Evaluation and Diagnosis of Low Back Pain

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Background

Low back pain is a common musculoskeletal condition, with considerable associated disability, work absenteeism, health care costs, and burden to US society. It has been estimated that 85% of adults suffer from low back pain at some time during their lives.1, 2, 3 The usual age of onset is between 30 and 50 years and is the most common cause of work-related disability among Americans younger than 45 years.4 Women are slightly more likely to report back pain (28% vs 24.3% level of evidence [LOE]

Multifactorial cause of low back pain

The low back is defined as the lumbar region from the inferior border of the thoracic rib cage to the sacrum. There are 5 lumbar vertebrae, each with a load-bearing central body. The pedicles and lamina extend from the body and support 2 transverse processes and a single spinous process. The intervertebral disk separates the vertebral bodies and acts as a shock absorber. The nucleus pulposus, a remnant of the embryonic notochord, is more viscoelastic, centrally positioned, and is not

Classification strategies

Low back pain can be classified by several categories. There is no one classification system that is better for the categorization of low back pain. In a meta-analysis that reviewed 60 articles on chronic low back pain, 28 articles met inclusion criteria and were critically evaluated. In addition to flaws in methodology and statistics, some were descriptive, some prognostic, and some attempted to direct treatment. The recommendation of the investigators was that no one classification system be

History

A thorough patient history is important in the evaluation of low back pain. Clinicians can approach the differential diagnosis of low back pain and determine if there are any medical red flags or cause that needs immediate or specific intervention.10 Box 1 lists historical red flags. The clinician tries to answer the following 3 questions:

  • 1.

    Is there a neurologic deficit that may require surgical intervention?

  • 2.

    Is there a systemic disease or cancer that can be causing the pain?

  • 3.

    Are there other

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