Low back pain

Low back pain is a common problem. Low back pain is most often caused by strain on bones, muscles and ligaments. It usually gets better after a few weeks of treatment.

Good care begins with physical exam by your doctor.

Simple tests in your doctor’s office may:

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  Locate the pain.

  
  


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  Rule out a serious problem.

  
  

Low back pain can be treated with:

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  Medicines for pain.

  
  


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  Heating pads.

  
  


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  Exercise or physical therapy.

  
  

Reduce your risk of low back pain by:

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  Maintaining a healthy weight.

  
  


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  Exercising regularly.

  
  


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  Lifting heavy objects carefully.

  
  

Ask your doctor about different treatment options for your low back pain.

Tell your doctor if are having:

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  Weight loss

  
  


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  Feveres

  
  


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  Weakness in your legs

  
  


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  Loss of feeling in your legs

  
  


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  Other symptoms not related to your back.

  
  

Other tests may be done if:

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  Your pain does not improve

  
  


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  Your pain gets worse.

  
  


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  Your doctor thinks the pain is from a serious medical condition not a strain.

  
  

Radiology test such as x-rays, CT scans and MRI’s for low back pain:

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  Usually do not show anything that would change the first treatment plan.

  
  


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  Often show problems that have nothing to do with low back pain.

  
  


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  Expose you to radiation.

  
  


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  May lead to further unnecessary tests and procedures.

  
  

Recommendation 1: Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause. The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain(strong recommendation, moderate-quality evidence).



Recommendation 2: Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence).



Recommendation 3: Clinicians should perform diagnostic imaging and testing for patients with lowback pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence).



Recommendation 4: Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy) (strong recommendation, moderate-quality evidence).



Recommendation 5: Clinicians should provide patients with evidence-based information on lowback pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options (strong recommendation, moderate-quality evidence).



Recommendation 6: For patients with low backpain, clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care. Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy (strong recommendation, moderate-quality evidence). For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs.



Recommendation 7: For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits — for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence).

In summary, the new ACP/APS guideline as compared to the old AHCPR guideline:

• Covers a broader spectrum of patients with back pain, including acute and chronic back pain


• Reinforces the statement about using brief history and physical examination findings to categorize patients into those requiring more evaluation to search for a potential other, serious cause of backpain, and those patients in whom this can be delayed or foregone completely


• Is a bit stronger on emphasizing the need for psychosocial assessment to help predict potentially delayed recovery


• Is similarly cautious about the use of plain x-ray imaging, but now more strongly supported by the availability of randomized trials showing no benefit for early x-ray imaging


• Is more forceful about the need to avoid specialized diagnostic imaging such as magnetic resonance imaging (MRI) or computed tomography (CT) without a clear rationale for doing so


• Is similarly strong about the need to stay active


• Is broader in the number of pharmacologic and nonpharmacologic options that may be offered to patients requiring them for symptom control