Lower Back Pain Homeopathic Remedies

Back Pain Breakthrough

Back Pain Breakthrough is a natural program aim for those suffering from chronic back pain. These methods are such that were discovered after the creator saw a drawing done by Leonardo Da Vinci. It is such that is scheduled to be used for only ten minutes per day and can be used any time of the day. The methods were not intended to permanently heal back pain instantaneously. However, it is something that the creator is so assured of that he promised to send $100 to anyone that didn't see the result. During the period of the usage of this program, one will get the chance to carry out some exercises and read some books that will give one the right knowledge as regards the program. The product comes in various formats- The 6-Part video masterclass, which is a complete step-by-step instruction on how to treat back pain in ten minutes; Targeted Spinal Release Methods: an E-book that has a 30-day plan; Advance Healing Technique E-book. It comes with various benefits such as relief from a long time Back Pain. After using this program, the users will get relief from crippling low- back pain and sciatica as well as longtime back pain. Read more here...

Back Pain Breakthrough Summary


4.8 stars out of 75 votes

Contents: 6-Part Video Masterclass, Ebook
Author: Dr. Steve Young
Official Website: www.backpain-breakthrough.com
Price: $37.00

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My Back Pain Breakthrough Review

Highly Recommended

I've really worked on the chapters in this book and can only say that if you put in the time you will never revert back to your old methods.

In addition to being effective and its great ease of use, this eBook makes worth every penny of its price.

My Back Pain Coach

My Back Pain Coach is a video series developed for people like you who want to once and for all live the life they had before the onset of excruciating back pain. You can call it a miracle because, in just 8 movements that take roughly 16 minutes, your life long bone breaking back pain will vanish in the thin air. That's not all, the eight movements are produced to strengthen your core, especially your abs for better balance and stability, improve your posture for the times to come, walk taller as your contracted and tightened muscles are relaxed, and increase blood flow, oxygen, and nutrients to your spine and the rest of the body so that all of the aching areas receive their deserved share of pain soothing chemicals. The beauty of these movements is that they are not anything like you've been doing in the traditional exercises such as Yoga, Pilates, massage therapy, and exercises recommended by physical therapists. The trustworthiness of this program can be judged from the fact that it has been developed by a trainer of Olympians, working in Serbia, and produced by fitness trainer. Besides the main video series, three bonuses are also given for free. Read more here...

My Back Pain Coach Summary

Contents: Video Series
Creator: Ian Hart
Official Website: mybackpaincoach.com
Price: $47.00

Diagnostic Process in Chronic Low Back Pain

Although no physician would deny patient's history is essential, there is no evidence to support that this helps in establishing a correct diagnosis, moreover, the best method of history taking in chronic low back pain has neither been defined nor validated. History must assess the patient in a bio-psycho-social context, particularly in FBSS (Guzman et al., 2001). Psycho-social ''red flags'', called yellow flags must be searched and a complete evaluation of the patient is mandatory if they are present (Deyo et al., 1992). Moreover, we recommend an interdisciplary approach for these patients. Localisation The origin of the main pain should be clearly defined, is the pain coming truly from the back Couldn't it be buttock pain or loin pain If it is back pain, is lumbar spinal, sacral-spinal or lumbo-sacral spinal pain (Merskey et al., 1994). This precision is important since each condition suggests different diagnostics. If more than one pain is present, a link between them should not be...

Algorithm for Diagnostic Assessment of Low Back Pain and FBSS

An algorithm to investigate low back pain must be based on the likelihood of the diagnosis. In 1995, Schwarzer et al. described the prevalence of the predominant aetiologies in low back pain. To investigate chronic back pain, minimally invasive tests have been developed during the last 15 years and there reproducibility and validity have been well documented (Bog-duk, 2002 b). The quality of the test itself or the expertise of the physician performing the procedure is a necessary but not sufficient condition. The diagnostic must be established according to a clear strategy. Back versus leg pain must first be distinguished when possible and nociceptive differentiated from neuropathic pain. Physical examination will stress signs of radiculopathy versus pseudoradiculopathy. Although differentiating back from leg or radicular pain is particularly difficult to achieve in FBSS, the predominant features will determine the diagnosis process and later the treatment. Predominant Low Back Pain

Minimally Invasive Approaches Diagnostic Procedures for Low Back Pain

Discogram Approach

The precision diagnostic approach was developed to determine in conjunction with other diagnostic tools the cause or the causes of pain in low back pain. By stimulating or anesthetising specific structures, needle procedures can determine precisely the source of the patient's pain (Steindler, 1938). These procedures can target the source of pain and unlike imaging studies determine whether the structure is generating pain or not. This approach is subject to control in order to ensure the validity of the test in each and every patient. The procedure requires fluoroscopy and special skills such as the ability to deliver a needle accurately and safely to the targeted structure. Epidemiologically, three causes of back pain are predominant with or without surgery. Discogenic pain, Facet joint pain and SI joint pain (Man-chikanti et al., 1999 a). For these three aetiologies, three test procedures are available in the investigation of chronic low back and FBBS pain Discog-raphy, Medial...

Minimally Invasive Treatments for Low Back Pain

Algorithm Treatment For Hydrocephalus

A diagnostic strategy properly conducted leads to specific treatment. For the predominant causes of back pain, treatment is available. When no diagnosis can be established, the treatment will be symptomatic and when all medical and conservative treatments have failed, minimally invasive approach including spinal cord stimulation and intrathecal drug delivery systems will be used. It is estimated that in a substantial percentage of patients with chronic back pain the lumbar disk is the pain generator. IDET was developed as an alternative for selected patients with chronic discogenic pain who have failed all conservative treatments and to whom the next step offered was arthrod-esis. Intra-discal electrotherapy was developed because this last treatment was not the perfect response to discogenic pain and because no specific treatment was available for internal disc disruption.

Clinical Presentation

Typical features of dissection are the acute onset of chest and or back pain of blunt, severe, and sometimes radiating and migrating nature. A history of or signs of chronic hypertension are common if obvious signs of connective tissue disorders are absent. Clinical manifestations of acute aortic dissection are often dominated by the anatomicopathological characteristics of specific malperfusion syndrome from dissection-related sidebranch obstruction. Up to 20 of patients with acute aortic dissection may present with syncope without a history of typical pain or neurological findings4,10-13,60,76. Cardiac tamponade may result in hypotension and syncope2,62. Syncope may also result from severe pain, obstruction of cerebral vessels, or activation of aortic baroreceptors. After an initial dominance of chest or back pain, cardiac failure may become the main symptom and is usually related to severe aortic regurgitation2,60,62. Cerebrovascular manifestations and limb ischemia with pulse...

Conclusions and Future

The low back pain population includes a wide variety of patients (Walker, 2000). Not all patients should go through such diagnostic processes and treatments. 90 of acute back pain patients will resolve spontaneously in the first three months and among the reminders not all will suffer enough to necessitate such approaches. For the small portion of the patients needing invasive therapies, non reversible procedures should take place only when a valid diagnostic strategy has been undertaken. In chronic back pain patients, surgery is never an emergency. Knowledge update All physicians taking care of low back pain patients should be aware of the leading epidemiological causes of acute and chronic back pain, of the headlines of the diagnostic algorithm in chronic back pain and detect the biological and psychological red flags. Common sense evidence Relying on history, physical examination and non MRI radiological findings may lead to wrong diagnostic, false security and sometimes to the...

Management options General management

Back care advice early in pregnancy has been reported to reduce the incidence and severity of low back pain during pregnancy. This may be particularly important for women with a history of prepregnancy back pain, who may be at increased risk of worsening pain during pregnancy. Simple physiotherapy, exercise programmes and the use of lumbosacral corsets have all been reported to provide symptomatic pain relief during pregnancy. Use of simple analgesics such as paracetamol and codeine-based preparations is acceptable during pregnancy but non-steroidal anti-inflammatory drugs should be avoided whenever possible. If their use is considered essential, treatment should be agreed with the obstetrician and fetal cardiac ultrasound monitoring arranged because of the risk of premature closure of the ductus arteriosus. Amitriptyline may be prescribed as a co-analgesic, especially if pain is disrupting normal sleep patterns. In cases of severe back pain, strong opioid analgesia may be required....

Intrathecal Medications

The nature of back pain and the conjunction of nociceptive and neuropathic symptoms frequently reduce therapeutic margin of single or even complex medication, therefore, many FBSS patients fail to respond to oral or transcutaneous drug administration. The characteristics and localization of the pain must first be established. Low back versus leg pain and nociceptive versus neuropathic pain help in choosing the most appropriate approach between SCS and Intra-thecal drug infusion. Hassenbusch et al. in a retrospective study in 1995 estimated that intrathecal infusion may be best for bilateral leg and back pain as compared to spinal cord stimulation (Hassenbusch et al., 1995). No evidence has yet determined the adequacy of a particular treatment modality to select between spinal infusion and SCS, however, clinical practice is helpful in this regard. Although Intrathecal drug infusion may be efficient in a wide range of pain patterns and share common indications with SCS, the latter is...

Is biofeedback useful in MS

However, in past studies with Dr. Ronald Melzack at McGill University, surprisingly, we found that Workman's Compensation patients with back pain responded better to biofeedback than MS patients with back pain did. Biofeedback, however, may be helpful in some MS patients. More sophisticated approaches to biofeedback have recently evolved from spinal cord injury centers and other medical clinics.

Problemsspecial considerations

May be associated with back pain Associated with back pain plus Associated with back pain may May be associated with back pain Not associated with back pain May be associated with back pain Associated with back pain May be associated with back pain anaesthesia, p. 128). Sinister signs such as pyrexia, severe back pain, bilateral distribution, or loss of bladder or bowel function are suggestive of a compressive lesion such as epidural or spinal haematoma abscess. These conditions are very rare (less than 1 in 100 000) but may cause major, irreversible damage unless relieved within hours of presentation. Any suspicion should prompt immediate referral for a neurosurgical opinion. In the case of early lesions, some effects of spinal or epidural blockade may persist for several hours, occasionally over 12 hours (up to 48 hours has been reported after epidural blockade, with no apparent cause), obscuring the underlying pathology. Since regression of a block often occurs under observation by...

Bipedicled Transverse Rectus Abdominis Myocutaneous Flap

Multiple reports have investigated the long-and short-term impact of bilateral rectus harvest. Hartrampf reported that 64 percent of patients could not perform a single situp after bipedicled reconstruction, compared to 17 percent in the unipedicled group. Petit reported a 20 percent incidence of subsequent severe back pain in bipedicled patients.96 much the same manner as the free technique. The use of mesh has markedly reduced the incidence of abdominal hernia formation and bulging. Although these patients have objective loss of abdominal function, subjective interference with daily activity is rare. There are reports of an increased incidence of long-term lower back pain. Use of the bipedicled TRAM for unilateral reconstruction has invoked substantial controversy in the plastic surgery literature. Antagonists claim the morbidity from bilateral muscle harvest, including abdominal wall weakness and the propensity toward future back pain, can no longer be defended in the current realm...

CMV polyradiculopathy

This well-recognised syndrome presents over a period of days with back pain followed by the development of a progressive flaccid weakness of the legs with sensory loss and sphincter disturbance. Imaging studies which are essential to exclude compressive lesions due to, for example, lymphoma are normal or may show thickened nerve roots. The CSF shows a characteristic neutrophil pleocytosis which is unusual in a viral infection. Without treatment there is a progression of the neurological deficits, with death in 2 or 3 months.

Anaesthetic management

Women with pre-existing musculoskeletal pathology should be fully assessed during the antenatal period. Previous spinal surgery is not a contraindication to regional analgesia and anaesthesia, although many women may have been told by their midwife, general practitioner or orthopaedic surgeon that they will be unable to have epidural analgesia. There may be respiratory impairment following significant corrective surgery, and some postoperative neurological deficit, and if so these must be documented antenatally. Women should be told that epidural analgesia for labour does not increase the likelihood of experiencing postnatal backache. There is no contraindication to vaginal delivery nor to the use of regional analgesia in women with pregnancy-related back pain, although many women request (and some obstetricians suggest) delivery by elective Caesarean section to avoid any risk of exacerbating existing back symptoms.

Clinical Profiles Of Type A And Type B Dissections

Type A dissections (AAD) tend to present more acutely with hemodynamic compromise, either from rupture, tamponade, myocardial ischemia, or neurological dysfunction due to involvement of branch vessels or the aortic arch. The location of the pain is also different, with type A dissections causing more anterior pain and pain resembling angina, and type B dissections (ABAD) often presenting with interscapular pain or back pain.

Stent Graft Repair of the Primary Tear

In patients with an acute dissection, indications for treatment with a stent graft include ischemia of multiple vascular beds, persistent back pain despite medical therapy, an entry tear in an atypical location or acute aortic rupture. The patients included 15 men and 4 women, with a mean age of 53.2 years (range 16-75 years). Fifteen patients had Type B dissection and 4 had Type A dissection. The primary tear was distal to the left subclavian artery in all patients, however in the 4 patients with Type A dissection there was retrograde extension to involve the ascending aorta. A distance of at least 1 cm between the left subclavian artery and the primary tear was necessary to be considered a candidate for stent graft treatment.

Management options

Women with backache often present to the anaesthetist in the antenatal period. Referral to the obstetric physiotherapist, lumbar support, simple analgesia and transcutaneous electrical nerve stimulation (TENS) may all be of help. With the evidence as it currently stands, there is no need to warn women of the risk of backache when preparing to perform epidural or spinal anaesthesia. However, many women ask about this complication, especially at antenatal classes, and the best approach is to inform them of the high risk of long-term backache associated with pregnancy and childbirth and to reassure them that epidurals do not appear to increase this risk. The woman who presents with severe backache or a long history of back trouble in the antenatal clinic should be warned that it is very likely that this will continue after childbirth. Epidural analgesia should not be contraindicated in these cases but it may sometimes be more painful having an epidural sited in a sensitive back. A...

Preoperative abnormalities

A review of 31 patients with Cushing's disease showed that the commonest clinical features, in order of frequency, were weakness, thin skin, obesity, easy bruising, hypertension, menstrual disorders, hirsutism, impotence, striae, proximal muscle weakness, oedema, osteoporosis, mental disorders, diabetic GTT, backache, acne, hypokalaemia and fasting hyperglycaemia (Urbanic & George 1981). Fractures occur, and wound healing is poor.

Clinical Presentation Diagnosis

Foot Malformations

Closed spinal dysraphism reveals itself through skin abnormalities in 50 to more than 80 of cases 1518 . In the context of ARM, vascular nevus, lumbo-sacral subcutaneous mass, skin dimple and deviation of the natal cleft should be searched for. The manifestations of tethered cord have rightfully been called protean by Hoffman and coworkers in 1976 19 . Presenting symptoms may include motor and sensory deficits in the lower extremities, gluteal and genital region, leg or back pain (especially in older children and adults), foot deformities, leg length discrepancies and scoliosis (neuro-orthopaedic syndrome) or bladder and bowel dysfunction (Fig. 18.1). The majority of our patients had abnormal findings in one or several of these aspects (27 35), but only a minority (6 35) presented with clear-cut progressive symptoms. Most authors agree, that faecal incontinence and urinary abnormalities are more common in patients with tethered cord 2,5,20 , whereas constipation is more common in ARM...

Minimally Invasive Treatments for Leg Pain

In FBSS patients, leg pain responds better than axial back pain to SCS and neuropathic better than nociceptive, mechanical pain, the later almost non responsive to SCS. In over 20 years, North's group reported no major morbidity defined as neurological injury, meningitis or life-threatening infection (North et al., 1993). Electrode migration is the most common complication occurring 24 of the time (Turner et al., 1995). For this reason multichannel devices have been shown to be more reliable in this regard. It has also been advocated that paddle electrodes are more stable (North et al., 1997). Although no randomized studies have been published, it seems that paddle electrodes are associated with improved long term effectiveness, particularly for low back pain. This region needs high voltage stimulation and the design of the paddle leads with the stimulating electrode directed towards the dura unlike the percutaneous electrodes which directs all the usable current towards the medulla....

Surgical Treatment of Infected Aortic Aneurysms

Ruptured Mycotic Aneurysm

The clinical presentation of patients with mycotic aortic aneurysms is different than those patients presenting with contained rupture of an atherosclerotic aneu-rysm. In our experience,5 we noted that all patients with ruptured atherosclerotic aneurysm presented with symptoms of less than 24 hours duration. In contrast, all patients in the mycotic group had symptoms that ranged between two to six weeks with a mean of 3.5 weeks. History of sepsis was absent in all patients presenting with atherosclerotic aortic rupture whereas two-thirds of patients with mycotic aneu-rysms had history of sepsis. Abdominal, chest and or back pain was present in all patients regardless of etiology. The age at presentation was similar with a mean age of 73 years in the atherosclerotic group and 74 years in the mycotic group. There were no differences noted in the incidence of cigarette smoking, hypertension or the presence of chronic obstructive pulmonary disease. Coronary artery disease was present in...

Identify risk factors for chronicity

Guidelines for primary care management of acute back pain highlight the identification of risk factors for chronicity. A useful approach has been developed in New Zealand. It aims to involve all interested parties patient, the patient's family, healthcare professionals, and, importantly, the patient's employer. Four groups of risk factors or flags for chronicity are accompanied by recommended assessment strategies, which include the use of screening questionnaires, a set of structured interview prompts, and a guide to behavioural management. The focus is on key psychological factors or yellow flags that favour chronicity The belief that back pain is due to progressive pathology The belief that back pain is harmful or severely disabling

Vertebral Anomalies and Myelodysplasias

In the literature there are essentially no reports concerning late problems related to vertebral anomalies in patients with ARM. In the author's consecutive series of 375 ARM during the period 1984-1994, 2 patients have required spinal bracing and 4 required operative spinal stabilization because of progressive scoliosis. A report from the same institution in adults with ARM noted that 18 (16 ) out of 116 patients reported symptoms, mainly chronic back pain, related to their vertebral anomalies 62,83 .

Drug Lore And Dietetics

The importance of dietary management is illustrated in a classic text presented to the Mongol Emperor at the Yuan court in 1330 by Hu Szu-hui, who served as court dietary physician for more than 10 years. Hu's Proper and Essential Things for the Emperor's Food and Drink explains early Chinese and Mongolian ideas about the importance of dietetics. For historians, the book is of special interest for the medical and hygienic ideas it contains rather than the recipes. Still, it is interesting to consider both the medical and culinary values of entries such as Roast Wolf Soup and Boiled Sheep's Heart. Most such recipes were said to increase ch'i, but some were more specifically valued for conditions like backache and agitation of the heart. The text suggests foods that promote longevity, warns against certain foods or combinations of foods, and gives special attention to proper diets for pregnant women. Edible plants and animals were carefully classified in terms of medical theories of...

Vulval Pain Syndromes

Dysaesthetic vulvodynia is a diagnosis given to cases of unprovoked vulval burning not limited to the vestibule and with no demonstrable abnormalities (McKay, 1988). It is mainly described in older women, who have burning that extends beyond the vaginal introitus to involve the labia majora and occasionally the inner thighs and anus. Uncontrolled observations have made links between diffuse vulval pain with low back pain or trauma, Herpes simplex virus, and pelvic surgery, which some investigators describe as pudendal neuralgia (McKay, 1993 Turner and Marinoff, 1991). However, there has been no data to support pudendal nerve dysfunction as a cause of vulval pain (Lotery et al., 2004).

Clinical Features

As the duplication cyst slowly fills with the fluid, it enlarges causing local symptoms such as tenderness, low back pain, suprapubic pain, intestinal obstruction, dysuria, dystocia, or sciatic pain. Drainage of mucus or pus from the anus or from a perianal fistula is a frequent presenting sign. Fistulae are reported to occur in approximately 20 of cystic rectal duplications and involve the perianal skin posterior to the anus or the distal canal in the midline 15 . The fistula rate of 45 in one series was based on both clinical and pathological examination, suggesting that not all communications are clinically evident 5 . A characteristic finding is a cone-shaped dimple in the midline just posterior or anterior to the anal verge. It may rarely present as a perforated ulcer 16 . No case with communication to the urinary tract has been reported, although some patients presented with urinary tract symptoms due to compression by a large duplication. Many of these patients who were...

Large tissue deficit in a neuroischaemic foot secondary to infection needing distal arterial bypass

Diabetic Heel Ulcers Pictures

He developed a fever with productive cough associated with rigors and vomiting. He was treated with vancomycin 1 g bd and meropenem 1 g tds intravenously empirically and improved. He complained of back pain and X-ray showed evidence of vertebral collapse. He had magnetic resonance imaging (MRI) of his spine as a metastatic abscess

History Of Surgical Management Of Sciatica

Goldthwait Procedure

Was able to go back to work, but with intermittent episodes of lumbago making him rest for 3 to 4 days. Only after 7 years did he begin to have (In June 1930) pains in the left leg that became increasingly severe and frequent. Examination on 20 February 1931 showed areas of pain in the lumbar region, calf and left heel. These were aggravated by the slightest movement, cough or strain. When he stood, his weight was placed on the intact right extremity. There was an antalgic spasm of the lumbar muscles, but hypotonia of the quadriceps and calf on the left side. His body was held forward when he walked with obvious pain. The spine was held flexed forward and to one side. There was some atrophy of the left thigh and calf, the latter measuring 3 cm less than the healthy calf. There was a slight decrease in strength of flexion and extension of the foot on the left side. Knee reflexes were equal, but the achilles and medial plantar reflexes were absent on the left. Sensory exam showed sharp...

Plating efficiency See efficiency of plating

Minor illness (respiratory, gastrointestinal or influenza-like) from which the patient soon recovers (4-8 ) non-paralytic poliomyelitis, with symptoms of back pain and muscle spasm from which the patient soon recovers (1-2 ) or paralytic poliomyelitis where following a minor prodromal illness as above, the predominant feature is flaccid paralysis resulting from lower motor neuron damage. Poliomyelitis is termed spinal if the lower spine is involved or bulbar if the upper spine and brain stem are involved. About 10 of cases, especially of bulbar poliomyelitis, are fatal and paralysis remains significant or severe in 80 of cases, with about 10 of cases recovering with only minor paralysis. Poliomyelitis was uncommon until standards of hygiene improved in the twentieth century. Formerly it was a common infection and the presence of maternal antibody probably protected infants from neurological disease. Once maternal infection became uncommon, infants were exposed to poliovirus and...

Pancreatic Islet Cell Tumors

Pancreatic or duodenal neuroendocrine tumors in MEN type I occur most frequently in the fourth or fifth decade. Greater than 95 of those who develop enteropancreatic neuroendocrine tumors already have hyperparathyroidism.13 However, Zollinger-Ellison syndrome may be the first manifestation in a small population of patients.14 The clinical presentation usually depends on the increased hormone levels therefore, patients may present early when tumors are small, for example, with duodenal gastrinomas that are unde-tectable on preoperative imaging but that cause significant ulcer disease, esophageal reflux symptoms, and diarrhea (Figure 16-3). Symptoms of local enlargement or infiltration including back pain and abdominal mass, left-sided portal hypertension, jaundice, or metastatic disease (cachexia, hepatosplenomegaly) may rarely be present at presentation, but more frequently in older patients with nonfunctional tumors. Nonfunctional neuroendocrine tumors, of which three-

Setting Priorities Among Diseases and Conditions

The relative weight given to each criterion varies among communities and decision-makers and often must be negotiated among the involved parties. Some practitioners believe that the relationship between the rarity (prevalence) of a candidate disease and the proportion of false positives (persons without the target condition who test positive, given fixed sensitivity and specificity) is the most important principle of screening. This principle explains why selective screening strategies and risk-based strategies are often preferable to mass screening. Moreover, sequential screening to reduce false positives in the case of a rare disease increases in importance when the adverse consequences of a false positive test are severe and costly. In the final analysis, therefore, conditions of low morbidity and mortality (e.g., lower back pain) tend to be unsuitable candidates for screening even when highly prevalent. Similarly, conditions of high morbidity and mortality (e.g., HIV ) tend to be...

Prevalence and Cost

The prevalence of FBSS should be placed in the context of low back pain in general (Anderson et al., 1999 Bressler et al., 1999). The economic environment and local beliefs have an important influence on the type of treatment offered to low back pain patients. Comparing rates of back surgery in eleven countries, Cherkin and al demonstrated an almost linear increase in The United States National Council on Compensation Insurance in Healthcare estimates the costs of work-related low back pain 8.8 billion US , not taking into account lost work, lost tax revenue, and indemnity (Williams, 1998). Most costly are diagnostic procedures (25 ), surgery (21 ), and physical therapy (20 ). The past 20 years have witnessed significant changes in the indications for, and use of, instrumentation in lumbar spine surgery. Between 1979 and 1990 there has been an increase of over 55 in the incidence of spine surgery for chronic low back pain (Gibson et al., 1999).

Musculoskeletal pain

Musculoskeletal symptoms of various types (neck pain, limb pain, low back pain, joint pain, chronic widespread pain) are a major reason for consultation in primary care. This article uses the example of low back pain because it is particularly common and there is a substantial evidence base for its management. The principles of management outlined are also applicable to non-specific musculoskeletal symptoms in general. The increasing prevalence of musculoskeletal pain, including back pain, has been described as an epidemic. Pain complaints are usually self limiting, but if they become chronic the consequences are serious. These include the distress of patients and their families and consequences for employers in terms of sickness absence and for society as a whole in terms of welfare benefits and lost productivity. Many causes for musculoskeletal pain have been identified. Psychological and social factors have been shown to play a major role in exacerbating the biological substrate of...


The complications associated with stent placement are the same as those frequently seen with diagnostic angiography and PTA procedures. Most often they are related to arterial access. A groin hematoma is most common but continued retro-peritoneal hemorrhage can also occur. Patient complaints of significant back pain following a PTA or stent procedure should be evaluated carefully and a CT scan should be considered to rule out hemorrhage.

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