Acute low back pain secondary to retroperitoneal hemorrhage in an elderly man.

Acute low back pain is a common complaint heard in the emergency room and in a physiatrist's practice. It is important to rule out occult pathology in patients with an atypical presentation. In the case presented here, the patient was elderly, developed back pain without preceding trauma or lifting, had a history of easy bruisability, had a large ecchymosis, and had worsening back pain with bedrest. An abdominal aortic aneurysm was ruled out and the patient was discovered to have a large retroperitoneal hemorrhage. He was diagnosed with acquired hemophilia secondary to factor VIII inhibitors. This has implications for physicians who treat patients with acute low back pain. They must be alert to potentially life-threatening causes of low back pain.

Modern medical electricity in the management of pain.

With the economics of medical care and the history of electrotherapeutics firmly in mind, one should seek treatments that are efficient and effective. There is no question that relief of the symptom of pain must be a primary focus of treatment, whether or not a specific pathology is known. Electric devices may be justifiably used for their placebo effects, if the cost is reasonable, because side effects are minor and infrequent. Research shows specific neurochemical effects of several electrotherapeutic devices, supporting the notion that specific therapeutic effects exist in addition to placebo effects. Passage of time and further research will determine which of the current techniques and devices will find their way into future similar articles or monographs.