Musculoskeletal lower back pain

Diagnosis of musculoskeletal lower back pain is made by eliminating specific lower back pain causes of neurologic compromise, neoplasia, inflammatory arthritis, fracture, or referred pain from other locations or organ systems.

Pain, stiffness, and/or soreness of the lumbosacral region are the symptoms. May be acute (lasting <4 weeks), subacute (4 to 12 weeks), or chronic (>12 weeks).

Patient education, return to normal activity, and self-care temperature treatments (ice, heat) are the first steps in therapy.

Nonpharmacologic approaches to control pain are preferred. When these are ineffective, first-line pharmacotherapy is oral nonsteroidal anti-inflammatory drugs. Acetaminophen, muscle relaxants, opioids, and duloxetine may be used as adjuncts.

Musculoskeletal lower back pain is pain, stiffness, and/or soreness of the lumbosacral region (underneath the twelfth rib and above the gluteal folds).

Lower back pain is subdivided by time frame into acute lower back pain lasting <4 weeks, subacute lower back pain lasting 4 to 12 weeks, and chronic lower back pain lasting >12 weeks.[1]US Department of Veterans Affairs. VA/DoD clinical practice guideline for diagnosis and treatment of low back pain. Feb 2022 [internet publication]. https://www.healthquality.va.gov/guidelines/Pain/lbp/VADoDLBPCPGFinal508.pdf ​

An exclusion diagnosis is made by eliminating specific causes of lower back pain arising from neurologic compromise, neoplasia, inflammatory arthritis, fracture, and referred pain from other locations or organ systems. The exact cause of pain is often impossible to identify precisely, but arises from any combination of pathology involving disks, vertebrae, facet joints, ligaments, and/or muscles.[2]Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007 Oct 2;147(7):478-91. http://annals.org/article.aspx?articleid=736814 http://www.ncbi.nlm.nih.gov/pubmed/17909209?tool=bestpractice.com