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A Practical Guide to Managing Low Back Pain in the Primary Care Setting: Imaging, Diagnostic Interventions and Treatment—Part 2

Teaser: 

Conner Joseph Clay1, José M. Orenday-Barraza, MD2, María José Cavagnaro MD2, Leah Hillier MD CCFP (SEM)3, Leeann Qubain1, Eric John Crawford MD MSc(c) FRCSC4, Brandon Hirsch MD5, Ali A. Baaj MD2, Robert A. Ravinsky MDCM MPH FRCSC5

1 University of Arizona College of Medicine – Phoenix, Phoenix, AZ.
2Department of Neurosurgery, University of Arizona College of Medicine – Phoenix, Phoenix, AZ.
3Department of Family Medicine & Community Medicine, Banner University Medical Center Phoenix, University of Arizona College of Medicine – Phoenix, Phoenix, AZ.
4Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
5Department of Orthopaedic Surgery, University of Arizona College of Medicine – Phoenix, Phoenix, AZ.

CLINICAL TOOLS

Abstract: Low back pain (LBP) is one of the most common presenting complaints in the primary care setting with significant economic implications and impairment of quality of life. Effective treatment of LBP can frequently be delivered in the primary care setting. Knowledge of common pain generators and recognition of pain patterns based on the history and physical exam helps guide the treatment of LBP without the need for excessive resource utilization. The majority of patients presenting with LBP can be confidently managed with targeted conservative management; when this fails further investigation may be warranted. Part 2 of this review focuses on imaging and diagnosis of LBP, as well as a detailed review of treatment modalities.
Key Words: low back pain, imaging, diagnostic interventions, treatment.

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Patients presenting with lumbar-related complaints, in the absence of red flags or neurological deficits, can safely undergo a course of conservative treatment prior to ordering imaging studies.
Nonsurgical treatment modalities that can be attempted in patients with LBP include oral medications, topical medications, passive modalities, active physical therapy and cognitive interventions.
Diagnostic interventions such as selective nerve root blocks, diagnostic facet joint injections, medial branch blocks and provocative discography can be useful in confirming that a particular anatomical structure is a clinically relevant pain generator.
Surgery, in the absence of red flags or neurological deficits, should only be considered after the patient fails a thorough course of conservative treatment.
Images of the spine are not necessary to initiate management of mechanical low back pain; they may even be counterproductive.
When required, initial radiological evaluation of the lumbar spine involves upright plain radiographs. Further investigation may include use of MRI or CT myelography.
Diagnostic interventions can aid in establishing the dominant pain-generating anatomical structure but are not required if the patient is improving as anticipated.
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Related Terms: Back Health, low back pain, imaging, diagnostic, intervention, treatment

Wandering: Clues to Effective Management

Wandering: Clues to Effective Management

Teaser: 


Donna L. Algase, PhD, RN, FAAN, FGSA, School of Nursing, University of Michigan, Ann Arbor, MI, USA.

Wandering is among the most challenging behaviours associated with dementia. While research is progressing toward a fuller understanding of this phenomenon, the basis for deriving effective and tested interventions has not been fully developed. In this paper, wandering is defined from multiple perspectives, and its various outcomes and risks are discussed. Putative causes of wandering are summarized. Finally, an approach to aid clinicians in discovering effective strategies for managing an individual’s wandering is presented.
Key words: wandering, dementia, assessment, intervention, primary care.

Related Terms: Dementia, assessment, dementia, intervention, primary care, wandering

Approaches to Treating the Older Substance User

Approaches to Treating the Older Substance User

Teaser: 

Randy Harris, MSW, RSW, Mental Health Therapist, Community Geriatric Mental Health Services, Calgary Health Region, Calgary, AB.

Substance abuse experienced by older clients is frequently seen in medical practices. This article reviews approaches to assessing and treating older adults, including practical ideas for conducting interviews with older clients. A philosophical stance that recognizes a client’s readiness to change is also discussed.

Key words: older adults, substance use, stages of change, assessment, intervention.

Related Terms: Drug Safety, assessment, intervention, older adults, stages of change, substance use

Identification of Nutrition Problems in Older Patients

Identification of Nutrition Problems in Older Patients

Teaser: 

Heather H. Keller, RD, PhD, Associate Professor, Dept. Family Relations and Applied Nutrition, University of Guelph, Guelph, ON.

Although the prevalence of malnutrition and, specifically, undernutrition are unknown among Canadian seniors, nutritional risk has been identified as a common problem. As nutritional risk can lead to malnutrition and all of its sequelae, efforts are needed to identify nutrition problems early in their course to improve the quality of life of seniors. The following article provides a variety of approaches for identifying nutritional problems, from simple indicators to a simplified and standardized nutritional assessment. Suggestions also are provided on how the practitioner can seek assistance with intervening and helping the senior to overcome these problems.
Key words: nutrition, older adults, screening, intervention, risk, weight.

Related Terms: Nutrition, intervention, nutrition, older adults, risk, screening, weight