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1.
Back pain following instillations of BCG for superficial bladder cancer is not a reactive complication: review of 30 Mycobacterium bovis BCG vertebral osteomyelitis cases.
Cadiou, S, Al Tabaa, O, Nguyen, CD, Faccin, M, Guillin, R, Revest, M, Guggenbuhl, P, Houvenagel, E, Pertuiset, E, Coiffier, G
Clinical rheumatology. 2019;(6):1773-1783
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Abstract
Mycobacterium bovis Bacillus Calmette-Guérin (BCG) instillations are used in bladder cancer treatment. Adverse effects can occur. Osteoarticular complications are mainly reactive arthritis, but true infections have been described, such as vertebral osteomyelitis. We made a review of M. bovis BCG vertebral osteomyelitis after instillations for bladder cancer using PubMed search. We added three new French cases. Twenty-seven cases of BCG vertebral osteomyelitis had been reported on PubMed. Of the 30 cases, all were male, averaging 73.4 ± 8.7 years old. Median time between diagnosis and first and last instillation was 22.5 and 14 months respectively. Half of vertebral osteomyelitis was thoracic and lumbar in the other half. Sensitivo-motor deficit was present at diagnosis in 42% of cases. Other infectious locations were common, mainly infectious abdominal aortic aneurysms (20%). Rifampicin, ethambutol and isoniazid were the usual therapy. Poor outcomes were reported with 50% of one or more spine surgery. M. bovis BCG vertebral osteomyelitis following bladder instillation for bladder cancer is a rare complication. However, the late onset of back pain after instillations differentiates them from reactive arthritis. Concomitant septic location such as infectious abdominal aortic aneurysms must be known.
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Vitamin D supplementation may improve back pain disability in vitamin D deficient and overweight or obese adults.
Brady, SRE, Naderpoor, N, de Courten, MPJ, Scragg, R, Cicuttini, F, Mousa, A, de Courten, B
The Journal of steroid biochemistry and molecular biology. 2019;:212-217
Abstract
Back pain is currently the greatest cause of disability worldwide, and there are very limited therapeutic options available. Vitamin D deficiency and obesity are both risk factors for back pain. The few randomised controlled trials examining the effects of vitamin D supplementation on back pain have methodological limitations and largely include non-vitamin D deficient participants. Thus, the aim of this study was to determine whether vitamin D supplementation improves back pain symptoms in vitamin D deficient and overweight or obese, otherwise healthy adults. Sixty-five overweight or obese adults (BMI ≥ 25 kg/m2) with vitamin D deficiency (25-hydroxyvitamin D [25(OH)D] concentrations ≤50 nmol/L) were randomised to a bolus oral dose of 100,000 IU followed by 4000 IU cholecalciferol/day or matching placebo for 16 weeks. We measured 25(OH)D concentrations (chemiluminescent immunoassays) and self-reported back pain (Chronic Pain Grade Questionnaire) before and after the intervention. Lifestyle habits including sun exposure, physical activity, and diet were collected using questionnaires. Fifty-four participants completed the study, of which 49 had complete data for back pain and were included in the present analyses (31 M/18 F; mean ± SD age: 31.8 ± 8.9 years; BMI: 31.1 ± 4.5 kg/m2). After the 16-week intervention, 25(OH)D levels increased significantly with vitamin D supplementation compared with placebo (55.7 ± 20.9 versus 3.9 ± 14.4 nmol/L, respectively, p < 0.001). There were no significant differences between vitamin D and placebo groups in change in back pain intensity or disability scores (all p > 0.05). However, in those with 25(OH)D concentrations <30 nmol/L at baseline (n = 20), there was a significantly greater reduction in back pain disability scores in the vitamin D group compared with placebo, after adjusting for important covariates known to affect vitamin D status and/or back pain (b [95%CI] = -11.6 [-22.4, -0.8], p = 0.04). Our findings suggest that vitamin D supplementation in overweight or obese and markedly vitamin D deficient adults (25(OH)D <30 nmol/L) may improve back pain disability. Although treating severe vitamin D deficiency is recommended for optimising bone health, this study suggests it may also improve back pain. Hence, testing for vitamin D deficiency in those with back pain who are overweight or obese may be warranted.
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[The efficacy of meloxicam in acute back pain: results of an observational non-interventional multicenter study].
Karateev, AE, Lila, AM, Pogozheva, EY, Filatova, ES, Amirdzhanova, VN
Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2018;(6):24-30
Abstract
AIM: To evaluate the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) (meloxicam) in acute nonspecific back pain (NSBP) depending on influence of clinical and anamnestic factors. MATERIAL AND METHODS The studied group included 2078 patients presented with an acute NSBP. All study subjects received meloxicam in a dose of 15 mg/day: 86.1% were given intramuscular meloxicam injections for the first 3-5 days and then switched to an oral meloxicam and 13.9% received an oral meloxicam throughout the therapy. Skeletal muscle relaxants (SMR) and oral or intramuscular group B vitamins were also prescribed to 52.3% and 17.4% of study patients, respectively. Pain was assessed on a 10-point numerical rank scale (NRS). The study assessed the rate of complete pain relief within a 2-weeks NSAID therapy. RESULTS Complete pain relief was achieved in 75.2% of study patients, mean period of treatment was 8.61±5.53 days. Adverse events were observed in 4.6% of patients. Age <65 years, first NSBP episode and a history of good response to NSAIDs were associated with better treatment outcomes. A severe baseline pain (NRS score ≥7), pain persistence at rest, at nights and, especially, sciatica were associated with poorer treatment outcomes. Co-administration of SMR and group B vitamins did not increase chances for pain relief compared to the NSAID monotherapy. CONCLUSION Meloxicam in a dose of 15 mg/day is an effective and safe therapy for the treatment of acute NSBP. The analgesic effect of NSAIDs is higher in young patients, patients with the first episode of NBC and a good response to NSAIDs in history. Treatment of patients with NSBP in the presence of severe pain, maintaining pain at rest and at night, and in case of sciatica, requires special control and integrated treatment.
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Genome-wide meta-analysis of 158,000 individuals of European ancestry identifies three loci associated with chronic back pain.
Suri, P, Palmer, MR, Tsepilov, YA, Freidin, MB, Boer, CG, Yau, MS, Evans, DS, Gelemanovic, A, Bartz, TM, Nethander, M, et al
PLoS genetics. 2018;(9):e1007601
Abstract
Back pain is the #1 cause of years lived with disability worldwide, yet surprisingly little is known regarding the biology underlying this symptom. We conducted a genome-wide association study (GWAS) meta-analysis of chronic back pain (CBP). Adults of European ancestry were included from 15 cohorts in the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium, and from the UK Biobank interim data release. CBP cases were defined as those reporting back pain present for ≥3-6 months; non-cases were included as comparisons ("controls"). Each cohort conducted genotyping using commercially available arrays followed by imputation. GWAS used logistic regression models with additive genetic effects, adjusting for age, sex, study-specific covariates, and population substructure. The threshold for genome-wide significance in the fixed-effect inverse-variance weighted meta-analysis was p<5×10(-8). Suggestive (p<5×10(-7)) and genome-wide significant (p<5×10(-8)) variants were carried forward for replication or further investigation in the remaining UK Biobank participants not included in the discovery sample. The discovery sample comprised 158,025 individuals, including 29,531 CBP cases. A genome-wide significant association was found for the intronic variant rs12310519 in SOX5 (OR 1.08, p = 7.2×10(-10)). This was subsequently replicated in 283,752 UK Biobank participants not included in the discovery sample, including 50,915 cases (OR 1.06, p = 5.3×10(-11)), and exceeded genome-wide significance in joint meta-analysis (OR 1.07, p = 4.5×10(-19)). We found suggestive associations at three other loci in the discovery sample, two of which exceeded genome-wide significance in joint meta-analysis: an intergenic variant, rs7833174, located between CCDC26 and GSDMC (OR 1.05, p = 4.4×10(-13)), and an intronic variant, rs4384683, in DCC (OR 0.97, p = 2.4×10(-10)). In this first reported meta-analysis of GWAS for CBP, we identified and replicated a genetic locus associated with CBP (SOX5). We also identified 2 other loci that reached genome-wide significance in a 2-stage joint meta-analysis (CCDC26/GSDMC and DCC).
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Association Between Vitamin D Deficiency and Outcomes Following Spinal Fusion Surgery: A Systematic Review.
Kerezoudis, P, Rinaldo, L, Drazin, D, Kallmes, D, Krauss, W, Hassoon, A, Bydon, M
World neurosurgery. 2016;:71-76
Abstract
BACKGROUND Vitamin D deficiency is a relatively common occurrence in patients presenting for spinal surgery; however, whether this abnormality has any effect on spinal fusion outcomes remains unclear. We performed a systematic review of the available literature relevant to the association between vitamin D deficiency and spinal fusion outcomes. METHODS We conducted a systematic and critical review of recent literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following databases were searched: MEDLINE/PubMed, Google Scholar, Cochrane, Web of Science, and Scopus. Key search terms were "vitamin D," "spinal surgery outcomes," "spinal fusion," and "pseudarthrosis." Papers included in the review were original research articles in peer-reviewed journals. The articles were thoroughly examined and compared on the basis of study design, outcomes, and results. RESULTS A total of 5 studies were included in the qualitative analysis. In these studies, patients presenting with vitamin D deficiency achieved lower fusion rates and suffered higher rates of recurrent-persistent low back pain compared with patients with normal vitamin D levels. Studies examining the effect of postoperative vitamin D supplementation in deficient patients reported significant improvements in low back pain intensity, patient-reported outcomes scores, and fusion rates compared with baseline as well as with control groups. CONCLUSIONS The literature suggests that patients presenting for spinal fusion may benefit from correction of vitamin D deficiency to maximize the chance of a successful arthrodesis and to achieve optimal surgical outcomes. Future prospective studies are needed to determine whether routine preoperative treatment of this metabolic derangement is warranted.
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An integrative review of complementary and alternative medicine use for back pain: a focus on prevalence, reasons for use, influential factors, self-perceived effectiveness, and communication.
Murthy, V, Sibbritt, DW, Adams, J
The spine journal : official journal of the North American Spine Society. 2015;(8):1870-83
Abstract
BACKGROUND CONTEXT Back pain is the most prevalent of musculoskeletal conditions, and back pain sufferers have been identified as high users of complementary and alternative medicine (CAM). Despite lacking evidence, CAM treatments (e.g., acupuncture, chiropractic, and massage) and CAM products (eg, vitamins, supplements, and aromatherapy oils) for back pain care have become widely available internationally, and CAM use by back pain sufferers has become a significant health service issue. However, to date, there has been no integrative review on CAM use for back pain. PURPOSE This study aims to conduct an integrative review on CAM use for back pain focusing on prevalence of use, commonly used CAM, characteristics of users, factors influencing decision making, self-perceived effectiveness, and communication with health-care providers. STUDY DESIGN/SETTING The study is based on an integrative literature review. METHODS A comprehensive search of international literature from 2000 to 2014 in MEDLINE, CINHAL, AMED, DARE, EMBASE, ExceptaMedica, psycINFO, and SCOPUS databases was conducted. The search was limited to peer-reviewed articles published in English language and reporting empirical research findings on CAM use for back pain. RESULTS The review reveals a considerable variation in prevalences of CAM use for back pain internationally. Acupuncture, chiropractic, osteopathy, and massage therapy are the commonly used CAM treatments besides a range of self-prescribed CAM, and back pain sufferers use CAM alongside conventional medical treatments. Female gender, chronicity of back pain, and previous exposure to CAM are key predictors of CAM use for back pain as highlighted from the reviewed literature. Family, friends, and recommendation by doctors appear to influence decision making on CAM use for back pain. The review reveals that users of CAM for back pain tend to report CAM as beneficial, but there is little knowledge on communication between CAM users with back pain and health-care providers about such use. Existing literature is largely based on the research investigating CAM use for back pain among a range of other health conditions. Further rigorous research is needed to investigate the use of a wider range of CAM treatments, particularly self-prescribed CAM for back pain. CONCLUSIONS The review findings provide insights for health-care providers and policy makers on the range of CAM treatments used by back pain sufferers. Conventional medical and CAM practitioners should be aware of back pain sufferers' decision making regarding a range of CAM treatments and be prepared to communicate with patients on safe and effective CAM treatments for back pain.
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¹⁸F-fluoride PET and PET/CT in children and young adults.
Grant, FD
PET clinics. 2014;(3):287-97
Abstract
18F-fluoride PET/CT has been used for a wide variety of indications in children and young adults. Nearly all pediatric 18F-fluoride PET/CTs are performed to evaluate benign conditions. The most common indication is the evaluation of back pain in a wide variety of circumstances, including patients with sports injuries, scoliosis, trauma, and back pain after surgery. The high image quality of 18F-fluoride PET/CT can make it particularly useful for evaluating benign skeletal lesions such as osteoid osteoma and Langerhans cell histiocytosis. Quantitative assessment of bone turnover with 18F-fluoride PET/CT may make it useful for assessing the skeleton in patients with metabolic bone diseases, eating disorders, and avascular necrosis. There is little pediatric experience using 18F-fluoride PET/CT for evaluation of skeletal or soft tissue disease in childhood cancers.
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Willow bark extract STW 33-I in the long-term treatment of outpatients with rheumatic pain mainly osteoarthritis or back pain.
Uehleke, B, Müller, J, Stange, R, Kelber, O, Melzer, J
Phytomedicine : international journal of phytotherapy and phytopharmacology. 2013;(11):980-4
Abstract
STUDY OBJECTIVE Efficacy and safety of willow bark extract for pain reduction in patients suffering from musculoskeletal disorders (MSD) has been shown in clinical short term trials. Therefore this observational study over 6 months should evaluate patterns of treatments like mono- or combinations therapy, dosage and safety during long-term treatment under pragmatic conditions with the aqueous willow bark extract STW 33-I, (Proaktiv(®); drug-extract-ratio 16-23:1). PATIENTS AND METHODS The patients were treated with STW 33-I; comedication with other NSAIDs and opioids was allowed. An extensive case report form including pain questionnaires and patient diary was used for outcome evaluation. RESULTS Four hundred and thirty-six patients with rheumatic pain mainly due to osteoarthritis (56.2%) and back pain (59.9%) were included. During the study the mean reductions from baseline value 58.4±22.6-31.8±22.5 after 24 weeks in the pain intensity scale (VAS 0-100mm) were significant even after 3 weeks with a reduction by 26 mm (45.6% of the baseline value) at the end of the study. The relative reductions of the weekly means of the daily patient self-rated scores of the pain (6-point Likert-scales) were between 33% and 44% of the baseline values during the course of the study. We present results of subgroups according their analgetic/antiphlogistic comedication. The distribution and specification of the main adverse events and the ratings of the treatment showed a good tolerability. No relevant drug interactions were reported. CONCLUSION These data suggest that STW 33-I can be used as a basic treatment in the long-term therapy of painful musculoskeletal disorders and that it can be combined with NSAIDs and opioids if necessary.
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Evaluation of the efficacy of pulsed electromagnetic therapy in the treatment of back pain: a randomized controlled trial in a tertiary hospital in Nigeria.
Oke, KI, Umebese, PF
The West Indian medical journal. 2013;(3):205-9
Abstract
Musculoskeletal system disorders (MSDs) are amongst the most commonly encountered problems in orthopaedics and physiotherapy practice all over the world and back pain is amongst the most prevalent of musculoskeletal presentations encountered in clinical practice. The attendant deformities, huge economic loss among many other sequelae on the affected individuals have always informed the search for cost-effective treatment modalities that are non-invasive and are devoid of or at least have minimal side effects. This randomized controlled trial was conducted to assess the therapeutic efficacy of the use of a non-pharmacological device [pulsed electromagnetic field (PEMF)] modality in the treatment of back pain. A total of 16 patients (mean age: 42.82 +/- 8.63 years) with back pain without radiculopathy who met the inclusion criteria were purposively enrolled in the study. Patients were randomly assigned into two groups. Group A had eight patients treated with PEMF plus medications (analgesics, nonsteroidal anti-inflammatory - diclofenac sodium) while the eight patients in group B were treated with only standard medications. The PEMF device was applied in group A four times a day for the period the patients were admitted (maximum of nine days). Measured outcome parameters were reduction in pain as assessed with numeric pain rating scale (NPRS) and improvement in functional ability status as assessed with functional activity scale (FAS). Obtained data were analysed with paired and independent t-test to test the significant efficacy of the treatment outcomes in the two groups. There was a statistically significant faster pain relief and resumption of active functions in patients treated with PEMF plus analgesic compared with the rates exhibited by patients treated with standard analgesics alone. These results suggest that PEMF therapy is beneficial in reducing pain and disability in patients with back pain and should be made part of holistic cape for back pain. Further studies using PEMF on larger patient populations are advocated to further confirm the efficacy of PEMF therapy in back pain management.
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[Efficacy of ketoprofen lysine salt (artrosilene) in the treatment of nonspecific vertebrogenic pain syndromes in outpatients].
Trubetskaia, EA, Boĭko, AN, Khozova, A, Kamchatnov, PR, Petrov, SV, Otcheskaia, OV, Gandzhula, PA
Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2013;(1):53-5