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Back pain

Back pain is the second reason responsible for absenteeism from work after the common flux.

Back pain is one of humanity's most frequent complaints.

Back pain is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine.

Classification

Back pain may have a sudden onset or can be a chronic pain; it can be constant or intermittent, stay in one place or radiate to other areas. It may be a dull ache, or a sharp or piercing or burning sensation. The pain may radiate into the arms and hands as well as the legs or feet, and may include symptoms other than pain. These symptoms may include tingling, weakness or numbness.

see Axial back pain.

see Chronic back pain.

see Low back pain

Diagnosis

The value of early diagnostic imaging in older adults for back pain without radiculopathy is uncertain 1).

Differntial diagnosis

Back pain affects 80% of adults at some point of their life and occurs at all ages. The first objective is to rule out a visceral disorder or a serious potentially life-threatening condition, which occurs in 2.7% of the cases 2).

Back pain may be the manifestation of thoracic involvement as in esophageal disease, pleurisy, aortic aneurysm, or coronary heart disease, or an abdominal process, such as gastrointestinal ulcer, gastric cancer, pancreatic cancer, pancreatitis, or biliary pathology.

Non-vertebral causes such as the presence of gallstones should be considered in patients with back pain. Physicians should be aware of atypical manifestations of common diseases, so as to avoid diagnostic delays. Gallbladder disorders should be taken into account in patients with dull, undefined right back pain, despite a normal physical examination. Abdominal ultrasound should be chosen as the first diagnostic procedure when considering gallstones, since CT scans have a very low sensitivity for their detection. In a patient with a typical clinical report of biliary colic and a negative abdominal ultrasound, an endoscopic ultrasound may be carried out in order to rule out biliary microlithiasis. 3).

Treatment

Current United States practice guidelines suggest an initial “wait and see” approach following onset of musculoskeletal pain, particularly for spinal pain.

Preliminary evidence is suggestive of decreased cost without compromising outcomes with early receipt of Physical Therapy (PT). The primary limitation of the current research on this topic is in study design. Additional high quality research involving prospective randomized designs and economic impact analyses is required to further investigate the outcomes with early initiation of PT. Level of Evidence Therapy, Level 1a 4).

Links

arc BackCare - The Charity for Healthier Backs BOA ISSLS National Centre for Osteopathic Research (NCOR) Scottish Society of Rehabilitation Spinal News International - The newspaper for the spinal specialist Spine Health The Bone & Joint Journal The Bone & Joint Journal - Orthopaedic Proceedings The United Kingdom Spine Societies Board (UKSSB) represents the Society for Back Pain Research (SBPR), the British Scoliosis Society (BSS) and the British Association of Spine Surgeons (BASS

1)
Jarvik JG, Gold LS, Comstock BA, Heagerty PJ, Rundell SD, Turner JA, Avins AL, Bauer Z, Bresnahan BW, Friedly JL, James K, Kessler L, Nedeljkovic SS, Nerenz DR, Shi X, Sullivan SD, Chan L, Schwalb JM, Deyo RA. Association of early imaging for back pain with clinical outcomes in older adults. JAMA. 2015 Mar 17;313(11):1143-53. doi: 10.1001/jama.2015.1871. Erratum in: JAMA. 2015 May 5;313(17):1758. PubMed PMID: 25781443.
2)
Murphy DR, Hurwitz EL. Application of a diagnosis-based clinical decision guide in patients with low back pain. Chiropr Man Therap. 2011;19:26
3)
Bobé-Armant F, Buil-Arasanz ME, Trubat-Muñoz G, Llor-Vilà C, Vicente-Guillen V. Cholelithiasis presented as chronic right back pain. J Family Med Prim Care. 2014 Oct-Dec;3(4):458-60. doi: 10.4103/2249-4863.148150. PubMed PMID: 25657967; PubMed Central PMCID: PMC4311366.
4)
Ojha HA, Wyrsta NJ, Davenport TE, Egan WE, Gellhorn AC. Timing of Physical Therapy Initiation for Nonsurgical Management of Musculoskeletal Disorders and Effects on Patient Outcomes: A Systematic Review. J Orthop Sports Phys Ther. 2016 Jan 11:1-31. [Epub ahead of print] PubMed PMID: 26755406.
back_pain.txt · Last modified: 2018/03/21 19:11 by administrador