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Low Back Pain And Associated Imaging Findings Among Hiv-Infected Patients Referred To An Hiv/Palliative Care Clinic 2013

Category General Spine Elizabeth Molony
Purpose Back pain is one of the most common reasons for physician visits in the US.  In the current treatment era, HIV is a chronic disease with a near-normal life expectancy.  Back pain in patients with HIV in the current treatment era has not been previously investigated. Our objective was to describe ambulatory HIV-infected patients with low back pain referred to an HIV/palliative care clinic (HPCC) and their associated imaging findings. Materials & Methods Trained study staff reviewed 137 charts from patients referred to the HPCC between 4/08-6/11.  Seventy-six had back pain listed as a diagnosis by the primary care or palliative care team.  Those 76 patients were cross-referenced with the UAB imaging database; 22 were found to have had MRIs of the lumbar spine with or without contrast.  A radiologist specializing in neuroimaging interpreted the images. Results Of the 22 patients with imaging, the median age was 46 (IQR 43-51), 8 (36%) were female, 7 (32%) were non-white, 19 (86%) were publicly insured or uninsured, the average CD4+ T-cell count was 610 cells/mm3 (IQR 297-696), and 11 (50%) of the patients had undetectable viral loads.  Fourteen (64%) had degenerative disc disease, 5 (23%) had nerve impingement, 3 (14%) had renal cysts, and 2 (9%) had likely metastasis.  Eleven (50%) of the patients had a finding that warranted follow-up, such as findings suggestive of malignancy, neural impingements that would benefit from physical therapy, and spinal hardware that had become dislodged. Conclusion This study describes a group of patients with HIV and low back pain who had imaging studies, half of which did not warrant any specific follow-up.  These preliminary data highlight the need to investigate imaging and management strategies for back pain in HIV-infected patients. References 1. Verhaak PFM, Kerseens CL, Dekker J, Sorbi MJ, Bensing JM. Prevalence of chronic benign pain disorder among adults: a review of literature. Pain. 1998; 77: 231–239. 2. Alford DP, Liebschutz J, Chen IA, Nicolaidis C, Panda M, Berg KM, Gibson J, Picchioni M, Bair MJ. Update in Pain Medicine. J Gen Intern Med. 2008; 23(6):841–5. 3. Hardt J, Jacobsen C, Goldberg J, Nickel R, Buchwald D. Prevalence of Chronic Pain in a Representative Sample in the United States. Pain Medicine. 2008; 9(7): 803–812.