Evaluation of back pain

Low back pain (LBP) causes more disability globally than any other condition.[1]Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014 Jun;73(6):968-74. https://www.doi.org/10.1136/annrheumdis-2013-204428 http://www.ncbi.nlm.nih.gov/pubmed/24665116?tool=bestpractice.com The point prevalence is 9.4% and the lifetime prevalence exceeds 80%.[1]Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014 Jun;73(6):968-74. https://www.doi.org/10.1136/annrheumdis-2013-204428 http://www.ncbi.nlm.nih.gov/pubmed/24665116?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. The general prognosis of acute LBP is favorable, as 90% of patients recover without sequelae.[4]Spitzer WO, LeBlanc FE, Dupuis M, et al. Scientific approach to the assessment and management of activity-related spinal disorders: a monograph for clinicians. Report of the Quebec Task Force on Spinal Disorders. Spine. 1987 Sep;12(7 Suppl):S1-59. http://www.ncbi.nlm.nih.gov/pubmed/2961086?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 >6 months. 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.[5]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.