Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline
Written by Editor   
Wednesday, November 16, 2016 12:44 PM

News Bite:  Low back pain is the fifth most common reason for all physician visits in the United States.  The stats reported here demonstrate the severity of the issue.  This article also provides seven recommendations for managing low back pain.

Low back pain is the fifth most common reason for all physician visits in the United States.  Approximately one quarter of U.S. adults reported having low back pain lasting at least 1 whole day in the past 3 months, and 7.6% reported at least 1 episode of severe acute low back pain within a 1–year period. Low back pain is also very costly: Total incremental direct health care costs attributable to low back pain in the U.S. were estimated at $26.3 billion in 1998. In addition, indirect costs related to days lost from work are substantial, with approximately 2% of the U.S. work force compensated for back injuries each year.  Up to one third of patients report persistent back pain of at least moderate intensity 1 year after an acute episode, and 1 in 5 report substantial limitations in activity. Approximately 5% of the people with back pain disability account for 75% of the costs associated with low back pain.

Many options are available for evaluation and management of low back pain. Numerous studies show unexplained, large variations in use of diagnostic tests and treatments. This report provides the recommendations for medical management.

Recommendation 1: Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause. The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain.

Recommendation 2: Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain.

Recommendation 3: Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination.

Recommendation 4: Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for incisive or invasive procedures.

Recommendation 5: Clinicians should provide patients with evidence–based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self–care options.

Recommendation 6: Clinicians should review contraindications and adverse effects when considering the use of medications with proven benefits in conjunction with back care information and self-care. Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy.

Recommendation 7: Clinicians should consider the addition of nonpharmacologic therapy with proven benefits.  For acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation.

Source:  http://chiro.org/wordpress/2016/11/diagnosis-and-treatment-of-low-back-pain-a-joint-clinical-practice-guideline-from-the-american-college-of-physicians-and-the-american-pain-society/