User Tools

Site Tools


acute_low_back_pain

Acute Low Back Pain

Quick Reference Guide for Clinicians contains highlights from the Clinical Practice Guideline version of Acute Low Back Problems in Adults, which was developed by a private-sector panel of health care providers and consumers. The Quick Reference Guide is an example of how a clinician might implement the panel's findings and recommendations on the management of acute low back problems in working-age adults. Topics covered include the initial assessment of patients presenting with acute low back problems, identification of red flags that may indicate the presence of a serious underlying medical condition, initial management, special studies and diagnostic considerations, and further management considerations. Instructions for clinical testing for sciatic tension, recommendations for sitting and unassisted lifting, tests for identification of clinical pathology, and algorithms for patient management are included 1).

The management of patients with acute low back problems by primary care physicians differs significantly from Agency for Health Care Policy and Research guideline recommendations in several key areas that include awareness of red flags, use of medication, use of radiographic studies, the need for patient education, and the use of physical modalities. Future research should focus on the impact of guideline compliance on patient outcomes and cost-effectiveness 2).

Rest. Ceasing activity for a few days allows injured tissue and even nerve roots to begin to heal, which in turn will help relieve lower back pain. However, more than a few days of rest can lead to a weakening of the muscles, and weak muscles have to struggle to adequately support the spine. Patients who do not regularly exercise to build strength and flexibility are more likely to experience recurrent or prolonged lower back pain. Heat and Ice Packs. Heat and/or cold therapy helps relieve most types of low back pain by reducing inflammation. Often patients use ice, but some prefer heat. Both may be used alternately.

Medications. A wide variety of over-the-counter and prescription medications is available to help reduce lower back pain. Many medications reduce inflammation, which is often a cause of pain, while others work to inhibit the transmission of pain signals from reaching the brain. Each medication has multiple unique risks, possible side effects and drug (or food or supplement) interactions, which need to be evaluated by a physician.

Outcome

Nearly 30% of patients who present to an ED with acute, new onset, low back pain (LBP) report LBP-related functional impairment three months later 3).

High initial pain intensity and disability combined with small pain reduction during the first week might predict unfavorable outcome and require adequate treatment 4).

1)
Acute low back problems in adults: assessment and treatment. Agency for Health Care Policy and Research. Clin Pract Guidel Quick Ref Guide Clin. 1994 Dec;(14):iii-iv, 1-25. PubMed PMID: 7987418.
2)
Di Iorio D, Henley E, Doughty A. A survey of primary care physician practice patterns and adherence to acute low back problem guidelines. Arch Fam Med. 2000 Nov-Dec;9(10):1015-21. PubMed PMID: 11115201.
3)
Friedman BW, Gensler S, Yoon A, Nerenberg R, Holden L, Bijur PE, Gallagher EJ. Predicting three-month functional outcomes after an ED visit for acute low back pain. Am J Emerg Med. 2017 Feb;35(2):299-305. doi: 10.1016/j.ajem.2016.11.014. Epub 2016 Nov 5. PubMed PMID: 27856138.
4)
Wirth B, Ehrler M, Humphreys BK. First episode of acute low back pain - an exploratory cluster analysis approach for early detection of unfavorable recovery. Disabil Rehabil. 2016 Oct 19:1-7. doi: 10.1080/09638288.2016.1239765. [Epub ahead of print] PubMed PMID: 27758141.
acute_low_back_pain.txt · Last modified: 2017/07/30 14:29 by administrador