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General Medicine

Back Pain, Low

Michael Maddaleni, MD and J. Herbert Stevenson, MD Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Low back pain (LBP) is extremely common and includes a wide range of symptoms involving the lumbosacral spine and pelvic girdle.

  • Characterized by duration or associated symptoms

  • Durati...

DIAGNOSIS

HISTORY

  • Onset of pain (sudden or gradual) (1)

  • Pain from spinal structures (musculature, ligaments, facet joints and disks) can refer to the thigh region but rarely below the knee. However, fac...

TREATMENT

The primary goal is to provide supportive care and allow return to functional activity. Patients should be aware of alarm symptoms to prompt a return visit. 

MEDICATION

First Line

  • Physical ther...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Regular exercise to manage weight and control symptoms (3)[A]

  • Educate patients regarding chronicity, recurrence, and red flags (3)[A].

Patient Monitoring

  • Reassurance...

REFERENCES

1
Golob AL, Wipf JE. Low back pain. Med Clin North Am.  2014;98(3):405–428. [View Abstract on OvidMedline]
2
Delitto A, George SZ, Van Dillen LR, et al; for Orthopaedic Section of the Ame...

ADDITIONAL READING

  • Andronis L, Kinghorn P, Qiao S, et al. Cost-effectiveness of non-invasive and non-pharmacological interventions for low back pain: a systematic literature review. Appl Health Econ H...

CODES

ICD10

  • M54.5 Low back pain

  • G89.29 Other chronic pain

  • M53.3 Sacrococcygeal disorders, not elsewhere classified

  • M53.3 Sacrococcygeal disorders, not elsewhere classified

  • M54.40 Lumbago with sciatica, uns...

CLINICAL PEARLS

  • LBP is one of the most common complaints in primary care. Most cases resolve spontaneously within 4 to 12 weeks of onset.

  • Assess for red flag symptoms in every patient, such as bowel/bl...

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FIG. 63.2. Anteroposterior radiograph of the upper pelvis and lumbar spine. Both sacroiliac joints (large arrows) are fused (grade IV sacroiliitis), and there are bilateral, symmetric syndesmophytes (small arrow), resulting in the typical "bamboo" appearance of ankylosing spondylitis.
FIG. 63.2. Anteroposterior radiograph of the upper pelvis and lumbar spine. Both sacroiliac joints (large arrows) are fused (grade IV sacro...
FIGURE 9-44. Lumbar spondylolysis. Imaging of the lumbar spine in four separate patients with low back pain, two with L4 spondylolysis (A,B,C,D,E) and two with L5 spondylolysis (F,G,H,I,J,K) demonstrates the multimodality approach to imaging when assessing for spondylolysis/spondylolisthesis. Conventional lumbar radiographs, including lateral and bilateral obliques (A,B,C) nicely demonstrate the bony break (arrows in A) within the region of the bilateral L...
FIGURE 9-44. Lumbar spondylolysis. Imaging of the lumbar spine in four separate patients with low back pain, two with L4 spondylolysis (A,B...
Causes of Low Back Pain Sagittal View Labeled
Causes of Low Back Pain Sagittal View Labeled
FIG. 9 A: Low back pain with small contained prolapse, L-5 to S-1, and high signal-intensity zone at L4-5. B,C: Major concordant pain responses by clinical distention at each level.
FIG. 9 A: Low back pain with small contained prolapse, L-5 to S-1, and high signal-intensity zone at L4-5. B,C: Major concordant pain respo...
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