Patients in the nonsomnolent/nonsedating subgroup who were on duloxetine showed improvements in daily average pain and night pain
severity, compared with those on placebo.
TABLE Red flags for underlying causes of low back pain Condition Red flags Cancer Age >50 History of cancer Unexplained weight loss Failure to improve after 4 to 6 weeks of conservative low back pain therapy Spinal infection Fever >38[degrees]C History of intravenous drug abuse Urinary tract infection Neurologic Cauda equina symptoms emergencies or Progressive neurologic deficit urgencies Suspicion of ankylosing spondylitis Unrelenting night pain
or pain at rest Pain with distal numbness or leg weakness Fracture History of osteoporosis Chronic oral steroid use Serious accident or injury Adapted from Institute for Clinical Systems Improvement (10)
Trauma is rarely a factor so imaging is rarely necessary but get an x-ray if there's an unusual history or refractory problems such as night pain
Improvement was also statistically significant for VAS night pain
, Jamar hand-grip strength, total number of Fibromyalgia tender points and the average tender point pain threshold as measured by algometry.
The pain was gradually relieved and particularly night pain
10) Upon hospital presentation, the patient discussed in this case reported aggravation with lying supine and occasional waking due to night pain
, symptoms fulfilling these criteria that may or may not have been present initially, emphasizing the importance of continued evaluation to ensure the recognition of latent symptoms of pathology.
The patient stated that he received topical treatment for the disease and did not experience an additional problem until he was 30, when he started to feel pain on his front chest wall, neck, and low back (with restriction in low back movements), swelling of the 2nd, 3rd, 4th, and 5th fingers of both hands, night pain
, and morning stiffness lasting 1-2 hours.
Adolescents usually report that back pain bothers them enough to keep them from participating in sports, but ask about night pain
when lying on the affected side and a history of trauma in a patient older than 65 years both suggest a rotator cuff tear, but no individual symptom is definitive for the diagnosis (Table 2).
She reported that her sleep was "good" and usually lasted 8 hours per night but that she did have some night pain
with rolling over in bed.