Although back pain is one of the most common patient complaints we see in many practice settings, I find it amazing how many clinicians are uncomfortable or unsure how to evaluate and manage their patients with back pain. If you boil this down to some no nonsense pearls you should be able to effectively manage the overwhelming majority of patients who present with back pain.
I think most clinicians who see patients with back pain want to identify a specific cause or pain generator for the patient’s symptoms. An interesting point in diagnosing back pain is that approximately 85-90% of patients will fall into the category of non-specific back pain. This essentially means the patient has some type of mechanical dysfunction and even if you make a “best guess” diagnosis the outcome will not change.
Clinicians absolutely need to be aware of the red flag and when to refer patients out of your practice for further evaluation. Remembering that back pain is not always just back pain, you need to consider the possibility of a non-spinal causes for back pain in your patient such as pyelonephritis, endometriosis or renal calculi. You absolutely need to be aware of the red flag symptoms indicating urgent or emergent treatment for things such as cancer, spinal infection, vertebral fracture, or abdominal aortic aneurysm.
For most patients with acute low back pain, in particular when there is no functional impairment, reassurance and education about the natural course of back pain is a cornerstone of the treatment plan. Most patients get some short term relief of their pain with heat; encouragement to remain active to some degree and avoid bed rest. As a clinician you should also use your discretion with specific meds (NSAIDS, muscle relaxers, or even narcotics) you might give to your patient. The good news to remember is that the symptoms are typically self-limited and almost 90% with non-specific low back pain will get better within a month even without treatment.
See Michael Zychowicz at the Pensacola Beach conference April 26-29,2016.