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Introduction: Chronic low back pain (CLBP), or low back pain lasting greater than 12 weeks, is a prevalent condition that profoundly impacts the quality of life in affected individuals. Traditional treatments - such as physical therapy, medications, injections, minimally invasive procedures, and surgery - often prove ineffective in a considerable number of cases, particularly when utilized as singular modalities. Given the complex biopsychosocial nature of CLBP, a multi-modality approach tailored to each patients' unique needs is essential.

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Shoulder abscesses, commonly resulting from bacterial infections, can occasionally present with atypical etiologies and delayed onset. We report a rare case of a massive polymicrobial shoulder abscess developing two decades after an insect bite, emphasizing its clinical presentation, diagnostic approach, and surgical management. A 65-year-old female presented with severe, progressively worsening right shoulder pain, a 20 cm swelling, and purulent discharge persisting for 15 days.

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Decision rules in the diagnostic work-up of aortic dissection.

Emerg Med J

January 2025

Department of Emergency Medicine, York Hospital, York, UK.

A short cut review of the literature was carried out to examine whether a decision rule in conjunction with a D-dimer can be used to rule out aortic dissection. 117 unique papers were found of which three systematic reviews included data on patients relevant to the clinical question; these are discussed in the paper. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated.

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Mediastinal lymphangiomas are rare benign tumors arising from lymphatic system malformations, most commonly seen in pediatric populations. In adults, they are exceedingly rare and present diagnostic challenges due to nonspecific symptoms and imaging overlap with other mediastinal masses. Diagnosis is typically based on imaging, including CT and MRI, with histopathology confirming the diagnosis.

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Nociplastic pain among individuals with chronic ocular surface pain: one cause for "pain without stain"?

Surv Ophthalmol

January 2025

Michigan Medicine, Department of Ophthalmology and Visual Sciences, Ann Arbor, MI, USA.

Chronic ocular surface pain (COSP) refers to interrelated symptoms such as eye burning, aching, and irritation and can occur as an isolated condition or comorbid with numerous ocular disorders, including dry eye syndrome Treatments for COSP are largely aimed at the ocular surface and modulating pain arising from damaged corneal nerves; however, the average impact of these treatments on COSP are low to absent. A potential explanation for this is that in a subset of patients with COSP, individuals have amplified and/or dysregulated neural signaling and sensory processing within the central nervous system (CNS). As in other chronic pain conditions, this might be the pathogenic mechanism primarily responsible for maintaining pain - a phenomenon now referred to as nociplastic pain.

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