Are Constant Pain, Night Pain, or Abnormal Neurological Examination Adequate Predictors of the Presence of a Significant Pathology Associated With Pediatric Back Pain?

2019 ◽  
Vol 39 (6) ◽  
pp. e478-e481
Author(s):  
Norman Ramírez ◽  
Gerardo Olivella ◽  
Pablo Valentín ◽  
José Feneque ◽  
Soniely Lugo ◽  
...  
Keyword(s):  
Back Pain ◽  
Neurological Examination ◽  
Night Pain ◽  
Constant Pain ◽  
Significant Pathology

scholarly journals NUMERICAL RATING SCALE AS A PREDICTOR OF AN UNDERLYING PATHOLOGY IN PEDIATRIC BACK PAIN USING MAGNETIC RESONANCE IMAGE AS DIAGNOSTIC TOOL

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0004
Author(s):  
Eduardo A. Lindsay ◽  
Gerardo Olivella ◽  
Manuel Rodríguez ◽  
Edwin Burgos-Rossy ◽  
Natalia Torres-Acevedo ◽  
...  
Keyword(s):  
Back Pain ◽  
Magnetic Resonance Image ◽  
Rating Scale ◽  
Chronic Back Pain ◽  
Numerical Rating Scale ◽  
Children And Adolescent ◽  
Constant Pain ◽  
Neurological Exam ◽  
Numerical Rating ◽  
Underlying Pathology

Background & Objectives: Recently, constant and night pain has been discarded as adequate clinical markers to predict the presence of an underlying pathology in pediatric back pain. The pain intensity has been recognized as an important domain in the pain assessment. Numerical Rating Scale (NRS) is one of the most common validated tools to assess pediatric pain intensity in children above 8 years of age. The aim of this study is to assess NRS as a predictor of underlying pathologies found by magnetic resonance image (MRI) in pediatric back pain. We hypothesize that a higher NRS score is associated with a high sensitivity, specificity and likelihood ratio to identify the present of organic pathology in pediatric chronic back pain. Methodology: After obtaining Institutional Review Board approval, a retrospective electronical medical record review was conducted. All pediatric patients who reported back pain lasting > 4 weeks between 2009 to 2018 were enrolled in the study. As per regular protocol, a pediatric orthopedic surgeon evaluated all patients who presented with back pain. After a non-diagnostic history, physical examination and spinal x-ray; spine MRI was order. Pain was graded with the use of NRS from 0 to 10. Patients were divided in two groups: NRS (1-5) & NRS (6-10). Variables such as gender, age, pain frequency, night pain, neurological exam, and the presence of an underlying pathology were compared between both groups. Patients that presented with injury due to trauma, previous diagnosis of back pain or cervical pain were excluded. Results: A total of 467 patients were evaluated in the study. Mean age of subjects was 15 years; 69% being female. An underlying pathology was identified in 131/315 (41.6%) patients with NRS (6-10), and 55/152 (36.2%) patients with NRS (1-5) (P=0.27). Patients with NRS (6-10) had two times more probability of suffering constant pain (P<0.03) and three times more likely of having an abnormal neurological examination (P<0.05). See table 1. Conclusion: Evaluation and treatment of children and adolescent with chronic back pain is challenging. Our study shows a strong association between NRS high (6-10) and constant pain and/or abnormal neurological exam. However, the use of NRS of (6-10) was not found as adequate predictor for the presence of an underlying organic pathology in children and adolescent patients. Therefore, physicians should not rely only high NRS score to recommend advance imaging study to assess chronic back pain in children and adolescent patients. Summary [Table: see text]

The Symptom of Night Pain in a Back Pain Triage Clinic

Spine ◽  
2005 ◽  
Vol 30 (17) ◽  
pp. 1985-1988 ◽  
Author(s):  
Ian J. Harding ◽  
Evan Davies ◽  
Elaine Buchanan ◽  
Jeremy T. Fairbank
Keyword(s):  
Back Pain ◽  
Night Pain

scholarly journals Is The Pain Real or Not?

2018 ◽  
pp. 45-46
Author(s):  
Nelson Hendler
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Nerve Conduction Velocity ◽  
Subjective Experience ◽  
Chronic Back Pain ◽  
Organic Basis ◽  
X Ray ◽  
Extensive Evaluation ◽  
Constant Pain ◽  
Objective Tests

Chronic pain (constant pain lasting 6 months or longer) is a subjective experience, which is influenced by many pre-morbid (before the onset of pain) psychological problems. However, chronic pain often can produce depression, anxiety, and marital difficulties. Although physical examination and other studies, including x-ray studies, 3D-CT, electromyelograms (EMG), nerve conduction velocity studies and MRI in many cases may document an organic basis of chronic back pain, some organic syndromes defy definition by objective tests. This may be a greater problem for women, where physician prejudice can result in a significantly less extensive evaluation of their complaints of back pain. Also, any litigation may influence symptoms and the type of litigation may influence outcomes [8]. Therefore, there is a need to differentiate between “organic” and “functional” (negative physical and laboratory examination) back pain.

56. Is the symptom of night pain important in the diagnosis of serious spinal pathology in a back pain triage clinic?

2004 ◽  
Vol 4 (5) ◽  
pp. S30
Author(s):  
Ian Harding ◽  
Evan Davies ◽  
Elaine Buchanan ◽  
Jeremy Fairbank
Keyword(s):  
Back Pain ◽  
Night Pain

Back Pain in Children

1984 ◽  
Vol 6 (6) ◽  
pp. 183-189
Author(s):  
William P. Bunnell
Keyword(s):  
Back Pain ◽  
Young Child ◽  
Primary Diagnosis ◽  
Accurate Diagnosis ◽  
Radiographic Evaluation ◽  
Age Group ◽  
Mutual Trust ◽  
Distinctive Features ◽  
Significant Pathology ◽  
Insight Into

Back pain in a young child or adolescent is an unusual complaint and must be regarded as a possible indication of the presence of significant pathology. Functional and mechanical causes of back pain in this age group are uncommon; therefore, it is most important that a vigorous attempt be made to establish the primary diagnosis. The purpose of this paper is to review the distinctive features of the history and physical examination that may lead to accurate diagnosis, and to outline a logical approach to the laboratory and radiographic evaluation for each of the major causes of back pain. HISTORY A carefully obtained medical history is frequently the most helpful factor in establishing a diagnosis. In addition to providing important information, it also establishes an attitude of mutual trust and understanding between the physician and patient. A skillfully taken history can help the physician gain vital insight into the patient's attitude toward his or her disease and suggest areas to be emphasized for further evaluation. Specific aspects of the history that are most revealing include: the mode of onset, nature and severity of the pain; a change in symptoms; and associated systemic complaints (Table 1). The mode of onset should be determined as specifically as possible.

scholarly journals Aortic thrombosis presenting with low back pain and paraplegia: a medical alert

2021 ◽  
Author(s):  
Fernanda Fenner ◽  
Francisco José Luis de Sousa ◽  
Hilton Mariano da Silva Jr ◽  
Andrei Fernandes Joaquim
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Neurological Examination ◽  
Survival Rates ◽  
Clinical History ◽  
Sudden Onset ◽  
Lower Limbs ◽  
Low Back ◽  
Vascular Surgeon ◽  
Axial Tomography

Context:The importance of a thorough neurological examination of the patient should always include research into differential diagnoses such as vascular syndromes, increasingly common in our population. Case report: A 46-year-old man evaluated and screened by the Neurosurgery’s department team, after an initial complaint of sudden onset low back pain and acute weakness in both lower limbs. The patient was healthy before the event. Patient didn’t have pathological history or use of chronic medications, referring only to use sporadic medication for sexual impotence, approximately 6 months ago. Observation revealed pale cold lower limbs, with livedo reticularis. Pulses of the femoral artery were absent bilaterally. Neurological examination revealed complete flaccid paraplegia with neurological level of L1. Below this level loss of pain, light touch and temperature sensation (0/2 in all dermatomes on both extremities), muscle weakness (0/5 in all neurotomes bilaterally), absent tendon and plantar reflexes. Axial tomography of the lumbar spine didn’t reveal vertebral lesions or pressure within the spinal canal. Consultation of the vascular surgeon confirmed absence of blood flow through femoral arteries and emergency angiotomography of the abdominal aorta showed complete occlusion of the descending aorta, upper renal arteries. Patient underwent percutaneous embolectomy treatment, with successful revascularization of lower extremities; unfortunately died about 10 hours after surgery due the development of revascularization syndrome. Conclusions: Acute aortic occlusion is a catastrophic event and can present itself as flaccid paraplegia, leading to misdiagnosis and loss of valuable time for positive outcome. Vascular examination should always be performed on each patient with neurological deficit in lower limbs, especially patients with clinical history of peripheral vascular disease. Immediate start of treatment is imperative to improve survival rates.

scholarly journals Is The Pain Real or Not?

2018 ◽  
pp. 45-46
Author(s):  
Nelson Hendler
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Nerve Conduction Velocity ◽  
Subjective Experience ◽  
Chronic Back Pain ◽  
Organic Basis ◽  
X Ray ◽  
Extensive Evaluation ◽  
Constant Pain ◽  
Objective Tests

Chronic pain (constant pain lasting 6 months or longer) is a subjective experience, which is influenced by many pre-morbid (before the onset of pain) psychological problems. However, chronic pain often can produce depression, anxiety, and marital difficulties. Although physical examination and other studies, including x-ray studies, 3D-CT, electromyelograms (EMG), nerve conduction velocity studies and MRI in many cases may document an organic basis of chronic back pain, some organic syndromes defy definition by objective tests. This may be a greater problem for women, where physician prejudice can result in a significantly less extensive evaluation of their complaints of back pain. Also, any litigation may influence symptoms and the type of litigation may influence outcomes. Therefore, there is a need to differentiate between “organic” and “functional” (negative physical and laboratory examination) back pain.

Clinical Update: Evaluation of Low Back Pain

2001 ◽  
Vol 6 (1) ◽  
pp. 3-10, 12
Author(s):  
True Martin ◽  
Christopher R. Brigham ◽  
Charles N. Brooks
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Sensitivity And Specificity ◽  
Clinical Evaluation ◽  
Neurological Examination ◽  
Deep Tendon Reflex ◽  
Low Back ◽  
Diagnostic Studies ◽  
Disc Herniations ◽  
Clinically Significant

Abstract This article provides an overview of the neurological examination and diagnostic studies commonly used in the evaluation of low back pain, information that is essential for both clinical assessment and impairment rating in the AMA Guides to the Evaluation of Permanent Impairment. Clinical evaluation begins with a careful review of medical records. After taking a thorough history, the physician performs the physical examination, including neurological testing, on the patient. The clinical evaluation also determines data needed for impairment evaluation. Neurological examination helps distinguish among the various types of pathology suggested by the history, but to some extent the neurological examination lacks sensitivity and specificity and only about two-thirds (69%) of patients with documented L4-L5 or L5-S1 disc herniations demonstrated weakness or deep tendon reflex changes. To maximize information from the evaluation, physicians routinely test for nonorganic physical signs. Isolated positive signs have no clinical or predictive value, and only a score of three or more positive signs is considered clinically significant. Further, these tests were not designed to detect malingering. Used in isolation, the history, neurological examination, and various diagnostic studies do not have the necessary sensitivity and specificity to diagnose and identify the structural pathology responsible for lumbar radiculopathy. Integrating these components into a logical, unbiased evaluation, physicians usually can perform an accurate assessment.

Pain-related factors associated with lost work days in nurses with low back pain: A cross-sectional study

2016 ◽  
Vol 11 (1) ◽  
pp. 27-33 ◽  
Author(s):  
Saurab Sharma ◽  
Nischal Shrestha ◽  
Mark P. Jensen
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Cross Sectional Study ◽  
Low Back ◽  
Sectional Study ◽  
Related Factors ◽  
Cross Sectional ◽  
Lost Work ◽  
Constant Pain ◽  
The Impact

AbstractBackground and aimsChronic low back pain is known to contribute to lost work days (LWDs) in nurses. However, there is a limited understanding of the factors that moderate the impact of low back pain (LBP) on LWDs – in particular factors that are modifiable and that could therefore be the treatment targets of interventions designed to help nurses more effectively manage LBP.This study aims to identify pain-related factors that are associated with LWDs in nurses with LBP, in order to inform the development of interventions that could reduce LBP-related work dysfunction and improve patient care.MethodsA cross sectional study was conducted on 111 female nurses who were asked to answer questions regarding demographic information, work history, presence or absence of LBP, number of LWDs due to illness, and a number of factors that could potentially be related to LWDs including: (1) average and worst pain intensity; (2) the temporal pattern of LBP (constant versus intermittent); (3) pain aggravating factors (lifting, bending, walking, and standing); and (4) pain alleviating factors (medications, rest, exercise).ResultsSixty-five percent (n = 72) of the sample reported LBP. Constancy of pain and having a LBP problem that was alleviated by rest were significantly associated with the number of LWDs, while maximum and average LBP intensity were only weakly associated.ConclusionThe findings provide important new information regarding whatis (and of equal importance) what is not associated with LWDs in nurses with LBP.ImplicationsTo effectively reduce LBP-related work disability, interventions may need to teach nurses how to better manage constant pain and remain active despite pain, rather than focus on pain reduction. Research to examine the potential efficacy of such treatment approaches for nurses with LBP is warranted.

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