Diagnostic workup

Diagnosis and Treatment of Acute Low Back PainMentored by : dr. Harry Hartono, Sp. SPresented by : Evarista Theofika FelisiaLaura Cynthia Bria

IntroductionLow back pain most common reasons for adult to see a family physician1st episode: 20-40 y.o31% not fully recover within 6 months25-62% recurrent within 1-2 years

Acute Low Back Pain

6-12 weeks of pain between costal angles & gluteal folds, may radiate down one/both legs (sciatica)

Goal treatment: Relieve painImprove functionReduce time away from workDevelop coping strategies through education

History & Physical ExaminationSymptoms: morning pain, pain after minor forward bending, twisting, liftingSpine structure (musculature, ligaments, facet joins, disk)

Referred pain:Spine structure thigh region, rarely below kneeSacroiliac joint thigh, can also radiate below kneeIrritation, impingement, compression lumbar root leg pain >> back pain

Neurologic examination:StrenghtSensationReflex

Disc Herniation

Diagnostic workupIf a serious condition is suspected, MRI is usually most appropriate CT is an alternative if MRI is contraindicated or unavailableRadiography may be helpful to screen serious condition but has little value because of its low sensitivity and specificityLaboratory test such as CBC may be beneficial if infection or bone marrow neoplasm is suspected.Treatment of non spesific painFirst visitPatient education Reassure the patient that the prognosis is often good, with most cases resolving with little intervention Advise the patient to stay active, avoiding bed rest as much as possible, and to return to normal activities as soon as possibleAdvise the patient to avoid twisting and bendingInitiate trial of a NSAID or acetaminophen first-line therapyConsider a muscle relaxant based on pain severityConsider a short course of opioid therapy if pain is severConsider referral for physical therapy (McKenzie method and/or spine stabilization) if it is not the first episode

Second visit

Consider changing to a different nonsteroidal anti-inflammatory drugConsider referral for physical therapy (McKenzie method and/or spine stabilization) if not done at initial visitConsider referral to a spine subspecialist if pain is severe or limits function

Treatment of Acute Low Back PainAcceptable

Prone LyingChair bendsElbow pressPress-upsBaclward bendingTreatment of Acute Low Back PainUnsupportedTreatment of Acute Low Back PainInadvisableBed Rest not recommended.Moderate-quality evidenceBed rest VS Stay active Bed rest is less effective at reducing pain and improving function at 3 12 weeks.Prolonged bed rest cause adverse effect (joint stiffness, muscle wasting, loss of bone mineral density, pressure ulcer, venous thromboembolism)