Mechanical pain is managed with analgesia ,brief rest and physiotherapy
LOW BACK PAIN TREATMENT
LOW BACK PAIN TREATMENT
Low back pain is a common symptom.It is often traumatic and work related ,although lifting apparatus and other mechanical devices are used to avoid it .Episodes are generally short lived and self limiting ,and patients attend a physiotherapist or osteopath more often than a doctor.Chronic back pain is the cause of 14% of long term disability in the UK .
MANAGEMENT OF BACK PAIN
MANAGEMENT OF BACK PAIN
Most back pain presenting to a primary care physician needs no investigation.
Pain between ages 20 and 55 years is likely to be mechanical and is managed with analgesia ,brief rest and physiotherapy.
Patients should stay active within the limits of their pain .
Early treatment of the acute episode ,advice and exercise programmes reduce long term problems and prevent chronic pain syndromes.
Physical manipulation of uncomplicated back pain produces short term relief and enjoys high patient satisfaction ratings.
Psychological and social factors may influence the time of presentation.
Pain between ages 20 and 55 years is likely to be mechanical and is managed with analgesia ,brief rest and physiotherapy.
Patients should stay active within the limits of their pain .
Early treatment of the acute episode ,advice and exercise programmes reduce long term problems and prevent chronic pain syndromes.
Physical manipulation of uncomplicated back pain produces short term relief and enjoys high patient satisfaction ratings.
Psychological and social factors may influence the time of presentation.
Appropriate early management reduces long-term disability.
ACUTE LOW BACK PAIN ( ALBP ) MANAGEMENT
Pain of 3 months duration ,full recovery occurs in 85%.Management controversial ,few well-controlled clinical trials exist.If risk factors are absent ,initial treatment is symptomatic and no diagnostic tests necessary.Spine infections ,fractures ,tumors or rapidly progressive neurologic deficits require urgent diagnostic evaluation.Patients with no risk factors and no improvement over 4 weeks are subdivided by the presence /absence of leg symptoms and managed accordingly.Clinical trials do not show benefit from bed rest >2 days.Possible benefits of early activity __ cardiovascula conditioning ,disk and cartilage nutrition.bone and muscle strength ,increased endorphin levels.Studies of traction or poture modification fall to show benefit .Proof lacking to support acupuncture ,ultrasound ,diathermy ,transcutaneous electrical nerve stimulation ,massage ,biofeedback or electrical stimulation.Self -application of ice or heat or use of shoe insoles is optional given low cost and risk ,benefit of exercises uncertain.A short course of spinal manipulation or physical therapy may lesson pain and improve function.Temporary suspension of activities known to increase mechanical stress on the spine ( heavy lifting ,straining at stool. prolonged sitting /bending /twisting ) may relieve symptoms .Value of education ( back school ) in long term prevention is unclear.
Pharmacologic treatment of Acute low back pain includes Non Steroidal Antiinflammatory drugs and acetoaminophen.Muscle relaxats ( cyclobenzaprine ,methocarbanol )provides short term benefit (4-7 days ),but drowsiness limits use .Opiods are not superior to Non Steroidal Anti inflammatory drugs or acetoaminophen for Acute Low Back Pain.Epidural anesthetic ,glucocorticoids ,opiods or tricyclic antidepressants are not indicated as initial treatment .
CHRONIC LOW BACK PAIN (CLBP) MANAGEMENT
Pain lasting >3months, differential diagnosis includes most conditions described above.Chronic low back pain causes can be lclarified by neuroimaging and EMG /nerve conduction studies,diagnosis of radiculopathy secure when results concordant with findings on neurologic exam .Management is complex and not amenable to a simple algorithmic approach .Treatment based upon identification of underlying cause ,when specific cause not found ,conservative management necessary.Pharmacologic and comfort measures similar to those described for acute low back pain.Exercise ( work hardening ) regimens effective in returning some patients to work ,diminishing pain ,and improving walking distances.
Hydrotherapy may be useful and some patients experience short term pain relief with percutaneous electrical nerve stimulation.Surgical intervent on based upon neuroimaging alone not recommended up to one third of asymptomatic young adults have a herniated lumbar disk by CT or MRI
ACUTE LOW BACK PAIN ( ALBP ) MANAGEMENT
Pain of 3 months duration ,full recovery occurs in 85%.Management controversial ,few well-controlled clinical trials exist.If risk factors are absent ,initial treatment is symptomatic and no diagnostic tests necessary.Spine infections ,fractures ,tumors or rapidly progressive neurologic deficits require urgent diagnostic evaluation.Patients with no risk factors and no improvement over 4 weeks are subdivided by the presence /absence of leg symptoms and managed accordingly.Clinical trials do not show benefit from bed rest >2 days.Possible benefits of early activity __ cardiovascula conditioning ,disk and cartilage nutrition.bone and muscle strength ,increased endorphin levels.Studies of traction or poture modification fall to show benefit .Proof lacking to support acupuncture ,ultrasound ,diathermy ,transcutaneous electrical nerve stimulation ,massage ,biofeedback or electrical stimulation.Self -application of ice or heat or use of shoe insoles is optional given low cost and risk ,benefit of exercises uncertain.A short course of spinal manipulation or physical therapy may lesson pain and improve function.Temporary suspension of activities known to increase mechanical stress on the spine ( heavy lifting ,straining at stool. prolonged sitting /bending /twisting ) may relieve symptoms .Value of education ( back school ) in long term prevention is unclear.
Pharmacologic treatment of Acute low back pain includes Non Steroidal Antiinflammatory drugs and acetoaminophen.Muscle relaxats ( cyclobenzaprine ,methocarbanol )provides short term benefit (4-7 days ),but drowsiness limits use .Opiods are not superior to Non Steroidal Anti inflammatory drugs or acetoaminophen for Acute Low Back Pain.Epidural anesthetic ,glucocorticoids ,opiods or tricyclic antidepressants are not indicated as initial treatment .
CHRONIC LOW BACK PAIN (CLBP) MANAGEMENT
Pain lasting >3months, differential diagnosis includes most conditions described above.Chronic low back pain causes can be lclarified by neuroimaging and EMG /nerve conduction studies,diagnosis of radiculopathy secure when results concordant with findings on neurologic exam .Management is complex and not amenable to a simple algorithmic approach .Treatment based upon identification of underlying cause ,when specific cause not found ,conservative management necessary.Pharmacologic and comfort measures similar to those described for acute low back pain.Exercise ( work hardening ) regimens effective in returning some patients to work ,diminishing pain ,and improving walking distances.
Hydrotherapy may be useful and some patients experience short term pain relief with percutaneous electrical nerve stimulation.Surgical intervent on based upon neuroimaging alone not recommended up to one third of asymptomatic young adults have a herniated lumbar disk by CT or MRI
