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...
Sometimes cancer cells spread to other parts of the body. When this happens, the breast cancer may be described in a few different ways: metastatic, advanced, or stage IV. The term "metastases" refers to specific areas of spread, such as bone metastases.
If you have signs or symptoms of metastases, your doctor will likely use local treatment (treatment directly to the cancer area) to relieve the symptoms and to control the disease at that spot. Radiation can shrink and help control specific spots where the cancer has spread. Radiation can help:
lower the risk of broken bones in areas that may be weakened from cancer
improve breathing by opening up a blocked airway
take pressure off a pinched nerve that might be causing pain, numbness, or weakness
The radiation dose and schedule for metastases depends on a number of factors, including:
the urgency of the situation (pain, loss of function, size and location of the metastasis, for example)
any previous ...
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