From the Guidelines
The management plan for back pain related to a positive stomp test typically involves a multifaceted approach targeting radicular pain, with an emphasis on conservative treatment and patient education, as recommended by the American College of Physicians and the American Pain Society 1.
Key Components of Management
- Conservative treatment with NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks to reduce inflammation
- Muscle relaxants like cyclobenzaprine (5-10mg three times daily) for 7-10 days to help with associated muscle spasms
- Physical therapy focusing on core strengthening, stretching exercises, and proper body mechanics, initiated within 1-2 weeks of symptom onset
- Patient education on self-care options, including remaining active and avoiding positions that exacerbate symptoms, as outlined in guidelines from the American College of Physicians and the American Pain Society 1
Advanced Imaging and Surgical Consultation
- If symptoms persist beyond 6 weeks or worsen, advanced imaging (MRI) is warranted to evaluate for disc herniation or nerve compression, as a positive stomp test suggests radicular involvement from nerve root irritation
- Surgical consultation may be necessary for severe or progressive neurological deficits, including significant weakness or bladder/bowel dysfunction, as recommended by guidelines from the American College of Physicians and the American Pain Society 1
Recent Guidelines and Recommendations
- The British Pain Society's pathway for care emphasizes self-management, early assessment using the STarT Back Tool, and onward referral to a range of interventions, including physical therapy and psychological therapies 1
- The American College of Physicians and the American Pain Society recommend a stepped care approach, with initial treatment focusing on conservative management and patient education, and progression to more invasive interventions as needed 1
From the Research
Management Plan for Back Pain Related to a Positive Stomp Test
The management plan for back pain related to a positive stomp test involves a combination of non-pharmacological and pharmacological approaches.
- Non-pharmacological approaches include education and self-management, recommencement of normal activities and exercise, and psychological programs for patients with persistent symptoms 2.
- Physical therapy exercise approaches are recommended as a first-line treatment for chronic low back pain, and can be used in combination with other non-pharmacological therapies such as tai chi, yoga, massage, and spinal manipulation 2, 3.
- Patients with acute low back pain may be treated with nonsteroidal anti-inflammatory drugs (NSAIDs), but the addition of acetaminophen to ibuprofen does not improve outcomes within 1 week 4.
- A novel intervention called "Skills TO Manage Pain" (STOMP) has been developed for people with HIV and chronic pain, and consists of group sessions, one-on-one pain self-management sessions, and peer leaders 5.
- Interdisciplinary multimodal pain therapy, which fosters self-efficacy by reconditioning physical and mental capability and improving positive self-perception, can effect superior and sustainable results in subacute and chronic nonspecific back pain 6.
Key Considerations
- The use of image diagnostics, chirotherapy, and invasive procedures should be avoided in cases of nonspecific back pain, as the evidence for these procedures is limited or doubtful 6.
- Patients and physicians should be aware of the risks and benefits of different treatment approaches, and should prioritize non-pharmacological and non-invasive methods whenever possible 2, 3, 6.
- Education and self-management are critical components of back pain management, and can help patients to become more active and engaged in their own care 2, 5.