What is the treatment for a healthy 21-year-old male with low back pain radiating to the shoulder?

From the Guidelines

For a healthy 21-year-old male with low back pain radiating to the shoulder, I recommend a stepwise approach starting with conservative management, as outlined in the most recent guidelines from the American College of Radiology (1). Begin with over-the-counter pain relievers such as ibuprofen (400-600mg every 6-8 hours with food) or acetaminophen (500-1000mg every 6 hours) for pain control, as suggested by the American College of Physicians and the American Pain Society (1). Apply ice for the first 48-72 hours (20 minutes on, 20 minutes off), then transition to heat therapy. Maintain gentle activity rather than bed rest, gradually increasing movement as tolerated. Stretching exercises focusing on the lower back, hamstrings, and shoulders can help relieve tension. Physical therapy may be beneficial if symptoms persist beyond 2-3 weeks. The radiation of pain from the lower back to the shoulder suggests possible muscle tension along the spine or referred pain patterns. If symptoms worsen, include neurological symptoms (numbness, weakness), or fail to improve within 2-3 weeks, medical evaluation is necessary to rule out more serious conditions like disc herniation or nerve impingement, and imaging with MRI (preferred) or CT may be considered (1). Proper posture and ergonomics during daily activities will help prevent recurrence. It is essential to note that the choice of medication should be based on the individual patient's risk factors and medical history, and that opioid analgesics should be used judiciously due to their potential risks (1).

Some key points to consider in the management of low back pain include:

• The importance of maintaining activity and avoiding bed rest (1)
• The use of over-the-counter pain relievers and other medications as needed (1)
• The potential benefits of physical therapy and other non-pharmacologic interventions (1)
• The need for medical evaluation and imaging if symptoms worsen or fail to improve (1)
• The importance of proper posture and ergonomics in preventing recurrence (1)

From the FDA Drug Label

Animal studies indicate that cyclobenzaprine does not act at the neuromuscular junction or directly on skeletal muscle. Such studies show that cyclobenzaprine acts primarily within the central nervous system at brain stem as opposed to spinal cord levels, although its action on the latter may contribute to its overall skeletal muscle relaxant activity Clinical Studies Eight double-blind controlled clinical studies were performed in 642 patients comparing cyclobenzaprine hydrochloride 10 mg, diazepam, and placebo. Muscle spasm, local pain and tenderness, limitation of motion, and restriction in activities of daily living were evaluated

The treatment for a healthy 21-year-old male with low back pain radiating up to the shoulder may include cyclobenzaprine.

• Key points:
  • The drug acts primarily within the central nervous system.
  • It is used to relieve muscle spasm, local pain and tenderness, limitation of motion, and restriction in activities of daily living.
  • The recommended dose is not specified in the provided text for this particular patient, but the drug label mentions doses of 5 mg and 10 mg t.i.d. 2

From the Research

Treatment Options for Low Back Pain

• The treatment for low back pain radiating up to the shoulder in a healthy 21-year-old male can vary depending on the underlying cause of the pain.
• According to 3, low back pain can be caused by various factors, including myofascial pain, facet joint pain, sacroiliac joint pain, discogenic pain, spinal stenosis, and failed back surgery.
• For acute low back pain, non-steroidal anti-inflammatory drugs (NSAIDs) may be effective in reducing pain and disability, as shown in 4 and 5.
• However, the use of NSAIDs should be cautious, especially in people who may be at greater risk of experiencing adverse events, as mentioned in 6.
• Muscle relaxants may also be superior to placebo for reducing pain in acute low back pain, as stated in 6.
• It is essential to note that paracetamol provides no additional benefit for acute low back pain, as mentioned in 6.
• For chronic low back pain, NSAIDs, antidepressants, and opioids may be superior to placebo for reducing pain, but opioids have an established profile of harms, as discussed in 6.

Diagnostic Imaging

• Diagnostic imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), may be necessary to evaluate the underlying cause of low back pain, as mentioned in 7.
• CT shows high values of sensitivity and specificity in most of the items evaluated, but sensitivity was low for the evaluation of density of the disc and for the detection of disc herniation, as shown in 7.
• MRI is the diagnostic imaging examination of choice in lumbar spine evaluation of low back pain, but availability of MRI is limited, as stated in 7.

Treatment Approach

• A multidisciplinary, logical approach to treatment is most effective for chronic back pain patients, including multimodal medical, psychological, physical, and interventional approaches, as mentioned in 3.
• The treatment approach should be individualized, considering the underlying cause of the pain, medical history, and other factors, as discussed in 6.