PubMed · 10693375
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M S Wilkes. 2000. Chronic back pain: does bed rest help?. https://doi.org/10.1136/ewjm.172.2.121
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STUDY DESIGN: Two institutional experiences in nonteratomatous sacral tumors of the child were analyzed retrospectively. OBJECTIVES: To examine noncongenital nonteratomatous sacral tumors, which are more common in older infants and, as a group, are rare. SUMMARY OF BACKGROUND DATA: Pediatric sacral tumors usually occur in the newborn period, with most of these tumors being sacrococcygeal teratomas. Other common benign congenital tumors of the sacrum include lipomas, dermoids, and epidermoids. METHODS: Six patients were found in a 6-year period. Four patients underwent posterior resection of their tumors. One underwent a combined anterior and posterior approach. One patient underwent a posterior resection and will undergo a second stage anterior approach later to allow for chemotherapy and radiation to shrink the intrapelvic portion of the tumor. RESULTS: Ages ranged from 8 to 11 years. Three were males, and three were females. Five of six presented with back pain, three had constipation, and two had gait difficulties. Pathologies were diverse. They included ganglioneuroma (n = 1), myxopapillary ependymoma (n = 2), primitive neuroectodermal tumor (n = 1), aneurysmal bone cyst (n = 1), and Ewing's sarcoma (n = 1). No progression of disease has occurred in the follow-up period of 1.5 to 7 years (average, 5 years). Radical resection did not result in instability. CONCLUSIONS: In contradistinction to adults, in whom chordomas and metastases are the most common primary and secondary tumors, the pediatric group does not have a predominant pathology. Tumors may attain extremely large sizes and may be very vascular. Multiple therapeutic methods may be required, including adjuvant chemotherapy and, possibly, embolization. Because of the wide range of pathologies, prognosis is varied.
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BACKGROUND: Given the high health care utilization, limited evidence for the effectiveness of back pain interventions, and the proliferation of e-mail health discussion groups, this study seeks to determine if the Internet can be used to improve health status and health care utilization for people with chronic back pain. METHODS: Randomized controlled trial. Participants included 580 people from 49 states with chronic back pain having at least 1 outpatient visit in the past year, no "red-flag" symptoms, and access to e-mail. Major exclusion criteria included continuous back pain for more than 90 days causing major activity intolerance and/or receiving disability payments. INTERVENTION: Closed, moderated, e-mail discussion group. Participants also received a book and videotape about back pain. Controls received a subscription to a non-health-related magazine of their choice. MAIN OUTCOME MEASURES: Pain, disability, role function, health distress, and health care utilization. RESULTS: At 1-year treatment, subjects compared with controls demonstrated improvements in pain (P =.045), disability (P =.02), role function (P =.007), and health distress (P =.001). Physician visits for the past 6 months declined by 1.5 visits for the treatment group and by 0.65 visits for the control group (P =.07). Mean hospital days declined nearly 0.20 days for the treated group vs and increased 0.04 days for the control group (P =.24). CONCLUSIONS: An e-mail discussion group can positively affect health status and possibly health care utilization. It may have a place in the treatment of chronic recurrent back pain.