From the Guidelines
Low back pain is most commonly caused by nonspecific factors, with specific spinal causes, such as radiculopathy or spinal stenosis, being less common. According to the American College of Physicians and the American Pain Society, a focused history and physical examination should be conducted 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. The common causes of low back pain include:
- Muscle strain
- Ligament sprains
- Poor posture
- Herniated discs
- Degenerative disc disease
- Arthritis
- Spinal stenosis Other causes include sciatica, structural problems like scoliosis, and underlying medical conditions such as kidney stones or infections. Risk factors include age, sedentary lifestyle, excess weight, improper lifting techniques, and smoking, which reduces blood flow to the lower spine and delays healing. It is essential to assess psychosocial risk factors, which predict risk for chronic disabling back pain 1.
The evaluation of patients with low back pain should include a thorough history and physical examination, with diagnostic imaging and testing only being performed when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected 1. Clinicians should provide patients with evidence-based information on low back pain, advise patients to remain active, and provide information about effective self-care options 1.
In terms of treatment, clinicians should consider the use of medications with proven benefits, such as acetaminophen or nonsteroidal anti-inflammatory drugs, in conjunction with back care information and self-care 1. Nonpharmacologic therapy with proven benefits, such as physical therapy or chiropractic care, may also be considered for patients who do not improve with self-care options. It is crucial to assess the severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy 1.
From the Research
Common Causes of Low Back Pain
- 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 2
- The prevalence of low back pain in the general US adult population is 10-30% annually, and the lifetime prevalence of US adults is as high as 65-80% 2
- Chronic low back pain can be effectively treated with a multidisciplinary approach, including multimodal medical, psychological, physical, and interventional approaches 2
Associated Conditions
- Lumbar spinal stenosis (LSS) symptoms are commonly reported by people with knee or hip osteoarthritis or low back pain, with a greater proportion of participants with LBP reporting LSS symptoms 3
- The prevalence of self-reported clinical LSS is less than 10% in people treated in primary care for knee or hip OA, although symptoms of LSS are common 3
- Tramadol has been shown to be effective in the treatment of chronic low back pain, with significantly lower mean pain visual analog scores and better scores on the McGill Pain Questionnaire and the Roland Disability Questionnaire compared to placebo 4
Diagnosis and Treatment
- Patient history, physical exam, and diagnostic testing are important components to accurate diagnosis and identification of patient pathophysiology 2
- A comprehensive review of low back pain, including associated pathophysiology, diagnosis, and treatment, is essential for effective management of the condition 2