What are the next steps for a patient with undiagnosed abdominal and lower back pain?

From the Guidelines

For a patient with undiagnosed abdominal and lower back pain, the next steps should include scheduling an appointment with a primary care physician for a comprehensive evaluation. The doctor will likely perform a physical examination, take a detailed medical history, and order appropriate diagnostic tests based on the specific symptoms. These tests may include blood work to check for inflammation or infection, urinalysis to rule out kidney issues, and imaging studies such as an ultrasound, CT scan, or MRI depending on the suspected cause.

Key Considerations

• While awaiting medical evaluation, the patient can take over-the-counter pain relievers like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or ibuprofen (400-600mg every 6 hours with food) for temporary relief, unless contraindicated by other medical conditions 1.
• Applying heat or cold packs to the painful areas for 15-20 minutes several times daily may also help manage discomfort.
• It's essential not to delay seeking medical attention, especially if the pain is severe, persistent, or accompanied by warning signs such as fever, unexplained weight loss, blood in stool or urine, or difficulty with bowel movements or urination.

Diagnostic Approach

• 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 1.
• Diagnostic imaging and testing should be performed 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 1.

Treatment Options

• Clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care, assessing severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy 1.
• For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs.

Importance of Proper Diagnosis

Abdominal and lower back pain can stem from various conditions ranging from muscle strain to more serious issues involving the digestive, urinary, or reproductive systems, which is why proper diagnosis is essential before determining specific treatment.

From the Research

Next Steps for Undiagnosed Abdominal and Lower Back Pain

The patient's symptoms of abdominal and lower back pain require a thorough evaluation to determine the underlying cause.

• The clinical manifestations of partial renal infarction can masquerade as other entities, including stone, infection, and tumor, making diagnosis challenging 2.
• A strong clinical suspicion is necessary, and the presence of abdominal or flank pain, fever with an elevated white cell count, and an elevated LDH should alert the clinician to the possibility of renal infarction 2.
• The patient's complaints should be translated into clear-cut, medically defined symptoms to avoid test degeneracy and diminish the number of possible interpretations 3.
• A medical history serves to record the patient's complaints and translate them into precise symptoms, which is essential for a diagnostic work-up.

Diagnostic Evaluation

• The diagnostic evaluation may involve laboratory tests, such as a complete blood count, measurements of creatinine, lactate dehydrogenase, and urinalysis 2.
• Imaging studies, such as CT scans, may be necessary to confirm the diagnosis 2, 4.
• The choice of diagnostic tests depends on the patient's symptoms and medical history.

Treatment Options

• For patients with acute low back pain, a combination of NSAIDs and muscle relaxants may be effective in managing symptoms 5.
• Tamsulosin has been used as an adjunct in the treatment of ureteral calculi, but its efficacy in a general emergency department population has not been established 4.
• The treatment approach should be individualized based on the patient's specific condition and medical history.

Prognosis and Outcome

• The outcome of common symptoms, such as abdominal pain and back pain, is often uncertain, and diagnostic testing may not always reveal an organic etiology 6.
• The cost of discovering an organic diagnosis can be high, particularly for certain symptoms 6.
• A favorable prognosis is associated with an organic etiology, a symptom duration of less than four months, and a history of two or fewer symptoms 6.