Abstract:
To diagnose patients with acute low back pain (LBP), a focused physical examination needs to be conducted and a detailed
history obtained. The patient should then be placed into one of three broad categories, namely nonspecific LBP, pain
associated with radiculopathy or spinal stenosis, or back pain potentially associated with serious organic disease. The
history should include an assessment of psychosocial risk factors that predict delayed healing and progression to chronic
pain. Routine imaging is not required within the first three weeks of nonspecific LBP. Imaging should be performed for
patients with severe or progressive neurological deficits, or when serious underlying pathology is suspected, based on the
history and the physical examination. Patients should be advised of the benign course of nonspecific LBP and that over
90% of patients recover within a few weeks. Occasionally, the pain may last for a few months. Patients should be advised to
remain active and should be provided with information on effective self-care options. Usually, first-line medication options are
paracetamol or nonsteroidal anti-inflammatory drugs. To treat severe pain, a stronger drug approach that includes opioids
may be considered, but only for a short time. Other therapies to be taken into account are spinal manipulation, intensive
interdisciplinary rehabilitation, exercise therapy, massage therapy, or progressive relaxation. Spinal surgery is an option in
the event of progressive neurological fallout, severe persistent pain of more than three months and patient unresponsiveness
to recommended treatment, or if there is acute cauda equina syndrome.
