Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment.

PURPOSE OF REVIEW: Low back pain encompasses three distinct sources: axial lumbosacral, radicular, and referred pain. Annually, the prevalence of low back pain in the general US adult population is 10-30%, and the lifetime prevalence of US adults is as high as 65-80%. RECENT FINDINGS: Patient history, physical exam, and diagnostic testing are important components to accurate diagnosis and identification of patient pathophysiology. Etiologies of low back pain include myofascial pain, facet joint pain, sacroiliac joint pain, discogenic pain, spinal stenosis, and failed back surgery. In chronic back pain patients, a multidisciplinary, logical approach to treatment is most effective and can include multimodal medical, psychological, physical, and interventional approaches. Low back pain is a difficult condition to effectively treat and continues to affect millions of Americans every year. In the current investigation, we present a comprehensive review of low back pain and discuss associated pathophysiology, diagnosis, and treatment.

Anesthesia considerations in stiff person syndrome.

A 34 year old morbidly obese stiffperson syndrome (SPS) patient was scheduled for a permanent catheter placement. SPS is a rare neurologic condition with a suspected autoimmune etiology. SPS most common manifestations are progressive, including severe muscle rigidity or stiffness affecting the spine and lower extremities more than other muscle groups. SPS have superimposed episodic muscle spasms that may resemble myotonic-like contractions and are precipitated by unexpected noises, tactile stimuli, or emotional stress. This case report describes a patient with SPS and morbid obesity, and his subsequent management perioperatively for a permanent catheter placement under monitored anesthesia care. Careful and methodical management of patients with SPS is strongly suggested given their sensitivity to inhalational anesthetics and neuromuscular blockers.