Low Back Pain

Low Back Pain

OVERVIEW:

Low back pain is generally a self-limited condition of the aging spine that responds to conservative measures, including rest and pain management. Pain is typically at the belt line, occasional involving the buttocks and/or posterior thighs. Low back pain is often the result of the stresses and demands placed on the low back area by everyday activities. In the vast majority of cases, the condition is of short duration and recovery is complete.

SIGNS AND SYMPTOMS:

• Onset of low back pain begins suddenly after an injury or gradually over the next 24 hours.
• Variable pain at posterior belt-line, typically on both sides
• Pain may radiate to buttocks and/or posterior thighs
• Pain is aggravated by back motion, sitting, standing, lifting, bending, and twisting.
• Pain relieved by rest

CAUSES:

• Normal aging process of musculoskeletal system
• Acute event (injury)

SCOPE:

80% of Americans experience mechanical low back pain at some point in their life.

MOST OFTEN AFFECTED:

Individuals 25-45 years of age, males and females in equal numbers

RISK FACTORS:

• Age
• Activity
• Smoking
• Obesity
• Vibration, e.g., driving motor vehicles
• Sedentary lifestyle
• Psychosocial factors

DIAGNOSIS

PHYSICAL EXAMINATION:

• Thorough, in particular evaluating the function of the back.
• Numerous other medical conditions that may be responsible for the symptoms should be investigated and ruled out.

TESTS AND PROCEDURES:

• Blood tests
• X-rays, bone scans may be done to assist in diagnosis.
• Magnetic resonance imaging (MRI) or computed tomography (CT scan) may be done.

TREATMENT

GENERAL MEASURES:

• Low back pain is managed in the outpatient setting.
• Initial short-term bed rest (2-3 days)
• Short-term pain relievers
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Muscle relaxants
• Physical therapy
• Manipulation

ACTIVITY:

• Restricted activities for 3-6 weeks
• Resume activities of daily living as tolerated.

DIET:

Weight reduction, if needed

MEDICATIONS

COMMONLY PRESCRIBED DRUGS:

NSAIDs: ibuprofen, naproxen, salsalate

CONTRAINDICATIONS:

Read drug product information.

PRECAUTIONS:

• History of ulcer disease
• Elderly patients
• Kidney disease
• Heart disease

DRUG INTERACTIONS:

Read drug product information.

Other Drugs:

N/A

FOLLOW UP

PATIENT MONITORING:

• The Physician should be seen as often as necessary.
• Duration of care is 1-6 weeks.

PREVENTION/AVOIDANCE:

• Smoking cessation
• Weight reduction
• General physical condition
• Avoid aggravating tasks; e.g., heavy lifting, bending, twisting, sudden unexpected movements

COMPLICATIONS: