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Low Back Pain
Harris B. Cohen, M.D., is a preceptor in family medicine at Abington Memorial Hospital, Abington, Pennsylvania. Here, he discusses the high incidence and extensive costs of low back pain and the importance of evaluation and reassurance of the patient by family practitioners. Dr.Cohen stresses the importance of a proper history and physical examination in order to "rule out red flags" in low back pain, such as infection or malignancy, and cauda equina syndrome where lesions involve multiple lumbar and sacral roots. In the absence of red flags, he says, laboratory evaluation is unnecessary. Physical examination includes not only visual inspection and palpation of the spine, but the author also describes several neurological examinations in low back pain, including those for involvement of various nerve roots. He further notes that the exam should include possible adjacent organ involvement, such as organomegaly or pulsatile mass, in low back pain. The author also discusses how the presence of three or more out of five signs – Waddell Signs – may indicate nonphysiologic causes. Radiologic imaging in low back pain is rarely necessary, says the author, but he lists some indications for plain radiographs, CT scans, MRI, and myelography in low back pain. The lecture concludes with a discussion of management, and physical therapy which includes pain relief, restoring range of motion, and maintenance exercises, as well as the use of various medications that help relieve pain and relax muscles. Reassurance that 90% of low back pain is self-limited is an important function of the primary care physician. |
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