Low Back Pain (LBP) is a common human condition with 60-80% of the world population experiencing pain at some point of time in their life. 1 Low back pain is second only to the common cold as the most frequent reason for visiting a physician and is most common chronic pain syndrome in individual countries. 2 Low back pain is a common musculoskeletal symptom that may be either acute or chronic. It may be caused by a variety of diseases & disorders that affect the lumbar spine. The most frustrating aspect in the treatment of low back pain is that there is "no magic bullets". 3 Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequently prescribed medications worldwide and are widely used for patients with low back pain. 4 Flupirtine maleate is a non-opioid drug without antipyretic and anti-inflammatory properties which is approved by European Medical Agency for acute & chronic pain especially of musculoskeletal origin. 5 It has ABSTRACT Background: Low back pain is a common musculoskeletal symptom caused by a variety of disorders that affect the lumbar spine. The most frustrating aspect in the treatment of low back pain is that there is "no magic bullets". The objective of the study was to compare the efficacy and safety of flupirtine versus piroxicam in patients with back pain. Methods: This was prospective, open labeled, randomized, comparative clinical study conducted by the Departments Orthopedics and Pharmacology, BMC&H, Chitradurga. Study was conducted on 60 patients of either sex, aged above 18 years with low back pain. Assessments were done for Finger-to-Floor Distance (FFD), lumbar pain, Lasegue's sign, tenderness of vertebral muscles, pain & sensory disturbance in lower limbs and response to therapy for efficacy. Parametric data was analyzed by t-test and proportions were compared using Chi-square test. Results: 74 patients were randomized to 2 groups of 37 each. Group I patients received flupirtine maleate 100 mg twice daily and Group II patients received piroxicam 20 mg twice daily for 14 days. 30 patients in each group completed the study and were analysed. On intergroup comparison, there was no statistical difference (p>0.05) in the efficacy parameters of finger-to-floor distance (FFD), lumbar pain, Lasegue's sign, tenderness of vertebral muscles, sensory disturbance in lower limbs, VAS scores & global assessment of response to therapy. 13.3% in flupirtine group and 16.6% in piroxicam group reported adverse events. Conclusions: Both flupiritine and piroxicam were equally effective but flupirtine was better tolerated than piroxicam.

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Hyponatremia is common after orthopaedic surgeries. The prevalence of hyponatremia in the postoperative period is 25-40% in elderly patients. It can cause serious and potentially life threatening complications. Identifying the cause (etiology) and providing appropriate treatment can mitigate the adverse effects of hyponatremia. Depending on the underlying cause, the treatment of hyponatremia can be markedly different. The aim of the study is to determine the cause of post-operative orthopaedic hyponatremia. Methods: This is a prospective study of adults aged more than 65 years admitted with major lower limb fractures who developed post-operative hyponatremia. ECF volulme status was assessed by clinical examination and biochemical parameters. Results: Thirty five patients developed post-operative hyponatremia. The most common cause of postoperative orthopaedic hyponatremia was hypovolemia 45.71% (n=16), followed by euvolemia (SIADH) in 25.71% (n=9). Acute kidney injury, hypervolemia and medications each in 3 cases (8.57% each), hypotonic fluids in one case. Etiology was multifactorial in 77.14% (n=27). Conclusions: Hypovolemia and euvolemia with SIADH are the two major causes of hyponatremia after orthopaedic surgery. The treatment requirements are exact opposites. Hypovolemia requires rehydration with IV fluids where as SIADH needs fluid (free water) restriction. Understanding the etiology of hyponatremia helps to treat hyponatremia with optimal use of IV fluids and avoids adverse outcomes.

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