of keeping this rare condition, often missed on CT scans, as part of the differential for CSF pleocytosis.

Hypertriglyceridemia-Induced Acute Pancreatitis Secondary to Glycogen Storage Disease Type Ia: Successful Treatment With Plasmapheresis | Annals of Internal Medicine: Clinical Cases

Glycogen storage disease type Ia (GSD-Ia) is a rare autosomal recessive disorder caused by a loss-of-function mutation in glucose-6-phosphatase, resulting in recurrent fasting hypoglycemia. This leads to several systemic metabolic complications, including hypercholesterolemia and hypertriglyceridemia, which can induce acute pancreatitis episodes. We report on using early plasmapheresis in addition to oral fibrate therapy as a successful treatment of a 27-year-old GSD-Ia patient with hypertriglyceridemia-induced acute pancreatitis. Plasmapheresis was initiated the day after admission and continued daily for three treatments, ultimately resulting in a seven-day admission.

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