Effects of infrared radiation and shortwave diathermy on the patients with chronic low back pain due to osteoarthritis of the lumbar spine

of atypical femoral fractures is a known complication of chronic bisphosphonate therapy; however, the finding of atraumatic lumbar pedicle fractures without a prior history of spinal surgery or contralateral spondylolysis is rare. While a few cases of osteoporotic pedicle fractures associated with adjacent vertebral compression fractures have been reported, only a single case of isolated atraumatic bilateral pedicle fractures has been published in a patient who had been on chronic risedronate therapy of 10-year duration. Case Report: The present case report illustrates a 63-year-old man who developed isolated atraumatic bilateral lumbar pedicle fractures after 3 years and 5 months on alendronate treatment. The patient’s past medical history had been significant for osteoporosis with a lumbar spine T-score of -2.7. At the time of initial diagnosis, a comprehensive work-up for secondary causes of osteoporosis proved to be negative; this was followed by initiation of bisphosphonate treatment with 70 mg of alendronate once per week. Ten months after starting bisphosphonate therapy, he underwent magnetic resonance imaging (MRI) of the lumbar spine for low back pain that had not responded to conservative management, with imaging not revealing any evidence of pedicle fractures or pedicle stress reaction. He was again seen in the spine clinic, for atraumatic exacerbation of his chronic low back pain with concurrent right lower extremity radiation, 6 months after stopping bisphosphonate therapy. Since the patient failed to respond to conservative management over the ensuing 6 months, a repeat MRI was obtained, which showed new acute/subacute bilateral L5 pedicle fractures. Conclusion: An isolated atraumatic lumbar pedicle fracture may be an additional type of atypical fracture associated with chronic bisphosphonate therapy in an osteoporotic patient. Key words: Chronic low back pain, bisphosphonate, alendronate, pedicle fracture Pain Medicine

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A Comparison of Pressure Pain Detection Thresholds in People With Chronic Low Back Pain and Volunteers Without Pain

Physical Therapy ◽

10.1093/ptj/85.10.1085 ◽

2005 ◽

Vol 85 (10) ◽

pp. 1085-1092 ◽

Cited By ~ 68

Author(s):

R Jason S Giesbrecht ◽

Michele C Battié

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Spine ◽

Chronic Low Back Pain ◽

Primary Care Physicians ◽

Detection Threshold ◽

Test Site ◽

Low Back ◽

Pressure Pain ◽

Pain Detection

Abstract Background and Purpose. Palpation is often utilized in the physical examination of patients with low back pain. The purpose of this study was to compare the pressure pain detection threshold (PPDT) of people with chronic low back pain (CLBP) and subjects without pain. Subjects and Methods. Thirty female subjects with CLBP were recruited from the offices of primary care physicians and physical therapists and compared with 30 female volunteers without pain for differences in PPDT at 6 sites tested bilaterally. Results. A significantly lower mean PPDT was found for all test site groups in subjects with CLBP compared with subjects without pain. A lower global PPDT was found in subjects with CLBP compared with subjects without pain (5.6 lb/cm2 versus 6.9 lb/cm2). This also was the case for PPDT for the group of test sites unrelated to the lumbar spine (5.1 lb/cm2 versus 6.1 lb/cm2) and for PPDT related to the lumbar spine (5.9 lb/cm2 versus 8.0 lb/cm2). Discussion and Conclusion. Neurobiological or biopsychosocial influences may have contributed to the lower PPDT evident in subjects with CLBP. Subjects with CLBP demonstrated a lower global PPDT compared with subjects without pain, which should be taken into account when interpreting findings of pain or tenderness from palpation.

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