[Inter-hospital CHUV-HUG medical consensus of back pain management. Its application in care pathways within CHUV of Lausanne]. / Consensus interdisciplinaire CHUV-HUG sur la prise en charge des douleurs du dos. Son application lausannoise dans la filière du dos.

Back pain is a considerable economical burden in industrialised countries. Its management varies widely across countries, including Switzerland. Thus, the University Hospital and University of Lausanne (CHUV) recently improved intern processes of back pain care. In an already existing collaborative context, the two university hospitals in French-speaking Switzerland (CHUV, University Hospital of Geneva), felt the need of a medical consensus, based on a common concept. This inter-hospital consensus produced three decisional algorithms that bear on recent concepts of back pain found in literature. Eventually, a fast track was created at CHUV, to which extern physicians will have an organised and rapid access. This fast track aims to reduce chronic back pain conditions and provides specialised education for general practitioners-in-training.

[Fibromyalgia diagnostic criteria]. / Critères de diagnostic de la fibromyalgie.

Fibromyalgia is nowadays an object of controversy. It is the most significant painful and chronic pathology, with a prevalence of 2 to 4% in the general population and a ratio of 3.5% of women for 0.5% of men. Since 1990, fibromyalgia has been defined according to the criteria of the American College of Rheumatology (ACR). The use of these criteria in practice has proved to be controversial and a wide range of studies has shown that an important percentage of patients with fibromyalgia are diagnosed without the criteria of the ACR. This article describes an alternative method for the diagnosis of fibromyalgia.

[Surgical treatment of radicular pain using minimally invasive techniques]. / Traitement chirurgical des douteurs radiculaires par techniques minimales invasives.

Radicular pain can be caused by disc herniation, lateral stenosis, isthmic spondylolisthesis with foraminal stenosis, or foraminal encroachment due to asymmetrical disc degeneration or scoliosis. Surgery is indicated following failure of conservative treatment. Minimally invasive discectomy is indicated for subjects presenting with radicular pain with or without neurological deficit and appropriate sized herniation in MRI. It offers equivalent efficacy but quicker recovery than microdiscectomy. Minimally invasive fusion is indicated for radicular pain due to foraminal compression in isthmic spondylolisthesis, asymmetric disc degeneration or scoliosis. It allows decrease in blood loss and postoperative pain. A less invasive technique should nevertheless not replace properly conducted conservative treatment.