By Guilherme H. M. Oliveira, Gillian C. Nesbitt, Joseph G. Murphy
If you are a doctor on name, you wish a prognosis and therapy advisor that can assist you make fast and exact decisions-one that is entire concise. Now, for the 1st time, the recent Mayo health facility scientific handbook offers simply the perfect info to accomplish virtually any differential analysis you come across. Conceived at Mayo health center, this new guide contains every little thing you must instantly investigate and evaluate symptoms and laboratory abnormalities in a condensed but concise easy-to-access guide.
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38 I SIGNS & SYMPTOMS ■ ■ ■ Treatment is same as for musculoskeletal pain. Epidural injections of corticosteroids can provide temporary relief. If pain does not resolve or if rapidly progressive neurologic deficits occur, surgery is indicated.
Regular exercise is beneficial (avoid overuse), as are heating pads or warm baths, weight reduction, and physical therapy. ■ Lumbosacral corset may provide symptomatic relief. ■ Can lead to radicular symptoms, cauda equina compression syndrome, spinal stenosis, disk herniation, and spondylolisthesis ■ Disk Herniation If nonprogressive radicular pain, initial nonsurgical treatment for 6 weeks allows inflammation to subside: pain resolves in 90% of patients. ■ 38 I SIGNS & SYMPTOMS ■ ■ ■ Treatment is same as for musculoskeletal pain.
Paget disease = chaotic bone resorption and formation— alkaline phosphatase is increased, but calcium and phosphate are normal; urinary pyridinoline collagen cross-links are increased. ▲ X-rays show mixed areas of sclerosis and lysis (also seen in some bone tumors). ▲ ■ ■ ■ Psychiatric Past history of mental illness (depression, anxiety, psychosis), substance abuse, or childhood abuse. Always rule out true pathology! ■ Waddell signs suggest significant psychologic distress rather than true pathology; consider psychologic/psychiatric referral if 3 of 5 tests are positive, although some may be seen in neuropathic pain.