Cases reported "Back Pain"

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1/8. The longer term effect of pulsed radiofrequency for neuropathic pain.

    pulse radiofrequency has been recently described as a technique to apply a relatively high voltage near a nerve but without the usual effects of a rise in temperature or subsequent nerve injury. In this set of case reports, the effect of pulsed radiofrequency (PRF) is described in patients with neuropathic pain syndromes which have been poorly controlled with other oral and invasive treatments. Whilst anecdotal, the results have been remarkable and should encourage further research into this technique. Observations from the basic science tend to support the concept that PRF may induce some sort of long-term depression in the spinal cord.
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2/8. Treatment of severe glaucomatous visual field deficit by chiropractic spinal manipulative therapy: a prospective case study and discussion.

    OBJECTIVE: To discuss the case of a patient with severely reduced visual fields arising from terminal glaucomatous retinal damage and the treatment of this condition by spinal manipulation. CLINICAL FEATURES: A 25-year-old uniocular female patient with congenital glaucoma sought chiropractic treatment for spinal pain, headache, and classic migraine. Advanced optic disk cupping was present, and loss of vision was near complete. A 3-degree island of central vision and a small area of peripheral light sensitivity had remained relatively stable for 3 years after a trabeculectomy procedure that had resulted in intraocular hypotony. INTERVENTION AND OUTCOME: It was considered possible that chiropractic spinal manipulative therapy may have a positive outcome in visual performance. Before commencing chiropractic spinal manipulative therapy, an ophthalmologic examination was performed, and visual performance was monitored through a course of treatment. Immediately after the first treatment, significant visual field improvement was recorded in the remaining eye. Maximal improvement of vision was achieved after 1 week (4 treatment sessions). Total monocular visual field had increased from approximately 2% to approximately 20% of normal. Corrected central acuity had improved from 6/12 to 6/9. Independent reexamination by the patient's regular ophthalmic surgeon confirmed the results. CONCLUSION: Recovery of vision in this patient was an unexpected and remarkable outcome, raising the question of whether chiropractic spinal manipulative therapy may be of value in the management of glaucomatous visual field loss. More intensive research is required.
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3/8. Management of herniated intervertebral disks during saturation dives: a case report.

    During research saturation dives at 5.0 and 5.5 atm abs, 2 divers developed an acute herniation of the nucleus pulposus of the L5-S1 intervertebral disk. In both cases the pain was severe enough to require intravenous morphine or intramuscular meperidine. Although the symptoms presented by these divers are frequently considered to be an indication for immediate surgical consultation, we decided that emergency decompression posed an unacceptable risk that decompression sickness (DCS) would develop in the region of acute inflammation. In both cases strict bedrest and medical therapy were performed at depth. In the first case, 12 h was spent at depth before initiating a standard U.S. Navy saturation decompression schedule with the chamber partial pressure of oxygen elevated to 0.50 atm abs. In the second case, a conservative He-N2-O2 trimix decompression schedule was followed to the surface. In both cases, no initial upward excursion was performed. The required decompression time was 57 h 24 min from 5.5 atm abs and 55 h 38 min from 5.0 atm abs. During the course of decompression, the first diver's neurologic exam improved and he required decreasing amounts of intravenous narcotic; we considered both to be evidence against DCS. The second diver continued to have pain and muscle spasm throughout decompression, however he did not develop motor, reflex, or sphincter abnormalities. Both divers have responded well to nonsurgical therapy.
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4/8. Common complaints, difficult diagnosis: multiple myeloma.

    PURPOSE: To review the presenting signs and symptoms of multiple myeloma, its pathophysiology, diagnostic evaluation, and treatment options. DATA SOURCES: A literature review of research articles and publications by oncology experts who specialize in multiple myeloma, supplemented by a case study. CONCLUSIONS: multiple myeloma is a cancer of the geriatric population, with the average age at diagnosis between 65 and 68 years. As the population of those over age 65 is predicted to double by the year 2050, the incidence of myeloma is expected to increase. nurse practitioners (NPs) must become familiar with the signs, symptoms, and complications of myeloma for patients to be diagnosed and referred to specialists in a timely manner. IMPLICATIONS FOR PRACTICE: patients with multiple myeloma often present with vague, common symptoms such as back pain, bony pain, fatigue, and anemia. These symptoms may be treated as separate medical conditions if NPs fail to include multiple myeloma in their differential diagnosis. If NPs are educated on this malignancy, they will have the expertise to look for other signs of the disease such as hypercalcemia, pathological fractures, osteopenia, or renal failure. Without early recognition of multiple myeloma and referrals to oncology specialists, patients are left with a delayed diagnosis and poor symptom control.
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5/8. Dysfunctional uterine bleeding with concomitant low back and lower extremity pain.

    In this case presentation, a temporal relationship between conservative chiropractic care and dysfunctional uterine bleeding (DUB) in a patient with mild low back and primary leg pain is described. Criteria are discussed to establish protocol that will be useful in the formulation of a diagnosis for DUB secondary to lower sacral nerve root compression and lumbar mechanical dysfunction. There have been investigations recently published that suggest a positive relationship between chiropractic lumbar, closed reduction distractive decompression (CRDD) and patients with pelvic pain and organic dysfunction. This case study presents the treatment response of one patient with one form of somatovisceral dysfunction, namely, dysfunctional uterine bleeding, in the absence of pelvic pain. Conservative chiropractic care may be an effective, noninvasive method for treating some individuals with dysfunctional uterine bleeding, caused secondarily from biomechanical and/or neurological insult. Further research in this area is encouraged.
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6/8. chiropractic management of spondylolisthesis with spondylolysis of the pars interarticularis: an example of the single-case study experimental design.

    Case records permeating the chiropractic literature, although claiming success utilizing conservative therapies, often are founded on isolated circumstances rather than scientific data. A detailed examination of such reports reveals a void with respect to definitive and specific approaches for the diagnosis and clinical management of disorders synonymous with chiropractic clinical practice. At best, therefore, such reports are fraught with empiricism, illustrating only the experiences of individual clinicians. The underlying difficulty encountered in reporting information on purely didactic grounds is likely due to the absence of a mechanism by which improvement in biomechanical function may be precisely and adequately quantified. In direct contrast, controlled clinical trials, as in medical research, offer the luxury of statistical clarity as to the selection of one treatment regimen over another. Researchers have indicated that the single-case study experimental design may be of value in chiropractic clinical practice, allowing for the formulation of deductive conclusions derived from each case. To facilitate the process, implementation of both retrospective and prospective aspects are proposed modifications to the general scheme. It is the purpose of this article to employ the concept of the single-case study experimental design, illustrating a condition commonly encountered in chiropractic clinical practice, that of spondylolisthesis. In so doing, we attempt to adhere to the prescribed format, while outlining both the retrospective and prospective aspects, commensurate with such a problem within the clinical setting.
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7/8. The psychological effectiveness of pain management procedures in the context of behavioral medicine and medical psychology.

    The application of operant, biofeedback, and cognitive-behavioral approaches to the management of chronic pain is reviewed. A conceptual and methodological overview of treatment studies is provided from the perspective of recent psychological and multidimensional viewpoints concerning the chronic pain experience. Difficulties in interpreting the clinical efficacy of pain management procedures are highlighted and the need for further controlled outcome studies is recommended, particularly in demonstrating the effectiveness of cognitive-behavioral procedures. Lastly, implications for further research investigating the relationships between individual coping styles and chronic pain are discussed.
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8/8. The comprehensive diagnosis of spinal pain. A new psychodiagnostic instrument.

    The psychological assessment of patients suffering back pain has become a standard part of comprehensive diagnostic protocol and an accepted responsibility of the clinical practitioner. This is for good reason, since research confirms the value of psychological evaluation to clinical diagnosis, treatment planning, and the outcomes of both medical and surgical treatment. However, the traditional psychological tests developed for use with psychiatric patients and in mental health settings are not appropriate for nonpsychiatric orthopaedic patients with back pain. However, a psychometric instrument has recently been developed for use with patients in pain. The Post-Traumatic personality Profile (P-3) is a 48-item, multiple-choice, paper-and-pencil instrument that takes only 15 to 20 minutes. This article discusses the psychometric properties of the P-3 and presents a typical test interpretation.
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