Chronic low back pain: Evaluation and management
Chronic low back pain is a common problem in primary care. A history and physical examination should place patients into one of several categories: (1) Non-specific low back pain, (2) Back pain associated with radiculopathy or spinal stenosis, (3) Back pain referred from a non-spinal source or (4) B...
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AOSIS
2010-06-01
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| Series: | South African Family Practice |
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| Online Access: | https://safpj.co.za/index.php/safpj/article/view/1607 |
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| author | A.R. Last K. Hulbert |
| author_facet | A.R. Last K. Hulbert |
| author_sort | A.R. Last |
| collection | DOAJ |
| description | Chronic low back pain is a common problem in primary care. A history and physical examination should place patients into one of several categories: (1) Non-specific low back pain, (2) Back pain associated with radiculopathy or spinal stenosis, (3) Back pain referred from a non-spinal source or (4) Back pain associated with another specific spinal cause. For patients who have back pain associated with radiculopathy, spinal stenosis, or another specific spinal cause, magnetic resonance imaging or computed tomography may establish the diagnosis and guide management. Because evidence of improved outcomes is lacking, lumbar spine radiography should be delayed for at least one to two months in patients with nonspecific pain. Acetaminophen and non-steroidal anti-inflammatory drugs are first-line medications for chronic low back pain. Tramadol, opioids, and other adjunctive medications may benefit some patients who do not respond to non-steroidal anti-inflammatory drugs. Acupuncture, exercise therapy, multidisciplinary rehabilitation programs, massage, behaviour therapy, and spinal manipulation are effective in certain clinical situations. Patients with radicular symptoms may benefit from epidural steroid injections, but studies have produced mixed results. Most patients with chronic low back pain will not benefit from surgery. A surgical evaluation may be considered for select patients with functional disabilities or refractory pain despite multiple nonsurgical treatments. |
| format | Article |
| id | doaj-art-acd339512d6241119d9a96d1e7ad577c |
| institution | Kabale University |
| issn | 2078-6190 2078-6204 |
| language | English |
| publishDate | 2010-06-01 |
| publisher | AOSIS |
| record_format | Article |
| series | South African Family Practice |
| spelling | doaj-art-acd339512d6241119d9a96d1e7ad577c2025-08-20T03:47:10ZengAOSISSouth African Family Practice2078-61902078-62042010-06-0152310.1080/20786204.2010.108739691244Chronic low back pain: Evaluation and managementA.R. Last0K. Hulbert1Medical College of WisconsinMedical College of WisconsinChronic low back pain is a common problem in primary care. A history and physical examination should place patients into one of several categories: (1) Non-specific low back pain, (2) Back pain associated with radiculopathy or spinal stenosis, (3) Back pain referred from a non-spinal source or (4) Back pain associated with another specific spinal cause. For patients who have back pain associated with radiculopathy, spinal stenosis, or another specific spinal cause, magnetic resonance imaging or computed tomography may establish the diagnosis and guide management. Because evidence of improved outcomes is lacking, lumbar spine radiography should be delayed for at least one to two months in patients with nonspecific pain. Acetaminophen and non-steroidal anti-inflammatory drugs are first-line medications for chronic low back pain. Tramadol, opioids, and other adjunctive medications may benefit some patients who do not respond to non-steroidal anti-inflammatory drugs. Acupuncture, exercise therapy, multidisciplinary rehabilitation programs, massage, behaviour therapy, and spinal manipulation are effective in certain clinical situations. Patients with radicular symptoms may benefit from epidural steroid injections, but studies have produced mixed results. Most patients with chronic low back pain will not benefit from surgery. A surgical evaluation may be considered for select patients with functional disabilities or refractory pain despite multiple nonsurgical treatments.https://safpj.co.za/index.php/safpj/article/view/1607chronic low back painspecific spinal cause |
| spellingShingle | A.R. Last K. Hulbert Chronic low back pain: Evaluation and management South African Family Practice chronic low back pain specific spinal cause |
| title | Chronic low back pain: Evaluation and management |
| title_full | Chronic low back pain: Evaluation and management |
| title_fullStr | Chronic low back pain: Evaluation and management |
| title_full_unstemmed | Chronic low back pain: Evaluation and management |
| title_short | Chronic low back pain: Evaluation and management |
| title_sort | chronic low back pain evaluation and management |
| topic | chronic low back pain specific spinal cause |
| url | https://safpj.co.za/index.php/safpj/article/view/1607 |
| work_keys_str_mv | AT arlast chroniclowbackpainevaluationandmanagement AT khulbert chroniclowbackpainevaluationandmanagement |