Human Case Study: 50-Year-Old Male with
Blood Pressure Recheck, Week #7 (Class 6512)
However, it is relatively inexpensive and easily accessible with a quick
turnaround time for the results.
Guidelines for plain films Criteria for lumbar films
Agency for Health Care Policy
and Research (AHCPR) (read) <<<100%Correctanswers>>Age <20
and >70
History of trauma
Strenuous lifting in patient with
osteoporosis
Prolonged steroid use
Osteoporosis
History of cancer
fever/chills/weight loss
Pain worse when supine or severe
at night (spinal fracture, tumor or
infection)
Criteria for lumbar films- Deyo series(read)
<<<100%Correctanswers>>Age over 50
Significant trauma
Neuromotor defect
Weight loss of 10 pounds
,Ankylosing spondylitis
Drug or alcohol abuse
History of malignancy
Fever of 100 degrees
Fahrenheit
Revisit without
improvement or financial
compensation
CT and MRI low back pain: indications for mri? (5)
<<<100%Correctanswers>>CT scans expose patients to contrast
materials that have renal toxicity.
Routine imaging with CT or MRI is not associated with improved outcomes,
but can identify abnormalities that are unrelated to the patient's back pain.
This can cause anxiety and could lead to more testing and possibly unnecessary
intervention.
Magnetic Resonance Imaging (MRI)
Not associated with clinical benefit in randomized trials.
Early MRI is not associated with improved outcomes in patients with acute
back pain or radiculopathy (Level 2/mid-level evidence).
Indications for MRI include:
Neurological deficit
Radiculopathy
Progressive major motor weakness
Cauda equina compression (sudden bowel/bladder disturbance)
Suspected systemic disorder (metastatic or infectious disease)
Failed 6 weeks of conservative care. (However, 75% of herniated
,discs improve with 6 weeks of conservative therapy.)
Some recommend that in the absence of red flags, it is reasonable to
obtain an imaging study after one month of symptoms if surgery is
being considered.
Management:
Acute low back pain (0-3 months)
Conservative therapy: first line therapy? don't use?
<<<100%Correctanswers>>General measures:
Apply local therapy (heat/cold) as tolerated.
Maintain good posture and practice good lifting techniques at all time.
Call the clinic if there is no relief or if the pain increases, progression of
neurologic deficits, development of problem with bowel or bladder control.
Pharmacologic
First line medications:
Non-steroidal anti-inflammatory drugs (NSAIDs)
A systematic review of randomized controlled studies found
strong evidence that NSAIDs and muscle relaxant are helpful in
the treatment of LBP.
Acetaminophen
There is conflicting evidence about the superiority of NSAIDs to
acetaminophen.
Muscle relaxants
The various NSAIDs and muscle relaxants are equally effective,
while some muscle relaxants are more sedating.
Opioids
Second- or third-line option for treatment of back pain.
There is little evidence regarding the benefits and harms of opioid use in LBP.
, Corticosteroids
No studies support the use of oral steroids in patients with LBP.
Activity level and physical therapy LBP
<<<100%Correctanswers>>Activity level
Avoid strenuous activities but to remain active
Bed rest is not more effective than continuation of activities of daily living.
Prolonged bed rest may contribute to muscle atrophy, cardiovascular
deconditioning, bone mineral loss, and reinforcement of illness behavior.
Physical Therapy
Tailored physical therapy is slightly more effective for acute back pain
compared to patients who just stay active.
At 4 weeks, patients who received physical therapy had 10-point
improvement in a 100-point disability score compared to the control group.
There is great variation in physical therapy because various interventions
(exercises, traction, massage) and different modalities (heat, ice,
ultrasound) may be used.
Spinal manipulation is safe and can help in the short term.
There is limited evidence in the use of acupuncture in the treatment of LBP,
with some studies showing that it is not beneficial.
Blood Pressure Recheck, Week #7 (Class 6512)
However, it is relatively inexpensive and easily accessible with a quick
turnaround time for the results.
Guidelines for plain films Criteria for lumbar films
Agency for Health Care Policy
and Research (AHCPR) (read) <<<100%Correctanswers>>Age <20
and >70
History of trauma
Strenuous lifting in patient with
osteoporosis
Prolonged steroid use
Osteoporosis
History of cancer
fever/chills/weight loss
Pain worse when supine or severe
at night (spinal fracture, tumor or
infection)
Criteria for lumbar films- Deyo series(read)
<<<100%Correctanswers>>Age over 50
Significant trauma
Neuromotor defect
Weight loss of 10 pounds
,Ankylosing spondylitis
Drug or alcohol abuse
History of malignancy
Fever of 100 degrees
Fahrenheit
Revisit without
improvement or financial
compensation
CT and MRI low back pain: indications for mri? (5)
<<<100%Correctanswers>>CT scans expose patients to contrast
materials that have renal toxicity.
Routine imaging with CT or MRI is not associated with improved outcomes,
but can identify abnormalities that are unrelated to the patient's back pain.
This can cause anxiety and could lead to more testing and possibly unnecessary
intervention.
Magnetic Resonance Imaging (MRI)
Not associated with clinical benefit in randomized trials.
Early MRI is not associated with improved outcomes in patients with acute
back pain or radiculopathy (Level 2/mid-level evidence).
Indications for MRI include:
Neurological deficit
Radiculopathy
Progressive major motor weakness
Cauda equina compression (sudden bowel/bladder disturbance)
Suspected systemic disorder (metastatic or infectious disease)
Failed 6 weeks of conservative care. (However, 75% of herniated
,discs improve with 6 weeks of conservative therapy.)
Some recommend that in the absence of red flags, it is reasonable to
obtain an imaging study after one month of symptoms if surgery is
being considered.
Management:
Acute low back pain (0-3 months)
Conservative therapy: first line therapy? don't use?
<<<100%Correctanswers>>General measures:
Apply local therapy (heat/cold) as tolerated.
Maintain good posture and practice good lifting techniques at all time.
Call the clinic if there is no relief or if the pain increases, progression of
neurologic deficits, development of problem with bowel or bladder control.
Pharmacologic
First line medications:
Non-steroidal anti-inflammatory drugs (NSAIDs)
A systematic review of randomized controlled studies found
strong evidence that NSAIDs and muscle relaxant are helpful in
the treatment of LBP.
Acetaminophen
There is conflicting evidence about the superiority of NSAIDs to
acetaminophen.
Muscle relaxants
The various NSAIDs and muscle relaxants are equally effective,
while some muscle relaxants are more sedating.
Opioids
Second- or third-line option for treatment of back pain.
There is little evidence regarding the benefits and harms of opioid use in LBP.
, Corticosteroids
No studies support the use of oral steroids in patients with LBP.
Activity level and physical therapy LBP
<<<100%Correctanswers>>Activity level
Avoid strenuous activities but to remain active
Bed rest is not more effective than continuation of activities of daily living.
Prolonged bed rest may contribute to muscle atrophy, cardiovascular
deconditioning, bone mineral loss, and reinforcement of illness behavior.
Physical Therapy
Tailored physical therapy is slightly more effective for acute back pain
compared to patients who just stay active.
At 4 weeks, patients who received physical therapy had 10-point
improvement in a 100-point disability score compared to the control group.
There is great variation in physical therapy because various interventions
(exercises, traction, massage) and different modalities (heat, ice,
ultrasound) may be used.
Spinal manipulation is safe and can help in the short term.
There is limited evidence in the use of acupuncture in the treatment of LBP,
with some studies showing that it is not beneficial.
