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The therapy of back pain – especially the medication with opioids – can be challenging for the treating physician. Specific back pain can often be diagnosed by imaging and successfully treated by surgery or medication. In contrast, nonspecific back pain can be worsened by inappropriate imaging, questionable surgical indications and uncontrolled drug use. For the therapy of nonspecific back pain, maintaining daily activity and exercise therapy is central. Opioids are effective drugs for short-term use. However, long-term use often leads to opioid-induced hyperalgesia and hormonal dysfunction with decreased quality of life and libido. Furthermore, opioids can lead to abuse and addiction. After an ineffective treatment with non-opioids, opioids may be given for a limited time period (if possible shorter than four weeks) according to international guidelines. [ABSTRACT FROM AUTHOR]

We evaluated prevalence of VitD deficiency and possible seasonal fluctuations in inhabitants of Southern Switzerland. We analysed clinical data (age, sex, diagnosis, comorbidity, number of drugs) as indicators for VitD deficiency. VitD values were measured in older internal medicine patient population enteringthe emergency unit of the Bellinzona regional hospital in spring (n = 53) and in autumn (n = 49, other population). Prevalence was 98% (average 21.4±12.2 nmol/l) in spring and 63% in autumn (average 43.7±18.6 nmol/l). After summer, 66% of patients presented a deficiency. No significant correlation was found between tested clinical data and deficiency. According to these results and federal recommendations, prophylaxis with 800 IU daily in all older people is reasonable, especially in winter. It is cost-efficient, safe and effective. [ABSTRACT FROM AUTHOR]

Up to 10% of patients with low back pain develop chronic low back pain. By definition, this is a pain that has persisted for longer than three months. Patients with chronic low back pain suffer from a disease, which has serious effects on the psycho-social and physiological integrity of the persons concerned. Pain syndromes of the lumbar region are among the greatest health care system problems in industrialised countries with direct and indirect annual costs of 150 to 250 billion Swiss francs. Despite intensive treatment some patients remain symptomatic. Out of it results a complaint-driven functional under-utilisation, which leads to an alleviation of the performance and increased inactivity -- the beginning of a vicious circle. A multimodal treatment concept including physio- and psychotherapy, supported by a targeted medicamentous therapy, normally improves physical functions and achieves a significant discomfort reduction. If resistance to therapy persists, it is suggestive to consider precociously minimal-invasive or invasive therapeutic options. [ABSTRACT FROM AUTHOR]