Retroperitoneal abscess with pylephlebitis

Stimulated by Lee et al 2019.[1] Photo by Anton Nikolov on Unsplash.My favourite place to get images is Unsplash. It doesn’t have anything on the retroperitoneum or abscesses, so I went with loin, and then kidney, and found this lovely image of a kidney shaped lake. The title may sound to you like another adverse … Continue reading Retroperitoneal abscess with pylephlebitis

Initial healthcare provider and opioid use in LBP?

Stimulated by Kazis et al 2019.[1] Photo by Aiony Haust on Unsplash.This photo was chosen to represent opioids being used on back pain because the first naturally occurring opioids were discovered in a flower. Yes, it is a shame (for my purposes here) that this artistic photographer did not use poppies :-). I am sure … Continue reading Initial healthcare provider and opioid use in LBP?

Laparoscopic needle fragment removal 2019

Stimulated by Liu et al 2019.[1] Photo by Idella on Unsplash.This image is chosen to illustrate the phrase 'like trying to find a needle in a haystack', and it reminds me of the difficulties surgeons used to have in finding embedded foreign bodies. This is a noteworthy case because it is the first report I … Continue reading Laparoscopic needle fragment removal 2019

Piriformis revisited

In regret triggered by the title of Probst et al 2019.[1] This diagram illustrates the anatomical location of piriformis relative to the pelvis, and the characteristic pain referral patterns that form part of the myofascial syndrome. The blue dots on the leg represent tingling that might occur if there is nerve entrapment in piriformis syndrome. … Continue reading Piriformis revisited

PGLBP or LBPGP during pregnancy

Inspired by Nicolian et al 2019 and Vas et al 2019.[1,2] Image by Janko Ferlič on Unsplash. Nicolian et al 2019 is the first paper to report a cost-effectiveness analysis of adding acupuncture to usual care of pelvic girdle and low back pain (PGLBP) in pregnancy. It was a pragmatic open randomised controlled trial with … Continue reading PGLBP or LBPGP during pregnancy

Do patient characteristics affect acupuncture treatment outcomes?

Inspired by Witt et al Clin J Pain 2019.[1] Photo by MC, taken at Kew Gardens Temperate House. This paper is clearly important to consider, despite the limited conclusion of the abstract, since it comes from the ATC (Acupuncture Trialists Collaboration) and involves further analysis of the largest dataset available in the field of acupuncture … Continue reading Do patient characteristics affect acupuncture treatment outcomes?

Too Earnest about Evidence

Inspired by observation and inequity… and a question from a patient in my clinic yesterday. In 1996 Sackett et al wrote an editorial in the BMJ titled:[1] Evidence based medicine: what it is and what it isn’t. The subtitle ran thus: It's about integrating individual clinical expertise and the best external evidence. Note that individual … Continue reading Too Earnest about Evidence