Low back pain (LBP)

Common low back pain (LBP) is defined as pain between the costal margins and the inferior gluteal sulcus, which may be associated with pain referred down to the leg (“leg pain”), and is usually accompanied by painful limitation of movement.

Intermittent LBP is defined as a clinical condition in which pain is induced by standing or walking but is absent at rest.

The impact of low back pain on any modern healthcare system is well known. In industrialized countries, LBP is one of the main causes of health-related and social costs 1) 2).

Therefore, many attempts are being made to develop a systematic, evidence-based approach to dealing with this from a public health perspective.

see also Leg pain.

Initial assesment is geared to detecting red flags.

see Low back pain treatment

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 low back 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 low back 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 back pain, 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).

Airaksinen O, Brox JI, Cedraschi C, et al. European guidelines for the man- agement of chronic nonspecific low back pain. European Spine Journal 2006;15(Suppl. 2):S192–300 [chapter 4].
National Collaborating Centre for primary care low back pain: early man- agement of persistent non-specific low back pain. Full guideline May 2009 http://www.nice.org.uk/cg88 [accessed 14.07.12].
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