Low back pain
From Standard of Care
85% of the population has at least one episode of acute low back pain.
The number one cause of disability worldwide, and one of the three top reasons for people to seek medical care.
More than 50% of Americans have back pain each year.
Acute low back pain, unless accompanied by: neurologic deficit, recent significant trauma, recent mild trauma in a patient older than 50 years, history of prolonged steroid use, history of osteoporosis, history of cancer, history of recent infection or an older patients with new onset back pain, do not require routine plain-film evaluation within the first month of symptoms.
Point prevalence is 25% and half of those with such pain seek health care (Walker BF).
Annual incidence is estimated at 5%.
Estimated 70% of individuals from industrialized Western countries have back pain in their lives.
90% of acute episodes resolve within 6 weeks.
25% or more of patients with back pain have recurrence within the next year.
Chronic low back pain develops in 7% of patients with acute back pain (Speed C).
Upwards of 30% of patients with low back pain will experience persistent or frequent recurrence (Henschke N, et al).
Cancer, infection and inflammatory disorders account for 1% of cases of low back pain.
Compression fractures, spinal stenosis, and disc herniation account for 10-15% of low back pain.
85% of cases back pain is idiopathic or nonspecific and most often associated with chronic or recurrent symptoms.
In most cases the cause is unknown.
Principal goal is to continue normal daily activities.
Bed rest does not relieve pain better than maintaining activity and leads to a decrease in function.
Skeletal muscle relaxants are helpful in treatment of acute nonspecific back pain.
Skeletal muscle relaxants have a risk of drowsiness, dependency and are not recommended for prolonged use and should not be used in the elderly or in patients with hepatic impairment.
Acute episodes less than 3 months in duration account for 90% of events and are usually benign an require no specific treatment.
Chronic back pain accounts for no more than 10% of cases with costs of 100-200 billion dollars a year in the U.S.
Some patients do not recover from acute back pain and will develop chronic low back pain that lasts for three months or longer.
Recurrences are common with subsequent low back pain episodes ranging from 20 to 44% within one year and lifetime recurrences of up to 85% (Van Tulder).
Second most common cause of disability in adults and the most common reason for lost work days.
The longer a patient is off work the greater the risk of chronic pain and the lower the chance of ever returning to work.
Spinal manipulative therapy is not superior to standard treatments.
Advanced radiologic imaging does not improve outcomes.
Indiscriminate use of MRI accounts for some of the increasing rate of spinal surgery.
MRI is recommended in the presence of serious or progressive neurologic deficits, when a serious underlying condition is suspected, or when surgery or epidural steroid injections are considered.
The American College of Occupational and Environmental Medicine recommend MRI only in the presence of focal neurologic symptoms that persist for at least six weeks and are not improving (Glass LS et al).