Musculoskeletal lower back pain
小结
定义
Anamnesis y examen
Principales factores de diagnóstico
- obesity, stress, and psychiatric comorbidities
- history of prior lower back pain
- pain radiation does not extend beyond the knee
- absence of red-flag symptoms
- absence of fever, fluctuance, exquisite tenderness to palpation
- sensory, motor, and deep-tendon reflex examinations within normal limits
- negative straight- or crossed straight-leg raise test
Otros factores de diagnóstico
- dull, gnawing, tearing, burning, or electric pain associated with muscle spasms
- lack of pain on flexion or relief on extension
- scoliosis or kyphosis
- negative FABER, Gaenslen's, or Schober's testing
Factores de riesgo
- obesity
- family history of degenerative disc disease
- poor musculotendinous flexibility and abnormal posture
- stress and psychiatric comorbidities
- increasing age
- female sex
- heavy physical and occupational activities
- tobacco use
- prolonged standing
- vitamin D levels
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- clinical diagnosis
Pruebas diagnósticas que deben considerarse
- lumbar spine MRI
- lumbar spine x-ray
- lumbar spine CT
- myelography
- FBC
- erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- urinalysis and culture
- blood cultures
- radionuclide bone scan
- electromyogram (EMG)
Algoritmo de tratamiento
acute and subacute lower back pain (≤12 weeks)
chronic lower back pain (>12 weeks)
recurrent lower back pain
Colaboradores
Autores
Andrew Sherman, MD, MS
Professor and Vice Chair
Department of Physical Medicine & Rehabilitation
University of Miami Miller School of Medicine
Miami
FL
Divulgaciones
AS declares that he has no competing interests.
Agradecimientos
Dr Andrew Sherman would like to gratefully acknowledge Dr Robert W. Irwin, Dr Louise Thwaites, Dr Karen Walker-Bone, Dr Joanne Borg-Stein, and Dr Philip Chiou, previous contributors to this topic.
Divulgaciones
RWI, LT, KWB, JBS, and PC declare that they have no competing interests.
Revisores por pares
Jennifer Baima, MD
Staff Physiatrist
Orthopedic and Arthritis Center
Brigham and Women's Hospital
Chestnut Hill
MA
Divulgaciones
JB declares that she has no competing interests.
Alexios G. Carayannopoulos, DO, MPH
Interventional Spine Physiatrist
Pain Medicine Specialist
Medical Director
Spine Center
Lahey Clinic
Burlington
MA
Divulgaciones
AGC declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
American College of Radiology. ACR appropriateness criteria: low back pain. 2021 [internet publication].Texto completo
Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514-30.Texto completo Resumen
National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. Dec 2020 [internet publication].Texto completo
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
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Más DiferencialesGuías de práctica clínica
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Más Guías de práctica clínicaFolletos para el paciente
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