Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- 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 exams within normal limits
- negative straight- or crossed straight-leg raise test
Outros fatores diagnósticos
- 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, or Schober testing
Fatores de risco
- obesity
- family history of degenerative disk 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
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- clinical diagnosis
Investigações a serem consideradas
- lumbar spine MRI
- lumbar spine x-ray
- lumbar spine CT
- myelography
- CBC
- erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- urinalysis and culture
- blood cultures
- radionuclide bone scan
- electromyogram (EMG)
Algoritmo de tratamento
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
Declarações
AS declares that he has no competing interests.
Agradecimentos
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.
Declarações
RWI, LT, KWB, JBS, and PC declare that they have no competing interests.
Revisores
Jennifer Baima, MD
Staff Physiatrist
Orthopedic and Arthritis Center
Brigham and Women's Hospital
Chestnut Hill
MA
Declarações
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
Declarações
AGC declares that he has no competing interests.
Créditos aos pareceristas
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Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
American College of Radiology. ACR appropriateness criteria: low back pain. 2021 [internet publication].Texto completo
National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. Dec 2020 [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 Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Spinal stenosis
- Radiculopathy/sciatica
- Cauda equina syndrome
Mais Diagnósticos diferenciaisDiretrizes
- Psychological and non-pharmalogical treatment of chronic musculoskeletal pain in adults
- Prescribing opioids for pain
Mais DiretrizesFolhetos informativos para os pacientes
Back pain (lower back)
Back pain: questions to ask your doctor
Mais Folhetos informativos para os pacientes
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