Managing acute low back pain in adults

Low back pain is one of the most common reasons for an outpatient visit, according to the American Academy of Family Physicians.

The evaluation for low back pain should include a complete, focused medical history looking for red flags. These include, but aren’t limited to:

• Severe or progressive neurologic deficits
• Fever
• Sudden back pain with spinal tenderness
• Trauma
• An indication of a serious underlying condition

It’s also important to rule out non-spinal causes of back pain. These include:

• Pyelonephritis
• Pancreatitis
• Penetrating ulcer disease or another gastrointestinal cause
• Pelvic diseases

Many doctors recommend avoiding imaging for acute low back pain within the first six weeks, unless red flags are present. Studies show that imaging has a limited affect for patients with acute low back pain without red flags, and that a conservative approach is preferable as most patients improve over time regardless of treatment.

When red flags aren’t present, clinicians and patients should consider nonpharmacologic treatment such as superficial heat, massage, acupuncture or spinal manipulation.

If pharmacologic treatment is needed, clinicians and patients should consider non-steroidal anti-inflammatory drugs or skeletal muscle relaxants.

In March 2018, the Michigan Quality Improvement Consortium published a guideline for adults who have low back pain or back-related leg symptoms for more than six weeks. Its recommendation is to focus on patient reassurance, detailed history and physical exam, appropriate therapy, referrals and medication strategies.

None of the information included in this article is intended to be medical advice.