Low back pain: State of art

European Spine Journal, 2006

Assistance with summaries and quality rating of exercise trials; assistance with literature management EMMA HARVEY University of Leeds Assistance cross-checking the SRs/RCTs on exercise JO JORDAN Chartered Soc Physio, UK Assistance with summaries and quality rating for KATHERINE DEANE Uni Northumbria, UK additional exercise trials 4 consisted of three women and eight men from various disciplines, representing 9 countries. None of the 11 members believed they had any conflict of interest. The WG for the chronic back pain guidelines had its first meeting in May 2001 in Amsterdam. At the second meeting in Hamburg, in November 2001, five sub-groups were formed to deal with the different topics (patient assessment; medical treatment and invasive interventions; exercise and physical treatment and manual therapy; cognitive behavioural therapy and patient education; multidisciplinary interventions).

Low Back Pain (LBP) is an extremely common problem that is often poorly managed. Most back pain is simple and self limiting but its important to recognize that which is not. LBP means a pain or ache some where between the bottom of the ribs at the back, and the top of the legs. About 80% of people report back pain at some time in their life. Standard management is rest and analgesic medication causist of nonsteroidal anti inflammation drugs (NSAIDs) or acetaminophen. An active rehabilitation programme uses exercise and grandual return to usual activities. Nerve blocks can be useful in a specific condition such as acute facet joint pain. Surgery is referred for use in patients with serve neurologic deficits and possibly, those with severe symptoms that persist despite adequate conservation treatment.

The Pain Management Handbook, 1998

Low Back Pain, 2012

Low Back Pain 170 acute) aimed at preventing chronicity more than the relief of symptoms of acute low back pain. These two modes of intervention are back school and multidisciplinary treatments 1,2325. Thus, in acute low back pain, it is observed at the base of treatment are three aspects that are crucial for clinical success:  One is to provide the patient with adequate information, an overemphasis on the fact that back pain is not too serious problem, the evolution in most cases the evolution is directed toward a rapid recovery and return to daily life. In this part of treatment is recommended to make it easier for the patient increase awareness about your pain, trying to be supportive and helps to eliminate the negative stigma of this disease skeletal muscle. This will important that there is consistency in message among all clinicians who work with the patient.  Provide adequate control of symptoms.  Advise patient to try to keep an active lifestyle and return to normal life, including his working life as soon as possible. www.intechopen.com Physiotherapy Treatment on Chronic Non Specific Low Back Pain 171 1.2 Low back pain clasifications 85% of low back pain who are diagnosed are performed without an objective test anatomical/radiological abnormality detected 28,29. People suffering from this disorder suffer musculoskeletal LBP. Optimal treatment remains a great mystery, but there are some randomized trials suggest some improvement of which is scientifically proven. Nevertheless, it was found that people with LBP, have impaired motor control, which varies greatly depending on each person 30. The approach is now more accepted in the scientific community is one that is based on the diagnosis for a classical determination, noting how the loss of motor control itself or as a result of secondary pathology. This diagnostic process places great emphasis on the conclusion between the subject's history, radiology, pain behavior, physical examination findings as well as significant pathology (red flags) and psychological (yellow flags), including negative beliefs, stress anxiety, catastrophizing, depression 31,32 , ... One of the key that has changed the concept of LBP is to observe the musculoskeletal imbalance from a bio-psycho-social, which is currently accepted and widespread. So based on this approach, this motor response can be classified into three distinct groups 32 :  Group 1: subjects whose response is adapted motor control and is secondary to an underlying disease process.  Group 2: subjects with secondary response is due to a psychological and / or social, not organic.  Group 3: subjects that offer a maladaptive response following a load on the tissue that is abnormal and leads to ongoing pain and anguish.

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2003

It is often claimed that up to 90% of low back pain (LBP) episodes resolve spontaneously within 1 month. However, the literature in this area is confusing due to considerable variations regarding the exact definitions of LBP as well as recovery. Therefore, the claim--attractive as it might be to some--may not reflect reality. In order to investigate the long-term course of incident and prevalent cases of LBP, a systematic and critical literature review was undertaken. A comprehensive search of the topic was carried out utilizing both Medline and EMBASE databases. The Cochrane Library and the Danish Article Base were also screened. Journal articles following the course of LBP without any known intervention were included, regardless of study type. However, the population had to be representative of the general patient population and a follow-up of at least 12 months was a requirement. Data were extracted independently by two reviewers using a standard check list. The included articles...

BMJ, 2006

The Spine Journal, 2010

BACKGROUND CONTEXT: Low back pain (LBP) is a prevalent, costly, and challenging condition to manage. Clinicians must choose among numerous assessment and management options. Several recent clinical practice guidelines (CPGs) on LBP have attempted to inform these decisions by evaluating and summarizing the best available supporting evidence. The quality and consistency of recommendations from these CPGs are currently unknown. PURPOSE: To conduct a systematic review of recent CPGs and synthesize their recommendations on assessing and managing LBP for clinicians. STUDY DESIGN/SETTING: Systematic review. METHODS: Literature search using MEDLINE, National Guidelines Clearinghouse, National Institute for Clinical Excellence, Internet search engines, and references of known articles. Only CPGs related to both assessment and management of LBP written in English were eligible; CPGs that summarized evidence from before the year 2000 were excluded. Data related to methods and recommendations for assessment and management of LBP were abstracted independently by two reviewers. Methodological quality was assessed using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument by two reviewers. RESULTS: The search uncovered 669 citations, of which 95 were potentially relevant and 10 were included in the review; 6 discussed acute LBP, 6 chronic LBP, and 6 LBP with neurologic involvement. Methods used to develop CPGs varied, but the overall methodological quality was high as defined by AGREE scores. Recommendations for assessment of LBP emphasized the importance of ruling out potentially serious spinal pathology, specific causes of LBP, and neurologic involvement, as well as identifying risk factors for chronicity and measuring the severity of symptoms and functional limitations, through the history, physical, and neurologic examination. Recommendations for management of acute LBP emphasized patient education, with short-term use of acetaminophen, nonsteroidal anti-inflammatory drugs, or spinal manipulation therapy. For chronic LBP, the addition of back exercises, behavioral therapy, and short-term opioid analgesics was suggested. Management of LBP with neurologic involvement was similar, with additional consideration given to magnetic resonance imaging or computed tomography to identify appropriate candidates willing to undergo epidural steroid injections or decompression surgery if more conservative approaches are not successful.

Clinical Orthopaedics and Related Research, 1984

Study Design. A stratified randomized single-blinded clinical trial. Objective. To compare the efficacies of 2 active therapies for chronic low back pain (CLBP). Summary of Background Data. Both a multidisciplinary biopsychosocial rehabilitation program and an intensive individual therapist-assisted back muscle strengthening exercise program used in Denmark have been reported to be effective for the treatment of CLBP. Methods. A total of 286 patients with CLBP were randomized to either a group-based 12-week program comprising 73 hours of therapist exposure (approximately 12 h/patient): 35 hours of hard physical exercise, 22 hours of light exercise/occupational therapy, and 16 hours of education (group A) or a 12-week program comprising 1 hour of personal training twice a week, i.e., therapist exposure 24 h/patient (group B). At baseline and at 3, 6, 12, and 24 months, patients filled out questionnaires on pain (visual analogue scale [VAS]-pain average, which was the primary outcome measure), Roland-Morris disability questionnaire, global perceived outcome, and 36-Item Short-Form General Health Survey. Data were analyzed using the intention-to-treat principle. Results. Of the 286 patients, 14 patients did not start treatment. Of the remaining patients, 25 (9%) dropped out of therapy. The 2 groups were comparable regarding baseline characteristic. After treatment, significant improvements were observed with regard to pain, disability, and most of the quality of life dimensions. These effects were sustained over the 24-month follow-up period. There were some statistically significant differences between the 2 groups relating to secondary end points, Roland-Morris disability questionnaire, and in the MOS 36-Item Short-Form Health Survey the "physical functioning" dimension and the "physical component summary." Conclusion. Both groups showed long-term improvements in pain and disability scores, with only minor statistically significant differences between the 2 groups. The minor outcome difference in favor of the group-based multidisciplinary rehabilitation program is hardly of clinical interest for individual patients.

Low back pain (LBP) is primarily managed in general practice and commonly underestimated or misdiagnosed by physicians. This article presents comprehensive review for diagnosis and evaluation of LBP according to current clinical studies guidelines. Our objectives are to define LBP, to establish how to take a detailed history and how to physically examine it in order to enable physicians to make an appropriate differential diagnosis for LBP, and to identify relevant investigations and referrals of patients with LBP. The article first offers a quick description of inflammatory back pain then discusses the importance of screening red flag patients with LBP and the importance of its early detection. Finally, we summarize how to outline a primary plan for managing and treating LBP. The article is prepared in the format of question and answer to make it targeted and accessible.