inflammatory conditions, disc herniation

inflammatory conditions, disc herniation

Reply Amanda

Causes Lower back pain is a common complaint seen in primary care. An acute episode is considered lower back pain lasting less than three months (Balague et al, 2007). Emergent causes associated with the complaint of lower back pain include; tumors, infections, inflammatory conditions, disc herniation, or vertebral fractures (Balague et al, 2007). Non-emergent causes include urinary tract infections, muscle strain. Assessment This complaint must be thoroughly investigated to rule out any emergent causes. “Patients should be assessed when standing and unclothed for spine symmetry, posture, and flexibility. Palpation can assess spinal (bone) versus paraspinal (soft tissue) pain and its severity” (Atlas et al, 2001). Diagnostics -Generally, imaging is not indicated for non-specific low back pain (Balague et al, 2007). If symptoms do not resolve with conservative treatment, imaging should be considered (Atlas et al, 2001). Advanced imaging such as a CT or MRI should be obtained in patients with a strong suspicion of serious etiology (Atlas et al, 2001). Other diagnostics which may be considered to identify etiology include; complete blood count, erythrocyte sedimentation rate, and urinary analysis. Treatment Treatment should begin as conservative with management including NSAIDs, activity modification, stretching, manipulation, application of heat/cold, and exercise for 4-6 weeks (Atlas et al, 2001). If symptoms do not improve or resolve management modalities may need to be elevated. Narcotics may be considered if pain is not managed well on NSAIDs. Referral Referral should be considered when a diagnosis is uncertain, when a patient is unresponsive to therapy, or for potential surgical candidates (Atlas et al, 2001). Specialists which patients may be referred to include; psychiatry, orthopedic, neurology, neurosurgery, or rheumatology.