TY  - CHAP
M1  - Book, Section
TI  - Approach to the Patient with Low Back Pain
A1  - Dixit, Rajiv K.
A2  - Stone, John H.
PY  - 2021
T2  - Current Diagnosis & Treatment: Rheumatology, 4e
AB  - Low  back  pain  (LBP)  affects  as  many  as  80%  of  individuals.  Degenerative  changes  of  the  lumbar  spine  are  the  most  common  cause.More  than  90%  of  these  patients  are  substantially  better  within  8  weeks,  although  recurrences  are  common.The  initial  evaluation  should  focus  on  identification  of  the  few  patients  with  neurologic  involvement,  fracture,  or  possible  systemic  disease  (infection,  malignancy,  or  spondyloarthritis),  the  management  of  whom  may  require  an  urgent  or  specific  intervention.Early  imaging  is  rarely  indicated  in  the  absence  of  significant  neurologic  involvement,  trauma,  or  suspicion  of  systemic  disease.Imaging  abnormalities,  often  the  result  of  age-related  degenerative  changes,  should  be  carefully  interpreted  because  they  are  frequently  present  in  asymptomatic  individuals  and  may  not  be  the  cause  of  the  patient’s  pain.Persistent  LBP  should  be  treated  with  an  individually  tailored  program  that  includes  analgesia,  core  strengthening,  stretching,  aerobic  conditioning,  loss  of  excess  weight,  and  patient  education.There  is  no  evidence  for  the  effectiveness  of  epidural  corticosteroid  injections  in  patients  without  radiculopathy  secondary  to  disk  herniation.A  large  number  of  injection  techniques,  physical  therapy  modalities,  and  nonsurgical  interventional  therapies  lack  evidence  of  efficacy.The  major  indication  for  back  surgery  is  presence  of  a  serious  or  progressive  neurologic  deficit.A  pathoanatomic  diagnosis  and  precise  identification  of  the  pain  generator  cannot  be  made  in  up  to  85%  of  patients.  Thus,  the  results  of  back  surgery  (especially  spinal  fusion)  are  disappointing  when  the  goal  is  relief  of  LBP  rather  than  relief  of  radicular  symptoms  or  treatment  for  the  relief  of  neurogenic  signs.  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2024/04/18
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1180195465
ER  -