The role of sacroiliac joint dysfunction in the genesis of low back pain: the obvious is not always right.

BACKGROUND CONTEXT: It is a common practice to the link low back pain with protruding disc even when neurological signs are absent. Because pain caused by sacroiliac joint dysfunction can mimic discogenic or radicular low back pain, we assumed that the diagnosis of sacroiliac joint dysfunction is frequently overlooked. PURPOSE: To assess the incidence of sacroiliac joint dysfunction in patients with low back pain and positive disc findings on CT scan or MRI, but without claudication or objective neurological deficits. METHODS: Fifty patients with low back pain and disc herniation, without claudication or neurological abnormalities such as decreased motor strength, sensory alterations or sphincter incontinence and with positive pain provocation tests for sacroiliac joint dysfunction were submitted to fluoroscopic diagnostic sacroiliac joint infiltration. RESULTS: The mean baseline VAS pain score was 7.8 +/- 1.77 (range 5-10). Thirty minutes after infiltration, the mean VAS score was 1.3 +/- 1.76 (median 0.000E+00 with an average deviation from median = 1.30) (P = 0.0002). Forty-six patients had a VAS score ranging from 0 to 3, 8 weeks after the fluoroscopic guided infiltration. There were no serious complications after treatment. An unanticipated motor block that required hospitalization was seen in four patients, lasting from 12 to 36 h. CONCLUSIONS: Sacroiliac joint dysfunction should be considered strongly in the differential diagnosis of low back pain in this group of patients.

Phenol neurolysis for severe chronic nonmalignant pain: is the old also obsolete?

OBJECTIVE: Our purpose was to reassess the effectiveness of phenol 4% in aqueous solution for neurolysis in patients with severe chronic nonmalignant pain syndromes who did not achieve adequate pain control (visual analog scale [VAS]

Association between hypophosphatemia and cardiac arrhythmias in the early stages of sepsis.

BACKGROUND: The purpose of this study was to evaluate a possible association between serum phosphate levels and the incidence of cardiac arrhythmias in the early stages of sepsis. METHODS: We conducted a prospective, controlled study in the General Intensive Care Unit (GICU) of a university hospital. Sixteen patients with sepsis, but without any previous cardiac disease, were studied during their first 24 h in the GICU. Patients were connected to a continuous ECG recording device. Blood samples for serum phosphate level determinations were drawn during the first 6 h after admission to the unit. RESULTS: Ten of 16 patients had 21 episodes of atrial and ventricular arrhythmias. These patients had higher mean Apache II scores (20.2+/-6.2) than the six patients without arrhythmias (13.2+/-1.7; P<0.05) and significantly lower mean phosphate levels (0.73+/-0.16 vs. 1.02+/-0.32 mmol/l; P<0.03). No association was found between serum phosphate levels and mortality among patients with arrhythmias, or when all survivors (with and without arrhythmia) were compared to all non-survivors. CONCLUSIONS: The results indicate that patients with sepsis and low serum phosphate levels are at a greater risk of developing cardiac arrhythmias. We suggest that phosphate supplementation in the early stages of sepsis may prevent cardiac arrhythmias.