DIAGNOSIS AND TREATMENT OF LOW BACK PAIN

Lower back pain (LBP) is an important problem that has a significant impact on the quality of life and adds a large financial burden. Doctors should divide patients with LBP into three categories: nonspecific LBP; LBP associated with radiculopathy or spinal stenosis; LBP associated with other diseases of the spine. The medical history includes psychosocial factors that are associated with a risk of developing chronic pain. Patients with nonspecific LBP usually do not need a imaging study. Physicians should perform imaging and other diagnostic tests in LBP patients with a severe or progressive neurologic deficit and with a suspicion of serious underlying pathology. Magnetic resonance imaging is indicated in patients with constant back pain, symptoms of radiculopathy and spinal stenosis only if they are potential candidates for surgery or epidural steroid injections. Doctors should provide patients with scientifically valid information about back pain in terms of expected treatment; advise patients to stay active; provide information on effective methods of self-treatment. Before the start of therapy, the initial degree of pain, functional deficits, potential benefits and risks of planned treatment should be assessed. For most patients, acetaminophen or non-steroidal anti-inflammatory drugs are first-line drugs. Patients who have not been improved by using self-management methods should receive non-drug therapy with proven benefits. In acute LBP - spinal manipulations; in chronic or subacute LBP - intensive multimodal rehabilitation.

low back pain, radiculopathy, spinal stenosis