Chronic Back Pain Management

Background

• One month prevalence of low back pain (LBP) is 35 – 37%

• Lifetime prevalence 59%, peaking 45 – 60 yo

• 90% improve after one month

• 20 – 25% recover completely

Risk Factors

• Psychologic stressors often associated

• Static work posture

• Smoking

• Hx of back pain

• Hx of physical abuse

Pathophysiology

• Low back pain may cause muscle spasms or inhibition of the muscles

• Prolonged pain may lead to avoidance behavior caused by fear of pain

• Development of deconditioning syndrome, decreased spinal mobility questioned

• Psychosocial prolongation integral in chronic patients

Diagnostic Tools

• Radiograph of Spine: Structural lesions, degeneration

• MRI: Nerve compression, disc inflammation/herniation

Management

• H&P to exclude inflammatory, neoplastic, infectious, metabolic, or mechanical causes

• 25% of back pain eventually attributed to identifiable cause

• Minimal correlation to degeneration on radiograph and symptoms

• Convince: pain and increased activity does not cause further spinal damage

• Aim to improve quality of life, not necessarily pain

Treatment

• Avoid bed rest and remain active

• NSAIDS, Analgesics, Muscle Relaxants

• Opiods when others have failed

• Physical Therapy: Pain and functional disability both have shown to decrease over 6mo, 1yr follow up (P <>

• Epidural steroids

• Psychosocial, surgical evaluation

• Concurrent therapies

References

• Mounce, K. “Back Pain.” Rheumatology 2002;41:1–5.

• Justins, M. “Management strategies for chronic pain.” 1996;55;588-596 Ann Rheum Dis.

• Kankaanpa, M, et al. “The Efficacy of Active Rehabilitation in Chronic Low Back Pain.” SPINE Volume 24, Number 10, pp 1034–1042

• Smeets, R, et al. “The deconditioning paradigm for chronic low back pain unmasked?” Pain, 2007.

Category: Medicine Notes , Pharmacology Notes