Low back pain

Fig. 1. Bone scan of a 75-year-old woman presented with acute onset of low back pain employing either Tc-medronate [25681-89-4] or Tc-oxidronate [14255-61-9]. The bone scan of (a) the anterior and (b) the posterior pelvis shows increased uptake in the region of the sacral bone (arrows). The bladder (arrowheads) is a normal route of tracer excretion and is also prominently identified in the image.

The financial impact of pain is considered to be significant. The National Institute for Occupational Safety and Health (NIOSH) estimated that the cost of low back pain alone was between 50 billion and 100 billion per year.12 The American Productivity Audit of the United States workforce, conducted from 2001 to 2002, revealed that the cost of lost productivity due to arthritis, back pain, headache, and other musculoskeletal pain was approximately 80 billion per year.13... 

In addition to chronic conditions such as arthritis and low-back pain, some musculoskeletal disorders are induced by... 

Frymoyer JW, Cats-Baril WL (1991) An overview of the incidences and costs of low back pain. Orthop Clin North Am 22(2) 263-271... 

Schwarzer AC et al (1995) The prevalence and clinical features of internal disc disruption in patients with chronic low back pain. Spine 20(17) 1878-1883... 

The most common osteoporosis-related fractures involve the vertebrae, proximal femur, and distal radius (wrist or Colies fracture). Two-thirds of patients with vertebral fractures are asymptomatic the remainder present with moderate to severe back pain that radiates down a leg after a new vertebral fracture. The pain usually subsides significantly after 2 to 4 weeks, but residual, chronic, low-back pain may persist. Multiple vertebral fractures decrease height and sometimes curve the spine (kyphosis or lordosis) with or without significant back pain. 

Acute bacterial prostatitis High fever, chills, malaise, myalgia, localized pain (perineal, rectal, sacrococcygeal), frequency, urgency, dysuria, nocturia, and retention Chronic bacterial prostatitis Voiding difficulties (frequency, urgency, dysuria), low back pain, and perineal and suprapubic discomfort Physical examination... 

Another SNRI, bicifadine (20), formerly under clinical development for chronic low back pain, is now being developed for neuropathic pain [65,66]. Flufenoxine, also known as F-98214-TA (21), was reported to display greater potency than several reference antidepressants in animal models predictive of antidepressant and anxiolytic activities [67]. SEP-227162 (structure undisclosed) is another SNRI reportedly undergoing clinical development [68]. 

Predisposing factors for low back pain include osteoporosis, trauma and pregnancy. 

Dubois EF, Wagemans ME, Verdouw BC, Zwmderman AH, Van Boxtel CJ, Dekhuijzen PN, Schweitzer DH. Lack of relationships between cumulative methylpred-nisolone dose and bone mineral density in healthy men and postmenopausal women with chronic low back pain. Clin Rheumatol 2003 22(l) 12-7. 

Rheumatic disease is defined as disease of connective tissue and medical disorders of the musculoskeletal system . The medical discipline concerned with these diseases is referred to as rheumatology. The majority of rheumatic diseases are soft tissue rheumatism and nonspecific low back pain (LBP), autoimmune inflammatory rheumatic diseases, osteoarthritis (OA), osteoporosis, crystal-deposition disease and infectious arthritis. 

Clinical treatment recommendations for low back pain based, on 5 international guidelines and on information in the Cochrane database of systematic reviews, can be summarized as follows there remains a lack of consensus regarding reported efficacy of spinal manipulative therapy for the treatment... 

Assendelft WJJ, Morton SC, Yu El, Suttorp MJ, ShekeUe PG. Spinal manipulative therapy for low-back pain. Cochrane Database Syst Rev 2004. 

Unlabeled Uses Low back pain, spasticity associated with multiple sclerosis or spinal cord injury, tension headaches, trigeminal neuralgia... 

Devil s claw (Harpagophytum procumbens) Harpagophytum procum-bens is native to South Africa, Namibia and Madagascar, and traditionally used in the treatment of osteoarthritis, rheumatoid arthritis, indigestion and low back pain. This plant contains 0.5-3 per cent iridoid glycosides. 

The pharmacological actions of salicylates in humans are well documented and are applicable to willow. In recent clinical studies, willow bark extract had moderate analgesic effects in osteoarthritis and low back pain (93-96). 

Chrubasik S, Eisenberg E, Balan E, Weinberger T, Luzzati R, Conradt C. Treatment of low back pain exacerbations with willow bark extract a randomized double-blind study. Am J Med 2000 109 9-14. 

Chrubasik S, Kunzel O, Model A, Conradt C, Black A. Treatment of low back pain with a herbal or synthetic anti-rheumatic a randomized controlled study. Willow bark extract for low back pain. Rheumatology 2001 40 1388-1393. 

Chrubasik S, Kunzel O, Black A, Conradt C, Kerschbaumer E. Potential economic impact of using a proprietary willow bark extract in outpatient treatment of low back pain an open non-randomized study. Phytomedicine 2001 8 241-251. 

The NSAIDs have a number of commonalities. Although not all NSAIDs are approved by the FDA for the whole range of rheumatic diseases, most are probably effective in rheumatoid arthritis, seronegative spondyloarthropathies (eg, psoriatic arthritis and arthritis associated with inflammatory bowel disease), osteoarthritis, localized musculoskeletal syndromes (eg, sprains and strains, low back pain), and gout (except tolmetin, which appears to be ineffective in gout). 

Nadler, S. F., Ranky, P. G., and Ranky, M. (2002-2003), A 3D multimedia approach to the diagnosis of low back pain (Vol. 1,18- and 40-year-old males), interactive 3D multimedia presentation on CD-ROM with off-line Internet support (650 Mbytes, approx. 150 interactive screens, 50 minutes of digital videos, 3D internal and external body tour, animation, and 3DVR objects), by CIMware (IEE and IMechE Approved Professional Developer) also in Multimedia design and programming by P. G. Ranky and M. F. Ranky. 

Ranky, P. G., and Nadler, S. F., A novel multimedia approach to low back pain diagnosis with internal and external 3D interactive body tours, paper presented at the 29th Annual Northeast Bioengineering Conference, New Jersey Institute of Technology, University Heights, Newark, NJ, Mar. 2003. 

Palangio, M., Morris, E., Doyle, R.T. Jr., Dornseif, B.E., Valente, T.J. Combination hydrocodone and ibuprofen versus combination oxycodone and acetaminophen in the treatment of moderate or severe acute low back pain, Clin. Ther. 2002, 24, 87-99. 

Goodkin, K., Gullion, C. M., Agras, W. S. A randomized, double-blind, placebo-controlled trial of trazodone hydrochloride in chronic low back pain syndrome, J. Clin. Psychopharmacol. 1990, 10, 269-278. 

Stein, D., Peri, T., Edelstein, E., Elizur, A., Floman, Y. The efficacy of amitryptiline and acetaminophen in the management of acute low back pain, Psychosomatics 1996, 37, 63-70. 

Postlumbar puncture syndrome with abducent nerve palsy followed the use of intrathecal prednisolone for the treatment of low back pain and sciatica (451). 

Bilateral posterior subcapsular cataracts have been reported after treatment with epidural methylpredniso-lone for low back pain secondary to degenerative joint disease and disk protrusion (453). 

A 46-year-old woman with low back pain and osteoporosis took salmon calcitonin subcutaneously 100 U/ day and calcium carbonate orally 1.5 g/day for 7 days before developing nausea and facial flushing (13). Calcitonin was continued for a further 8 days and then stopped. The next day she developed intermittent generalized convulsions. She was subsequently found to have breast cancer with skeletal metastases and hypercalcemia (3.9 mmol/1) without a reduced... 

Schnitzer TJ, Ferraro A, Hunsche E, Kong SX. A comprehensive review of clinical trials on the efficacy and safety of drugs for the treatment of low back pain. J Pain Symptom Manage. 2004 28 72-95. 

---