The management of acute low back pain in adults: a guide for the primary care physician

Abstract

To diagnose patients with acute low back pain (LBP), a focused physical examination needs to be conducted and a detailed history obtained. The patient should then be placed into one of three broad categories, namely nonspecific LBP, pain associated with radiculopathy or spinal stenosis, or back pain potentially associated with serious organic disease. The history should include an assessment of psychosocial risk factors that predict delayed healing and progression to chronic pain. Routine imaging is not required within the first three weeks of nonspecific LBP. Imaging should be performed for patients with severe or progressive neurological deficits, or when serious underlying pathology is suspected, based on the history and the physical examination. Patients should be advised of the benign course of nonspecific LBP and that over 90% of patients recover within a few weeks. Occasionally, the pain may last for a few months. Patients should be advised to remain active and should be provided with information on effective self-care options. Usually, first-line medication options are paracetamol or nonsteroidal anti-inflammatory drugs. To treat severe pain, a stronger drug approach that includes opioids may be considered, but only for a short time. Other therapies to be taken into account are spinal manipulation, intensive interdisciplinary rehabilitation, exercise therapy, massage therapy, or progressive relaxation. Spinal surgery is an option in the event of progressive neurological fallout, severe persistent pain of more than three months and patient unresponsiveness to recommended treatment, or if there is acute cauda equina syndrome.

Quality of complementary and alternative medicine recommendations in low back pain guidelines: a systematic review

“…Eligible guidelines were published from 2008 to 2018 in the USA, Canada, Netherlands, UK, Hong Kong, South Africa, Germany, China, Saudi Arabia, Belgium and Australia [1][2][3][4][5][6][7][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. The guidelines were funded and/or developed by professional associations or societies (n = 10), academic institutions (n = 7), disease-specific foundations (n = 3), a government agency (n = 1) and an international agency (n = 1).…”

“…The guidelines were funded and/or developed by professional associations or societies (n = 10), academic institutions (n = 7), disease-specific foundations (n = 3), a government agency (n = 1) and an international agency (n = 1). Twenty guidelines made mention of CAMs [1,2,[4][5][6][7][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. The NCCIH has classified CAM therapies into three types: (1) natural products (herbs, vitamins, minerals, probiotics), (2) mind and body practices (yoga, chiropractic and osteopathic manipulation, meditation, acupuncture, relaxation techniques, Tai Chi, Qi Gong, hypnotherapy) and (3) other complementary health approaches (ayurvedic medicine, traditional Chinese medicine, homeopathy, naturopathy, functional medicine) [10].…”

“…The overall objectives were well defined and specified in all but one guideline [4]. The health questions being covered by each guideline were specifically described in all but two guidelines [4,33].…”

“…The overall objectives were well defined and specified in all but one guideline [4]. The health questions being covered by each guideline were specifically described in all but two guidelines [4,33]. In CAM subsections of the guidelines, the overall objectives and health questions encompassed the scope of the CAM recommendations in all but two guidelines [4,33].…”

“…LBP is predominantly classified into three categories: acute, subacute and chronic LBP. Acute LBP lasts less than 6 weeks, subacute LBP spans from 6 to 12 weeks, and chronic LBP persists for greater than 12 weeks [3][4][5][6]. LBP can additionally be categorized as nonspecific and specific LBP.…”