Latest news with #chronicbackpain
Medscape
2 days ago
- Health
- Medscape
Sacroiliac MRI Lesions Set Apart axSpA and Other Back Pain
The analysis of structural lesions in sacroiliac joints using MRI showed distinct patterns of structural changes across multiple groups, with patients with axial spondyloarthritis (axSpA) showing higher rates of erosions and fatty lesions than other groups without axSpA. Inflammatory and structural lesions occurred simultaneously in those with axSpA. METHODOLOGY: Researchers assessed differences in the structural lesions appearing on sacroiliac joint MRIs in 172 participants (mean age, 30.1-34.3 years) from two projects comparing patients with axSpA with those without. They included patients with axSpA (n = 47) and those without axSpA comprising patients with chronic back pain (n = 47), women with postpartum back pain (n = 7), runners (n = 24), and healthy individuals (n = 47). Two trained, calibrated readers independently inspected the sacroiliac joint MRIs for erosions, fatty lesions, sclerosis, and ankylosis. A scoring system similar to that of the Spondyloarthritis Research Consortium of Canada scoring method was used for the assessment. Several structural lesion cutoffs were identified and tested as suggested by two working groups, with specific definitions for three or more erosions, three or more fatty lesions, and five or more erosions and/or fatty lesions. The frequency of patients meeting the cutoffs was assessed within different subgroups. TAKEAWAY: Structural lesions were identified in 79% of patients with axSpA and 13% of those without axSpA, with erosions (75% vs 9%) and fatty lesions (40% vs 4%) showing the most marked differences and sclerosis (13% vs 3%) and ankylosis (15% vs 2%) showing smaller group differences. Erosions were also prevalent in women with postpartum back pain (57%), and fatty lesions were the most prevalent in healthy individuals (6%). Significant differences were noted across groups for fatty lesions ( P < .001), erosions ( P < .001), and ankylosis ( P = .016); however, sclerosis showed no significant variation. The proposed cutoff definitions performed well in differentiating axSpA from non-axSpA. < .001), erosions ( < .001), and ankylosis ( = .016); however, sclerosis showed no significant variation. The proposed cutoff definitions performed well in differentiating axSpA from non-axSpA. In the axSpA group, an overlap of 72%-79% was observed between structural lesions and inflammation, while non-axSpA subgroups showed a significantly lower rate of overlap. However, 4%-29% of patients in the non-SpA subgroup compared with only 6% in the axSpA group had structural lesions without inflammation. IN PRACTICE: "We are convinced that if structural lesions ought to be part of axSpA classification criteria, the implementation of cut-offs for these lesions should be considered. Nevertheless, for a comprehensive understanding of the possible added value of structural lesions, it is crucial to look at the prevalence of structural lesions in the absence of inflammation," the authors wrote. SOURCE: This study was led by Zohra Kerami, Amsterdam UMC Locatie AMC, Amsterdam, the Netherlands. It was published online on May 28, 2025, in RMD Open . LIMITATIONS: The sample sizes were notably small for some subgroups. Additionally, comprehensive clinical and demographic information was lacking for healthy individuals, women with postpartum back pain, and runners. Data on previous pregnancies and the interval between MRI and delivery were not collected systematically, which limited the analysis of pregnancy-related effects. DISCLOSURES: This study did not receive any specific funding. Few authors reported receiving consultancy fees, research support, and/or speaking fees and honoraria for lectures or participation in advisory boards from various pharmaceutical companies. One author reported being an associate editor and another reported being an owner of Joint Imaging BV.
Forbes
16-05-2025
- Health
- Forbes
How Does Medicare Treat Chronic Back Pain?
Chronic back pain is the bane of tens of millions of older Americans. You've heard about these problems: My back hurts so bad I can't straighten up. My back pain is relentless. I can't do anything. I don't know what to do to get relief from this back pain. Maybe you've even experienced back pain. Too many times, back pain is chronic, which meaning Medicare defines as lasting 12 weeks or longer. Almost 50% of those aged 65 and over suffer from back pain. That's probably because so many medical conditions can cause the issue. The more common ones include: Some of the first recommendations for dealing with chronic back pain are walking, swimming, exercise routines, back braces; all safe, cheap, and sometimes effective options. When those measures don't provide adequate relief, it's time to move into prescribed treatments. That's where Medicare enters the picture. Medicare coverage begins with prescription medications; that brings in Part D drug plans. There are many different categories of drugs that treat back pain and the choice depends on the situation. Here are five of the more common groups. Not every drug plan will cover every medication and a plan may require prior authorization. If a new drug is under consideration, check the Medicare Plan Finder or with the drug plan to determine whether it's covered, the cost and any restrictions. Part B will pay for medically necessary services that meet accepted standards of medical practice to diagnose and treat a medical condition (illness or injury). That means the treatment must be supported by a diagnosis, is appropriate for that diagnosis, and is recognized as a medical treatment. How Medicare deals with back pain can vary a bit based on the coverage you have. Here are four frequently prescribed procedures for treatment of low back pain. 1. Physical therapy: Therapeutic exercises, performed by a physical therapist and incorporated into a home program, help manage pain, and improve flexibility and mobility. PT can also help with any adaptative equipment, such as a cane or walker. Medicare no longer has a cap or limit on how much it pays for PT in one year. 2. Chiropractic services: Treatments aim to adjust misalignments in the spine that can cause back pain and limited range of motion. Medicare covers chiropractic services for one reason only: manual manipulation of the spine to treat subluxation: when one or more spinal vertebrae are out of alignment as documented by an X-ray. However, the X-ray will have to be done somewhere else since Medicare does not pay for X-rays or tests that are ordered, performed or interpreted by the chiropractor. There is no limit on the number of visits as long as the treatments are leading to improvement of function. Once the spine has been realigned, Medicare coverage ceases. Medicare Advantage plans may cover chiropractic care for other reasons, such as joint pain, headaches, or stress relief. 3. Acupuncture: This is a treatment in which practitioners stimulate specific points on the body, most often by inserting thin needles through the skin. Five years ago, Medicare started covering all types of acupuncture, including dry needling as an alternative to opioid medications for low back pain. Here's three things to know. Medicare Advantage plans may cover acupuncture for other conditions. 4. Epidural injections: This non-surgical treatment is commonly used to manage radicular pain or pain that radiates along the path of a spinal nerve. Approximately 9% to 25% of people describe having low back pain with pain traveling down to below the knee. The treatment involves injection of solution containing corticosteroids and/or anesthetic into the epidural space (inside the vertebral canal but outside the spinal cord). The corticosteroids can significantly reduce inflammation around an irritated nerve that is causing back and leg pain. Medicare has very specific criteria but here are some important (but not all-inclusive) points about coverage criteria for epidural injections. (Find the complete Local Coverage Determination here.) A patient once told me he believed Ralph Nader (Boomers remember him) would have rejected the design of the back. We can do so many things to keep our backs healthy and happy but because chronic pain increases with age, we may not always succeed. That's when we may need to seek medical help so it's good to know Medicare's role.
