Management of Acute Back Pain

Abstract

Introduction Low back pain (LBP) imposes a considerable social and economic burden as one of the most serious public health issues in the developed nations and is one of the most common reasons for patient presentation to primary health care providers, outpatient clinics or A&E departments. Currently point prevalence of acute LBP adds up to 40%, 1-year prevalence exceeds 70% and life time prevalence equates 80%. Despite these facts, the complex pattern generating LBP is still not satisfactory understood. Additionally, the complexity of diagnostics and treatment in lumbar pain syndrome provokes insecurity and restraint especially in younger clinicians when faced with a patient suffering from acute back pain. To counter these problems, alleviate operational sequences in A&Es, outpatient departments and health care centers minimize the risk of mis- or underdiagnoses of life threatening internistic conditions respectively spinal emergencies and provide patients with appropriate diagnostics and treatment this algorithm has been originated. Materials and Methods The algorithm is based upon existing clinical guidelines of national and international scientific associations as well as on experienced data in the daily work of spine specialists. Hereby, consistency with the guidelines and recommendations of the literature on one hand and feasibility in the course of action in a day-to-day routine with as much practical relevance as possible on the other hand were the main goals to achieve. Results In synopsis, an algorithm was formed which evaluates the crucial differential diagnosis of lumbar back pain according to their clinical relevance and targets a plot of action according to reasonable diagnostic and therapeutic steps. By distinct yes-no decisions within the scope of history taken together with instructions according to clinical, laboratory, and radiological investigational steps, even clinicians without long-time experience in spine surgery should be able to handle patients with acute LBP in any situation according to the guidelines and treatment needed. Conclusion The designated target in developing this algorithm was to render assistance to colleagues of primary health care providers, outpatient clinics, and A&E departments in the complexity of diagnostics and treatment in lumbar pain syndrome and its differential diagnosis. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared Van Tulderm, Becker A, Bekkeringt, Breena, Gil De Real, Hutchinsona, Koesb, Laerume, Malmivaaraa. European Guideline for the management of acute nonspecific back pain Chour, Fur, Carrinoj, Deyor. Imaging strategies fr Low back Pain: Systematic Review and Metaanalysis. The Lancet 2009;373:463–467 Koesb, Van Tulderm, Lin C, Macedol, Mcauleyj, Maher C. An updated Overview of clinical guidelines for the managemnt of non-specific low back pain. European spine Journal 2010;19:2075–2094 Chou R, Qaseema, Snow V, Casey D, Cross JT Jr., Shekellep, Owens. Diagnosis and treatment of low back pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American pain society. Annals of Internal Medicine 2007;147:478–491 Haswell K, Gilmour J, Moore B. Clinical decision rules for identification of low back pain patients with neurologic involvement in primary care. Spine (Phila Pa 1976). 2008;;33(1):68–73 New Zealand Guidelines Group. New Zealand acute low back pain guide