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 1891 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 97 in Annals of Internal Medicine: Clinical Cases
Insidious Spinal Brucellosis and Psoas Abscess in a 67-Year-Old Patient: A Case Report | Annals of Internal Medicine: Clinical Cases
A 67-year-old man presented with chronic low-back pain, unintentional weight loss, and intermittent fevers in the setting of a recent trip to Mexico. Imaging showed discitis and osteomyelitis, and epidural cultures confirmed brucellosis. Brucellosis is a zoonotic infection endemic to Eurasia and South America but has a low incidence in the United States. Although the vast majority of cases of vertebral osteomyelitis are due to common bacterial organisms, a thorough history can prompt earlier consideration of atypical infections. This case highlights brucellosis as an etiologic consideration in cases of unexplained osteomyelitis and how expanded history-taking can help clinicians more readily identify risk factors for less common infections.
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.
Meningitis Caused by Campylobacter jejuni in a Patient With Immunodeficiency Due to Bispecific Antibody Therapy | Annals of Internal Medicine: Clinical Cases
Bispecific antibodies, such as talquetamab and teclistamab, offer promising treatment options for refractory multiple myeloma but are associated with significant immunosuppression and susceptibility to atypical infections. We report a case of recurrent Campylobacter jejuni meningitis in a 44-year-old man undergoing talquetamab and teclistamab therapy, highlighting the role of hypogammaglobulinemia in disease recurrence. Diagnosis was confirmed using molecular tools, emphasizing their value in detecting pathogens with low bacterial loads. This case underscores the need for vigilance, advanced diagnostics, and tailored prophylaxis to mitigate infection risks in immunocompromised patients receiving novel therapies.
Abdominal Radicular Pain From Neuroborreliosis: A Case of Bannwarth Syndrome in the Midwestern United States | Annals of Internal Medicine: Clinical Cases
A man in his mid-50s from Illinois presented with a circular rash without central clearing on his thigh. Two weeks later, he developed radicular lower abdominal and back pain. While initial imaging of the abdomen and lumbar spine was unrevealing, a physical examination later uncovered the subtle finding of dermatomal hypoesthesia. After a positive 2-tier test for Lyme disease, a diagnosis of Bannwarth syndrome was confirmed by cerebrospinal fluid, revealing lymphocytic pleocytosis and an elevated Lyme antibody index. Despite its historical association with the European Borrelia species, in the United States, Bannwarth syndrome should be considered in patients with radicular pain.
A Rare Case of Severe Vitamin D Deficiency Presenting as Diffuse Osteosclerosis | Annals of Internal Medicine: Clinical Cases
Maintaining calcium homeostasis is essential for various physiologic processes, with vitamin D playing a key role. Hyperparathyroidism typically causes fragility fractures and osteolytic lesions but rare cases can present with osteosclerosis. We report a 64-year-old woman with a history of gastric bypass presenting with back pain who was found to have diffuse osteosclerosis and hyperparathyroidism due to severe vitamin D deficiency. Nutritional supplementation led to symptom resolution. This case underscores the importance of considering bone-mineral pathology in patients with unexplained pain and highlights the need for close follow-up in postoperative care after bariatric surgery.
More Than 20 Centimeters of Intracardiac Cement Removed After Kyphoplasty | Annals of Internal Medicine: Clinical Cases
Intracardiac cement embolization through the venous system is a potentially deadly complication of the vertebroplasty and kyphoplasty. We present a case involving a 55-year-old woman who exhibited dyspnea on exertion, chest pain, and back pain 2 weeks after a kyphoplasty of the T12 vertebrae. The patient had open-heart surgery to remove a winding intracardiac segment of cement more than 20 cm long. Our review of the literature suggests this is one of the largest intracardiac cement emboli removed to date.
A Case of Combined Baclofen and Carisoprodol Withdrawal: The Hidden Dangers of Muscle Relaxants | Annals of Internal Medicine: Clinical Cases
Muscle relaxant prescriptions are on the rise for the treatment of chronic pain, although physician education about the effects of overdose, medication interactions, and withdrawal is limited. Simultaneous use of the muscle relaxants baclofen and carisoprodol can result in withdrawal at relatively low doses, possibly because of their synergistic effect. Prior case reports have described withdrawal from either of these muscle relaxants. However, this case report describes the course of a patient who was experiencing withdrawal from both baclofen and carisoprodol. To address such scenarios appropriately, it is important for prescribers to be aware of the withdrawal syndromes associated with these medications.
The Unregulated Opioid: Neurologic and Electrolyte Imbalance From Long-Term Kratom Use | Annals of Internal Medicine: Clinical Cases
Mitragyna speciosa, commonly known as kratom, is a Southeast Asian herb gaining popularity as an alternative to opioids for chronic pain and opioid withdrawal treatment. The U.S. Food and Drug Administration classifies it as a “new dietary ingredient” with the potential to damage the kidneys, liver, and heart. Despite this, kratom is widely available in drug stores and online. We present a case of a patient with long-term daily use of kratom who exhibited altered mental status and focal neurologic deficits with hyponatremia 1 week after abruptly discontinuing kratom use. This case underscores the necessity of obtaining a comprehensive history of all regularly consumed medications and supplements, whether prescribed or otherwise.
Recurrent Abdominal Aortic Aneurysm After Aortoiliac Endograft Stent Placement | Annals of Internal Medicine: Clinical Cases
We report a case of a 59-year-old man with multiple comorbid conditions who had endovascular aortic repair for an abdominal aortic aneurysm (AAA). Despite the procedure's initial success, the patient later presented with recurrent AAA as the result of an enlarged aneurysmal sac and a 90-degree angle kink at the midportion of the endograft stent, necessitating emergent open surgery. This case underscores the challenges in managing AAA post endovascular aortic repair and the potential for serious complications. Our experience highlights the importance of close surveillance and prompt intervention for optimal patient outcomes.
Miliary Tuberculosis Presenting With Meningitis, Tuberculomas, Osteomyelitis, Psoas Abscesses, and Pulmonary Involvement | Annals of Internal Medicine: Clinical Cases
Tuberculosis (TB) is endemic in many areas of the world and is a leading infectious cause of death in adults globally. Miliary TB can affect multiple organs and systems. This case report describes a patient with miliary TB that affected the central nervous system, lumbar spine, psoas muscles, and lungs. We highlight the diagnosis and management of miliary TB with central nervous system involvement.