Neuropathic low back pain

In this discussion, we hope to advance a clinical approach to low back pain that is more in line with our modern understanding of neuropathic pain. We review the current understanding of normal and pathologic neuroanatomy of the lumbar spine and then outline how pathology in the different structures can lead to neuropathic pain and cause common pain patterns seen in clinical practice. We also detail the available treatments for neuropathic low back pain.     

Chronic low back pain

Low back pain (LBP) is one of the most prevalent medical problems in society today. In addition to the profound effect LBP can have on patients, it has an exceedingly high societal cost. Although most acute episodes of back pain will ultimately resolve, this condition will become chronic for many. Those with chronic LBP are a challenge to treat. Nonetheless, with a better understanding of the underlying pathophysiology and treatment options, our management of these patients is gradually improving. Conservative therapy remains the mainstay treatment of chronic LBP. If this has failed, surgical options may be considered in the carefully selected patient. Fusion is the most established treatment option for this condition. Disc arthroplasty is being increasingly considered. Class I studies critically evaluating established and evolving technologies continue to help shape our understanding of the surgical options for this condition.     

Work-related low back pain

Low back pain is a common problem among working adults in the United States. Occupational risk factors for low back pain include forceful lifting, bending and twisting of the trunk, whole body vibration and heavy manual labor. The initial assessment of the patient with low back pain requires obtaining an occupational history to identify risk factors in the workplace in addition to the usual inquiries and physical assessment. For those with uncomplicated low back pain, minimal use of medical tests and rapid return to limited activity are indicated. Long-term prevention of low back pain requires modification of occupational or other risk factors.     

Neuroimaging in low back pain

Patients commonly present to family physicians with low back pain. Because the majority of patients fully or partially recover within six weeks, imaging studies are generally not recommended in the first month of acute low back pain. Exceptions include patients with suspected cauda equina syndrome, infection, tumor, fracture, or progressive neurologic deficit. Patients who do not improve within one month should obtain magnetic resonance imaging if a herniated disc is suspected. Computed tomographic scanning is useful in demonstrating osseous structures and their relations to the neural canal, and for assessment of fractures. Bone scans can be used to determine the extent of metastatic disease throughout the skeletal system. All imaging results should be correlated with the patient's signs and symptoms because of the high rate of positive imaging findings in asymptomatic persons.     

Pregnancy and low back pain

Back pain is ubiquitous in today’s society and is particularly common during pregnancy. There are multiple factors contributing to these symptoms during pregnancy including pelvic changes as well as alterations to loading. Potential imaging modalities are limited during pregnancy due to the desire to limit ionizing radiation exposure to the fetus. Treatments are generally conservative, exercise-based interventions and alternative modalities may also be considered. Low back pain associated with pregnancy does generally resolve postpartum.     

Neck and low back pain

These cases represent a sample of conditions that impact the spine and paraspinous structures. Central to establishing a correct diagnosis and the cost-effective application of neurodiagnostic tests is a careful history and physical examination. The primary care physician is often the only physician to have a perception of the whole patient. The primary care physician is in an excellent position to initiate the evaluation of patients with spine symptoms and, where appropriate, monitor the treatment plans of consulting physicians.     

下背痛康复

下背痛是一组临床十分常见的症候群,是症状名称而非疾病名称.涉及多学科,有关文献亦较多,本文将根据最新文献对其进行较为系统的介绍从其命名病因分类入手,探讨相关危险因素,如吸烟、职业因素等,对其发病机制、诊断及其鉴别、康复治疗原则、预防复发以及最新研究的进展亦作了简要介绍.     

澳式手法治疗下腰痛

下腰痛是康复科门诊的常见病症,主要包括腰椎间盘突出、腰椎骨关节病、腰椎小关节紊乱等。常用的治疗方法有牵引、推拿按摩、理疗等。根据以往的经验,下腰痛的治疗常需要较长的疗程。１９９０年我们在香港理工大学学习了Ｍａｉｔｌａｎｄ手法（又称澳式手法）,并回科开...     

Electrodiagnostics for low back pain

Low back pain with radiating pain to the hip, buttock, or limb is the most common reason for electrodiagnostics referral. Electrodiagnostics is used to assess for lumbosacral radiculopathy potentially underlying low back pain. It serves as an extension of the clinical history and physical examination, and complements neuroimaging. Common low back pathologies amenable to electrodiagnostic evaluation include lumbosacral disk herniation and spinal stenosis. Electrodiagnostics may aid in the decision-making process when considering surgical management, and may aid in patient selection. The usefulness of electrodiagnostics is maximized when performed for the appropriate patient, and when the findings are properly interpreted.