Chapter 52 Chronic low back pain

Abstract

Publisher Summary This chapter explores that it is commonly held that the cause of back pain cannot be diagnosed in over 80% of patients. It discusses that spondylolysis or spondylolisthesis cannot be held as the cause of back pain in adults. These conditions occur with equal prevalence in subjects with no symptoms as they do in patients with back pain. Similarly, so-called degenerative changes occur only slightly more frequently in patients with back pain than they do in asymptomatic individuals. They represent no more than normal age changes. Serious causes of low back pain, such as tumors and infections, are rare. The chapter also reviews that computed tomography (CT) has no value as a primary investigation of back pain. Although CT can show disk herniations in patients with radicular pain in the lower limb, this does not constitute a utility for the investigation of back pain and somatic referred pain. Multiple studies have explored psychological variables that might constitute risk factors for the persistence of low back pain. Consequently, it has become customary to undertake psychological assessment of patients with chronic low back pain, the principle is that if psychological abnormalities can be normalized, the patient's disability might be reduced.