title: Low back pain and associated imaging findings among HIV-infected patients referred to an HIV/palliative care clinic.
abstract: BACKGROUND
  Low back pain is a common cause of chronic pain in human immunodeficiency virus (HIV)-infected patients. The American College of Physicians and American Pain Society guidelines for diagnostic imaging in low back pain are difficult to apply to patients with chronic illnesses like HIV who may have risk factors for cancer or compression fractures, but whether imaging all such patients for low back pain improves outcomes is unknown.
  
  
  OBJECTIVE
  Our objective was to describe patients referred to a chronic pain-focused HIV/palliative care clinic (HPCC) with back pain and their associated lumbar spine imaging findings.
  
  
  METHODS
  We conducted a retrospective chart review of patients at a palliative care clinic that sees patients with HIV, most of whom have chronic pain. Charts with a diagnosis of low back pain were cross-referenced with an imaging database and any magnetic resonance imaging (MRI) of the lumbar spine with or without contrast were identified.
  
  
  RESULTS
  Seventy-six of 137 patients referred to the HPCC were found to have back pain. These patients were mainly young (median age 45, interquartile range 40-51) with well-controlled HIV. Twenty-two (29%) of these patients had an MRI of the lumbar spine, and 11 (50%) of these warranted follow-up, most of whom had degenerative disc disease, including four with findings concerning for malignancy.
  
  
  CONCLUSIONS
  This is the first study to explore the role of spinal imaging in HIV-infected patients. In our study, four patients had findings concerning for malignancy. These findings suggest that spinal imaging should be considered in the work up of HIV-infected patients with moderate to severe back pain.
authors.affiliation: School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Molony
authors.forename: Andrew O
authors.initials: AO
authors.lastname: Westfall
authors.forename: Brian A
authors.initials: BA
authors.lastname: Perry
authors.forename: Rodney
authors.initials: R
authors.lastname: Tucker
authors.forename: Christine
authors.initials: C
authors.lastname: Ritchie
authors.forename: Michael
authors.initials: M
authors.lastname: Saag
authors.forename: Michael
authors.initials: M
authors.lastname: Mugavero
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Sullivan
authors.forename: Jessica S
authors.initials: JS
authors.lastname: Merlin
mesh_terms: D000328:Adult; D002908:Chronic Disease; D003952:Diagnostic Imaging; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D017116:Low Back Pain / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012189:Retrospective Studies
keywords: Chronic Pain; HIV; Low Back Pain; Radiology
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