Evaluation of back pain

Low back pain (LBP) causes more disability globally than any other condition.[1]Wu A, March L, Zheng X, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020 Mar;8(6):299. https://www.doi.org/10.21037/atm.2020.02.175 http://www.ncbi.nlm.nih.gov/pubmed/32355743?tool=bestpractice.com The point prevalence is 7.5% and the lifetime prevalence exceeds 80%.[1]Wu A, March L, Zheng X, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020 Mar;8(6):299. https://www.doi.org/10.21037/atm.2020.02.175 http://www.ncbi.nlm.nih.gov/pubmed/32355743?tool=bestpractice.com [2]Balagué F, Mannion AF, Pellisé F, et al. Non-specific low back pain. Lancet. 2012 Feb 4;379(9814):482-91. http://www.ncbi.nlm.nih.gov/pubmed/21982256?tool=bestpractice.com LBP accounts for over 4% of emergency department visits, making it one of the ten most common presenting complaints.[3]Edwards J, Hayden J, Asbridge M, et al. Prevalence of low back pain in emergency settings: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2017 Apr 4;18(1):143. https://www.doi.org/10.1186/s12891-017-1511-7 http://www.ncbi.nlm.nih.gov/pubmed/28376873?tool=bestpractice.com

The primary purpose of the initial encounter is to evaluate whether the symptoms suggest a more serious underlying condition.[4]Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018 Nov;27(11):2791-2803. https://www.doi.org/10.1007/s00586-018-5673-2 http://www.ncbi.nlm.nih.gov/pubmed/29971708?tool=bestpractice.com The general prognosis of acute LBP is favorable, and most patients recover without sequelae.[5]Henschke N, Maher CG, Refshauge KM, et al. Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. BMJ. 2008 Jul 7;337:a171. https://www.doi.org/10.1136/bmj.a171 http://www.ncbi.nlm.nih.gov/pubmed/18614473?tool=bestpractice.com [6]Williams CM, Maher CG, Latimer J, et al. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. Lancet. 2014 Nov 1;384(9954):1586-96. https://www.doi.org/10.1016/S0140-6736(14)60805-9 http://www.ncbi.nlm.nih.gov/pubmed/25064594?tool=bestpractice.com Recurrences are common, but most relapses are not disabling.

A smaller subset of the population may be incapacitated from chronic LBP, defined as symptoms persistent for >12 weeks.[7]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):514-530. https://www.doi.org/10.7326/M16-2367 http://www.ncbi.nlm.nih.gov/pubmed/28192789?tool=bestpractice.com Several factors have been found to increase the risk of developing disabling LBP. These include maladaptive pain coping behaviors, nonorganic signs, functional impairment, poor general health status, and psychiatric comorbidities.[8]Chou R, Shekelle P. Will this patient develop persistent disabling low back pain? JAMA. 2010 Apr 7;303(13):1295-302. http://www.ncbi.nlm.nih.gov/pubmed/20371789?tool=bestpractice.com The clinician should be aware of these risk factors when counseling and treating patients.