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Ulcerative Colitis Dementia Resource Back Health Resource Dermatology Resource
August 27, 2014

1,2Darren M. Roffey PhD; 1Simon Dagenais DC, PhD, MSc; 3Ted Findlay DO, CCFP; 4,5Travis E. Marion MD, MSc; 6Greg McIntosh MSc; 7,8Mohammed F. Shamji MD, PhD, FRCSC; 1,2,4,5Eugene K. Wai MD, MSc, FRCSC

1University of Ottawa Spine Program, The Ottawa Hospital, Ottawa, ON, 2Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON,

3
Department of Family Medicine, University of Calgary, Calgary, AB, 4Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, 5Department of Surgery, Faculty of Medicine, University of Ottawa, ON, 6CBI Health Group, Toronto, ON, 7Division of Neurosurgery, Toronto Western Hospital, Toronto, ON,

8Department of Surgery, University of Toronto, Toronto, ON.

Abstract

Obesity and low back pain are equally complex medical conditions with multi-factorial etiologies. Their clinical practice guidelines both include recommendations for screening and examination that can be easily implemented. There is sufficient information to compile a framework for the primary care provider, partnering with the patient and appropriate specialists, to manage obesity and low back pain in a structured fashion. Weight loss and exercise are paramount and should be recommended as the first options. Cognitive behavioural therapy, pharmacological treatment and bariatric surgery may then be implemented sequentially depending upon the effectiveness of the initial interventions.

Key Words: Obesity, low back pain, exercise, nutrition, cognitive behavioural therapy, bariatric surgery, weight loss, pharmacological, evidence-based guideline.

Untitled Document

1,2Darren M. Roffey PhD; 1Simon Dagenais DC, PhD, MSc; 3Ted Findlay DO, CCFP; 4,5Travis E. Marion MD, MSc; 6Greg McIntosh MSc; 7,8Mohammed F. Shamji MD, PhD, FRCSC; 1,2,4,5Eugene K. Wai MD, MSc, FRCSC

July 22, 2014

1,2Darren M. Roffey PhD; 1Simon Dagenais DC, PhD, MSc; 3Ted Findlay DO, CCFP; 4,5Travis E. Marion MD, MSc; 6Greg McIntosh MSc; 7,8Mohammed F. Shamji MD, PhD, FRCSC; 1,2,4,5Eugene K. Wai MD, MSc, FRCSC

1University of Ottawa Spine Program, The Ottawa Hospital, Ottawa, ON, 2Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON,

3
Department of Family Medicine, University of Calgary, Calgary, AB, 4Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, 5Department of Surgery, Faculty of Medicine, University of Ottawa, ON, 6CBI Health Group, Toronto, ON, 7Division of Neurosurgery, Toronto Western Hospital, Toronto, ON,

8Department of Surgery, University of Toronto, Toronto, ON.

Abstract

Recognizing that the increasing incidence of obesity coincides with the rising prevalence of LBP, there is growing interest in establishing the relationship between over-weight and back pain. It is likely that any association is multi-factorial and that the connection is not as mechanistically simple as previously believed. Systemic inflammation associated with obesity may be an important contributor. Proposed treatment options vary from cognitive behavioural therapy to bariatric surgery with none yet fully proven. Despite the ambiguity, it appears prudent for primary care providers treating obese patients with LBP to recommend weight loss and exercise.

Key Words: Obesity, low back pain, inflammation, intervertebral disc, multi-factorial, causality, association.

Untitled Document

1,2Darren M. Roffey PhD; 1Simon Dagenais DC, PhD, MSc; 3Ted Findlay DO, CCFP; 4,5Travis E. Marion MD, MSc; 6Greg McIntosh MSc; 7,8Mohammed F. Shamji MD, PhD, FRCSC; 1,2,4,5Eugene K. Wai MD, MSc, FRCSC

May 29, 2014

Dr. Ted Findlay, DO, CCFP, Clinical Assistant Professor, Department of Family Medicine, University of Calgary, Calgary, Alberta.

Mohammed F. Shamji, MD, PhD, FRCSC, Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

Abstract
Low back pain is one of the most common conditions for which patients seek medical attention. It can be managed with lifestyle modification, or less commonly medical and surgical intervention. Appropriate selection among various pharmacological options mandates an understanding of the underlying symptomatology and the over-riding treatment plan and objectives. The range of potential medications is substantial: over-the-counter analgesics include acetaminophen and non-steroidal anti-inflammatory drugs, muscle relaxants, and weak opioid combinations including codeine or tramadol. More potent versions of many of the same components are available on prescription, commonly employing stronger opioids either singly or in a combination analgesic. When the pain involves either chronic or neuropathic features, other classes of medications, including anti-epileptic drugs and anti-depressants, may be appropriate.
Key Words: low back pain, acute, chronic, neuropathic pain, nociceptive pain, medications.

Untitled Document

Dr. Ted Findlay, DO, CCFP, Clinical Assistant Professor, Department of Family Medicine, University of Calgary, Calgary, Alberta.

April 1, 2014

Dr. Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH, is a Family Physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. In addition, she trained as a physiotherapist and maintained an active license for 30 years. She is appointed at the University of Toronto, Department of Family and Community Medicine as an Associate Clinical Professor.

Greg McIntosh, MSc, completed his Masters in Epidemiology from the University of Toronto’s Faculty of Medicine. He is currently the Director of Clinical Research for CBI Health Group and research consultant to the Canadian Spine Society.

Abstract
This article helps clinicians decide on appropriate referral to rehabilitation professionals while answering some of the common questions that clinicians are often asked by low back patients. The evidence for appropriate rehabilitation techniques will be interwoven into this article to promote a critical appraisal approach to evaluating rehabilitation outcomes. At the conclusion of this paper, clinicians should be able to identify best practices for rehabilitation referral.
Key Words: Low back pain, indications, rehabilitation, inter-professional referral.

Dr. Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH, is a Family Physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. In addition, she trained as a physiotherapist and maintained an active license for 30 years. She is appointed at the University of Toronto, Department of Family and Community Medicine as an Associate Clinical Professor.

January 7, 2014
HealthPlexus.net
For immediate release:
January 7th 2014


The Canadian Spine Society (CSS), as part of its educational mandate, is partnering with www.healthplexus.net (HealthPlexus) and the Journal of Current Clinical Care (JCCC) to promote best practices and knowledge translation for fast and effective diagnosis and management of back pain.

As part of the multi-faceted collaboration, CSS and HealthPlexus will work on a comprehensive continuing education program aimed at healthcare professionals that will be delivered via www.healthplexus.net and the Journal of Current Clinical Care.

Dr. Hamilton Hall is a well-recognized key opinion leader both nationally and internationally on the subject of back pain. He has taken on the position of Editor-in-Chief for the Back Health Resource Center @HealthPlexus.

Dr. Hall and his colleagues from the CSS will present an ongoing series of Clinical Reviews and Case Studies, which will be available through the HealthPlexus channels. Their goal is to provide those healthcare professionals who are managing patients with back health issues with deeper knowledge and increased ability to address their patients' needs.

"Numerous population wide surveys have confirmed that arthritic disorders that limit mobility are the most important factors in impairing quality of life for older adults. Back pain is one of the key issues limiting mobility, and I applaud HealthPlexus for addressing this very important topic."

-Barry J. Goldlist, MD, FRCPC, FACP, AGSF, senior member of the advisory board for HealthPlexus.net [Geriatrics and Dementia] and the Journal of Current Clinical Care. Dr. Goldlist is a nationally recognized geriatrician with a long standing interest in medical education and medical journalism.

“For practitioners who look after the adult population, especially those in the middle and later years, disorders of musculo-skeletal mobility and acute and chronic pain is one of the most common challenges they face with their patients. There is enormous suffering and impairment of full function and ability to participate in normal activities much less those of a recreational nature when someone experiences back pain that is unrelieved by simple and safe methods. Having an additional means to learn about and find methods to address the issues of back pain with all its complexities of diagnosis and treatment, is an important addition to the HealthPlexus spectrum of clinical support for practicing physicians.”

-Michael Gordon, MD, MSc, FRCPC, FACP, the Editor-in-Chief of the Dementia Educational Resource. Dr. Gordon is the Medical Program Director of Palliative Care at Baycrest Geriatric Health Care System

"As a medical professional who has trained as both a Radiologist and a Family physician, I have seen many patients who suffer from the entire spectrum of lower back pain. I don't think that medical school and residency prepares you enough to adequately to deal with the complexity of this condition. A dedicated CME resource focusing on back health is a much needed tool for both students and practicing physicians who wish to acquire skills and keep their skills up to date on this subject. Dr. Hall is eminently qualified for such an endeavor. I still recall his teachings, some years ago now, in my medical school class at the University of Toronto vividly. As medical editor of the Journal of Current clinical Care, I encourage you to take advantage of this learning opportunity."

-D’Arcy Little, MD, CCFP, FRCPC, the editorial director of HealthPlexus.net and its sister publication, the Journal of Current Clinical Care. Dr. Little is a family physician, diagnostic radiologist and medical writer. He completed fellowships in Care of the Elderly and Academic Medicine


About Health Plexus:
Comprised of 1000s of clinical reviews, CMEs, bio-medical illustrations and animations and other resources, all organized in the 34 condition zones, our vision is to provide physicians and allied healthcare professionals with access to credible, timely and multi-disciplinary continuing medical education from anywhere and on any media consumption device. The Back Health Educational Resource is the compilation of high quality clinical reviews, online CME programs, library of original visual aids, interviews, roundtable discussions and related conference reports.


About The Canadian Spine Society:

The CSS is a collaborative body of Canadian neurosurgical and orthopaedic spine surgeons and other spine care professionals with a primary interest in advancing excellence in spine patient care, research and education.

Contact Person:
Mark Varnovitski
mark@healthplexus.net
www.healthplexus.net

March 1, 2005


Arto Herno, MD, PhD, Senior Consultant, Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland.

The degeneration of the lumbar spine is strongly associated with aging, but this does not mean that pain is an unavoidable accompaniment (though the recorded incidence of low back pain suggests otherwise). Recently, more attention has been drawn to the problem of changes related to the aging of our musculoskeletal system and the associated socioeconomic implications. We now have advanced equipment to examine patients and our store of knowledge is enormous, but the application of this knowledge to a working practical plan at the individual level is problematic. Understanding the automatism of the normal function of the lumbar spine is essential for treating mechanical low back pain because the main goal is to correct this functional disorder. However, the long-term goal of treatment should be to involve patients in their back disorder management.

Key words: aging, degeneration, lumbar spine, low back pain, exercise.


Arto Herno, MD, PhD, Senior Consultant, Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland.