Restless leg syndrome (RLS) is a common and sometimes
devastating condition. I see it quite frequently
in many of my chronic pain patients. In
fact, it contributes to quite a bit of chronic pain, because of the difficulty
it causes in terms of getting a good night's rest, and because it in and of
itself can be rather painful. And there
are diseases associated with chronic pain which can result in so-called
Restless Leg Syndrome is a nighttime condition that has a huge impact on
daytime functioning for those afflicted.
The diagnosis of RLS is mostly arrived at through interviews
with the patient, and basically involves four important features:
is a compelling need to move, usually associated with unpleasant
sensations in the legs, which have been described variously as painful,
electric or "creepy-crawly."
sensations of RLS are worse or exclusively present at rest.
sensations are at least partial...
Last month, the American Pain Society added to its recommendations to health care providers regarding the diagnosis and treatment of low back pain .
In addition, the Society decided to discuss openly procedures that could be risky to sufferers of low back pain, including recommendations on surgery and other invasive therapies.
Unfortunately, there is not a significant body of good evidence to justify unquestioningly embracing these new recommendations. It is difficult to find well-done clinical studies which support the use of a number of the more invasive treatments used for chronic low back pain.
The initial set of guidelines for the management of chronic low back pain were published in "Annals of Internal Medicine" last October. However, these recommendations dealt more with the initial evaluation of a low back pain patient, and included thoughts on what type of x-rays to order in addition to more conservative treatments such as massage/manipulation and exerci...
If I had an episode of lower back pain, am I always going to be more likely to have lower back pain in the future?
It is true that once you have an episode of lower back pain or shooting leg pain, you are probably more likely to have it in the future - if you do nothing. But you are not going to "do nothing."
I see a lot of patients with lower back pain and shooting leg pain. Once we work together to resolve the pain, a very common question and concern that is raised is whether the pain is likely to return. A typical example is the following: Mr. X comes in with lower back pain that shoots into the right leg all the way to the foot. MRI reveals a herniated disc at L5-S1 level. After an injection, the pain is 90% better. Next, Mr. X starts physical therapy. Six we...
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