Australian Family Physician June 2004 - Back Pain
Vol 33(6):385-480
The June 2004 issue of AFP includes articles on
back pain including clinical assessment, acute low back and lumbar
radicular pain. Also find out more about interventions and
rehabilitation and opioid seeking behaviour.
Back pain: the Australian experience
Scott Masters
There is growing recognition of the burden musculoskeletal disorders place on the Australian population. At present, the direct and indirect costs of this burden is over $15 billion per annum.
Back pain - clinical assessment
Steve Jensen
Low back pain accounts for approximately 5% of all general practice consultations. Although the majority of patients will have somatic low back pain of musculoskeletal origin, vigilance in excluding 'red flag' conditions is paramount.
Acute low back pain - assessment and management
Victor Wilk
Back pain is a common presenting problem in Australian general practice. Serious causes, however, are rare. Tumours, infections and fractures account for less than 1% of cases and can usually can be recognised or excluded by taking a careful history. Patients should expect a good outcome.
Lumbar radicular pain
Jay Govind
Radicular pain is caused by irritation of the sensory root or dorsal root ganglion of a spinal nerve. The irritation causes ectopic nerve impulses perceived as pain in the distribution of the axon. The pathophysiology is more than just mass effect: it is a combination of compression sensitising the nerve root to mechanical stimulation, stretching, and a chemically mediated noncellular inflammatory reaction.
Diagnostic imaging for back pain
Michael Yelland
X-rays and computerised tomography (CT) scans for back pain are often ordered to exclude pathology, to make a positive diagnosis and/or as a response to patient expectations.
Interventions in chronic low back pain
Paul Verrills, David Vivian
Chronic low back pain presents a major challenge for general practitioners and is a significant drain on community resources. Patients often feel frustrated by modern medicine's apparent failure to validate their symptoms with a specific diagnosis and management plan.
Back pain rehabilitation
Clayton H Thomas, David MacAdams
Back pain is a universal problem that becomes persistent in 5-10% of patients following an acute episode. This makes it one of the most costly areas
of health care in Australia.
Back pain and opioid seeking behaviour
Moira G Sim, Gary Hulse, Eric Khong
Back pain is a common presentation associated with opioid seeking behaviour.
Patient education: Low back pain
Victor Wilk
It is not always clear what causes acute back pain. It may result from injuries to muscles, ligaments, bones, joints and discs in the back or to injury to a combination of these structures. Increased muscle tension, for whatever reason, can increase pain.
Undertaking a literature search using PubMed
Farooq Qureshi
PubMed is accessible through the National Library of Medicine, or via the RACGP website.
Brain teaser: Red, irritated eyes
Jerzy K Pawlak
This man presented with red, irritated, watery eyes and palpable left preauricular lymph nodes.
Unilateral red eye
Chris Hodge, Anthony Dunlop
Jason, 25 years of age, presents with a 3 day history of pain 'like bruising' and redness in his right eye.
Clinical challenge
Jenni Parsons
Clinical challenge is now ONLY available as an online activity.
Teaching medical students - what's in it for teachers?
Carol Lawson, Mee Yoke Ling
The term 'doctor' comes from the Latin 'docere' meaning 'to teach'. Although few general practitioners have formal teaching skills or qualifications, we are all involved in teaching patients every day.
How to plan, deliver and evaluate a training session
John Fraser
The long term aim of general practice teaching is to train competent general practitioners to provide high quality care to patients in any setting.
A pain in the back case
Sara Bird
This article discusses a Supreme Court case involving a patient who was referred to a chiropractor for treatment of neck pain.
Marriage: is it good for you?
Craig Hassed
Marriage, which for the purpose of this article will be taken in its traditional sense, has been the subject of much ridicule over the years and, indeed, if one could be objective enough, there is much to laugh at, for it often has a way of bringing out that which is most ridiculous in us.
Postcard from Kirakira
Rosalie Schultz
My partner and I are working in Kirakira, the main town in Makira Province in the Solomon Islands. Our life here is fantastic: a 2 year holiday in tropical paradise.
Primary Care Alliance for Clinical Trials
Jane Gunn, Maria Potiriadis
Well conducted randomised trials provide the most rigorous evidence of effectiveness of primary health care (PHC) interventions.
Enhancing the population health capacity of general practice
Simon Morgan, Paul M Kelly
There is currently a strong trend in Australia to increase general practitioner participation in population health activities.
Which patients are prescribed COX-2 inhibitors rather than nonspecific anti-inflammatory drugs?
Katie Paddon, Bruce Green
Nonsteroidal anti-inflammatory drugs (NSAIDs) including cyclooxygenase-2 (COX-2) specific inhibitors are commonly prescribed by general practitioners.
Suboptimal anticoagulant management after hospital initiation of warfarin
Shane Jackson, Gregory Peterson, Janet Vial, David Jupe
In 1992, adverse events from warfarin use in Australia were estimated at more than $100 million annually in direct hospital costs alone.
General practitioner multidisciplinary skills for enhanced primary care
Stephen F Wilson, Rhona Marks, Susan Donohoe, Margaret Chapman, Nicholas Zwar
Enhanced Primary Care (EPC) was introduced in November 1999 with the aim of encouraging general practitioners to conduct health assessments, care plans, and case conferences, and to achieve improved health outcomes for patients with chronic and complex care needs.