Low Back Pain

Cause

• Strain / Sprain 70%
• Degenerative changes 10%

Red Flags

• Requires early imaging
  • History Findings
    • Cancer metastatic to bone (breast, lung, thyroid, renal, • prostate) •
    • Urinary or fecal incontinence 
    • Urinary retention
    • Progressive lower extremity motor or sensory loss
    • Significant trauma related to age
    • Severe pain and lumbar spine surgery in the prior 12 months
      
      
  • Exam Findings
    
    • Major motor weakness or sensory loss
    • Saddle anesthesia
    • Loss of anal sphincter tone

Acute Low Back Pain Treatment

• 1. NSAIDs = most beneficial
  
• 2. Skeletal muscle relaxants – beneficial but weight side effects
  
• 3. Epidural steroids
  
• 4. Physical therapy

Chronic Low Back Pain Treatment

• *Beneficial
  
  • NSAID, tramadol, duloxetine (Mindfulness-based stress reduction – know this one )
  • Acupuncture
  • Exercise therapy (walking prgm = PT)
  • Yoga
  • Massage
  • Superficial heat*
  • Physical therapy
  • Intensive multidisciplinary treatment program (B) Behavioral therapy (B)
    
    
• Likely Beneficial
  
  • Skeletal muscle relaxants
  • PT directed home exercise program Prolotherapy
  • Antidepressants (B)Back school (B)
    
  • S-adenosyl-L-methionine Harpagophytum procumbens (devil’s claw) Salix alba (white willow bark)