Low Back Pain (Acute)

A report of acute low back pain (ALBP), ~}though quite common, requires a thor­ ough evaluation. The underlying pathophysi­ o logy of back pain is frequently multifactorial and includes both physiological and psy­ chological components . The most common causes ofALBP relate to musculoligamentous injuries and age-related degenerative pro­ cesses. A bout 90% of ALBP episodes in adults are related to mechanical causes that resolve within 4 weeks without serious se­ quelae. A smaller percentage of patients will continue to have chronic symptoms without organic pathology or have underlying disease.

In children, the prevalence of back pain increases with age and with involvement in sports. Anthropometric variations in children place them at risk for excess strain on the spine, producing back pain. These variations include reduced hip mobility, decreased lum­ bar extension and increased lumbar flexion , poor abdominal muscle strength, tight ham­ string muscles, and lumbar hyperlordosis.

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Acute low back pain is defined as activity intolerance producing lower back or back­ related leg symptoms of less than 3 months ‘ duration. The Agency for Healthcare Research and Quality (AHRQ) guidelines provide the fo llowing framework for causes of ALBP: • Potentially serious conditions (e.g., spinal fracture, tumor, infection, or cauda equina syndrome)

• Sciatica, or leg pain and numbness of the lateral thigh, leg, and foot, suggesting nerve root compression (Fig. 24. I)

• Nonspecific back problems such as mus­ culoskeletal strain, diskogenic pain, or bony deformity secondary to inflamma­ tory diseas e

• Nonspinal causes secondary to abdominal involv~ment (e.g., gallbladder, l iver, renal, pelvic inflammatory disease, prostate tumor, ovarian cyst, uterine fibroids, aortic a n eurysm, or thoracic disease)

• Psychological causes such as stress related to work environment (e.g ., disability, workers’ compensation, secondary gains). When evaluating ALBP, the goal of the clinician is to first identify signs and symp­ toms of potentially serious conditions through a careful history and physical examination. A holistic approach to the patient is needed to appreciate the extent to which pain affects the patient’ s daily routine or work- related activi­ ties. Because ALBP is a common occupation­ related complaint and a cause of disability and lost productivity, the clinician must gain insight into the patient’s psychosocial and economic situation to help arrive at a correct diagnosis.

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