Discover and read the best of Twitter Threads about #backpain

Most recents (16)

1/Remembering spinal fracture classifications is back breaking work!

A #tweetorial to help your remember the scoring system for thoracic & lumbar fractures—“TLICS” to the cool kids!

#medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery Image
2/TLICS scores a fx on (1) morphology & (2) posterior ligamentous complex injury. Let's start w/morphology. TLICS scores severity like the steps to make & eat a pizza:

Mild compression (kneading), strong compression (rolling), rotation (tossing), & distraction (tearing in) Image
3/At the most mild, w/only mild axial loading, you get the simplest fx, a compression fx—like a simple long bone fx--worth 1 pt.

This is like when you just start to kneading the dough. There's pressure, but not as much as with a rolling pin! Image
Read 13 tweets
Our Cochrane review on spinal cord stimulators for #backpain out today.

Bottom line:
-Mod certainty evidence of no benefit vs placebo in medium term
-Uncertain if benefit on pain in immediate term
-Adverse events (infection, re-operation) common…

Although it looks like there is an effect in the immediate-term, the certainty of evidence was very low
When analysis on immediate term pain outcomes (<1mo - where most data were available) was restricted to studies with evidence of adequate blinding of participants, the effect disappeared
Read 8 tweets
1/Remembering spinal fracture classifications is back breaking work!

A #tweetorial to review the scoring system for thoracic & lumbar fractures—“TLICS” to the cool kids! #medstudenttwitter #medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery
2/We’ll talk about the imaging part of TLICS. TLICS scores a fx on (1) morphology & (2) posterior ligamentous complex (PLC) injury. Let’s start w/morphology. W/only mild axial loading, you get the simplest fx, a compression fx—like a simple long bone fx--worth 1 pt.
3/As the axial force grows, this becomes a burst fx with retropulsion of the posterior vertebral body—just as greater force causes more comminution in long bone fxs. A burst is worth 2 points.
Read 10 tweets
1/Understanding cervical radiculopathy is a pain in the neck! But knowing the distributions can help your search
A 🧵to help you remember cervical radicular pain distributions #medstudenttwitter #medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery
2/First, a rule of thumb—or rather a rule of elbow! You have 10 fingers. If you divide that in half, you get 5. Similarly, if you divide your arm in half at the elbow, you get 5--C5 that is! C5 radiates towards the elbow. So if it radiates below this, it is > C5 & above is < C5
3/So let’s start with C2. C2 predominantly radiates along the dorsal aspect of the scalp, as it supplies the greater occipital nerve. I remember this bc the number 2 has a swan like neck that mimics the contour of the back of the head and its distribution
Read 9 tweets
1/Even attendings have to use google sometimes! Never be afraid to do whatever it takes to get the right diagnosis
A🧵about an interesting spine case that I gasped, “What the…” when I opened it #medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery Image
2/Older pt w/lower extremity numbness. MRI showed intradural, extra-axial rounded lesions in the lower thoracic region that avidly enhanced on post-contrast imaging—like gang busters enhancement Image
3/On the T2 weighted images, the lesions showed a very distinct donut-like appearance, with a very dark, almost black rim and a bright center. Image
Read 6 tweets
1/”Tell me where it hurts.” How back pain radiates can tell you where the lesion is—if you know where to look!
A 🧵about how to remember lumbar radicular pain distributions. #medstudenttwitter #medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery Image
2/Let’s start with L1. L1 radiates to the groin. I remember that b/c the number 1 is, well, um…phallic. So the phallic number 1 radiates to the groin. Image
3/Let’s skip to L3 for a second. I remember L3 is to the knee—easy, it rhymes! Image
Read 7 tweets
What causes back pain?🤔
Specifically: how much do nervous system, spine tissue and psychosocial contribute to #backpain?

#systematicreview with multivariate #metaanalysis in European J Pain @EFIC_org…

Led by @ScottTags 🙏collaborators

👇 Image
Low #backpain is leading cause of disability worldwide… 90-95% of cases are considered 'non-specific'

Many factors can contribute

Image 👇from… @chadcookpt

But which ones and how much? Image
Individual meta-analyses + factors associated with back pain
➡️ pain processing…
➡️ disc degeneration…
➡️ muscle atrophy…
➡️ depression / distress…

But is one more important than other?
Read 13 tweets
#backpain #exercise
I know many therapists saying they don't give exercises to patients since they don't do them.
But I'd give 30 seconds of exercises to do once a day, but every day. Compliance was very good.
I do this before getting out of bed, and sitting on edge of bed. 1/4
Acommon problem with people with back pain was a low back instability. There is a simple exercise to help this.
Sitting, push one leg down, then against the other leg.
Repeat on other side. Breathe out as you do this. 2/
The most important muscle is the gluteus maximus.
If there is an instability, it weakens. Stabilize first, then strengthen.
But respect the nerve which might be irritated. Don't do too many. Often one is possible, but two is too much. So do one, and only one. 3/4
Read 4 tweets
Can #exercise “strengthen” the intervertebral disc?

A brief history of research from 2013 to 2020:


🙏 collaborators

Thread 👇 👇 👇 👇
First, we did a review of the literature (narrative, not a #systematicreview. This was back in my pre-systematic review days!)… in @SportsMedicineJ

🙏 @DieenJaap, Kirsten Albracht, Prof. Brüggemann, Dr. Vergroesen
It has been well established that exercise and loading can impact IVD height. E.g.……

So, exercise and movement protocols can at least ‘influence’ the IVD
Read 20 tweets
I spoke to a very upset elderly patient (more than 80 years old yesterday) who has hardly had any sleep the night before due to back pain and wanted to speak to a doctor. She was not online. I listened to her, suggested some painkillers and promised I would call her back today.
I asked her as I finished if she was online at all. She replied she wasn’t but she knew her son was. So I asked her if she would like to ask her son if he might get #recordsAccessAndUnderstanding for her. She said she would ask him and then inform me today #DigitalDivide
Today I called her back as promised and she immediately gave me her son’s telephone number eager for him to access her records. I just wanted to know how her back was and if meds I had given her had helped. (She has been waiting 6 months for epidural for lumbar stenosis)
Read 9 tweets
Back pain is the greatest cause of disability and lost productivity world-wide:…

Back pain generates significant financial costs for society in developed countries, such as the United States of America, Japan, Europe and Australia (e.g. US$80 billion per year in direct and indirect costs in the United States of America):

Read 26 tweets
Treatment for #backpain costs the nation almost $5bln a year as more patients undergo expensive, complex surgery. But some argue there's little evidence that procedures such as spinal fusion are always the best option. #abc730 @tabowden
In 2017-18 nearly 18,000 spinal fusions were carried out in Australia. “It's a low level of evidence we accept and I don't think that's good enough particularly for highly invasive, risky & costly procedures like spine fusion.” Prof. Ian Harris, orthopaedic surgeon. #abc730
After three back operations including a spinal fusion, Steve Durell turned to physiotherapy. “If I had my time again and doing this whole process again, I would definitely explore other options than getting surgery to start off with.” #abc730 #backpain
Read 6 tweets
I will be sharing my Ph.D. research during the next 30 days #Covid19 lockdown, while I wait for my Ph.D. defence!

My Ph.D. mainly aimed to improve pain care in Nepal.

Paper 1: Nepali Numerical Rating Scale and Global Rating of Change! Image
Paper 2: Validation of the Nepali Patient-Specific Functional Scale published in our very own @JOSPT. We found that PSFS is comprehensible, reliable, valid, and responsive in people with MSK pain (who r able to comprehend numbers). Full-text:… Image
Paper 3: Clinimetric properties of the Nepali version of the Pain Catastrophizing Scale (PCS). We found a 2 factor structure for the Nepali PCS. The scale is reliable and valid. @DovePress… Image
Read 24 tweets
"Mendenhall says they see thousands of patients a year with substance use problems and about half of them are addicted or dependent on opioids"
.Oct 2018 Oregon…
Back pain is one of the most common reason someone goes to a physician in the United States. It’s also the leading reason someone is prescribed opioids, Roger Chou, M.D.
“I would say [the opioid crisis] is probably our number one public health issue at this time,” said Chou
Keeping in line with the OHA guidelines, Oregon Health and Science University doctors are now treating ACUTE back pain differently. Chou helped create the new back pain guidelines at the hospital.
Read 6 tweets
starting the day with drugs is not as fun as it sounds #chronicpain
strong cannabis cookie, 1/2 soma, 600 mg ibuprofen, 1/2 a joint, heating pad, and now we wait. #migrainemorning #backpain #walkinglikeagnoll
a whole nother joint and several hours later, i can move and managed a shower! now to eat breakfast and then probably rest again. I've got schoolwork to do, laundry and dishes piling up... i will do what i can do today #spoonie #chronicillness
Read 12 tweets

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