Review of "Diagnosis and Treatment of Acute Low Back Pain" by Dr. Brian Cassazza

this is a review/synopsis of the article "Diagnosis and Treatment of Acute Low Back Pain by BRIAN A. CASAZZA, MD"


Am Fam Physician. 2012 Feb 15;85(4):343-350



     Since my back pain is only slightly better I figured that this would be  an appropriate time to reread and review an article on Low back pain. First off , acute low back pain is pain for 6-12 weeks , between the area of your back from your "lower costal angle to your gluteal fold". I  have never heard that geographic description so I thought I would mention it . So the most common causes are compression fractures, herniated discs,  lumbar strain/ sprain, stenosis, and sponylo's (-losis, lysis, and listhesis). There are also connective tissue diseases, osteomyelitis, aortic aneurysms  and a lot more so you may want to check out this article to see the complete differential. I'm pretty sure I have a lumbar sprain/strain. 
     When you take your history it is important to pay attention to red flags that MAY OCCASIONALLY be associated with a serious pathology. Bowel or bladder incontinence or saddle anesthesia may be a sign of cauda equina syndrome. Vertebral tenderness and weight loss may be a sign of malignancy. Trauma in the elderly could be a fracture.
     Spine pain rarely radiates below the knee. Sacro-iliac pain radiates often to the thigh and below the knee. Nerve root irritation often manifests as leg pain over back pain. L1-L3 radiates to the hip and though whereas L4-S1 radiates below the knee.
Imaging is often not needed (unless in trauma). It may be considered if pain persists beyond 4-6 weeks and you are considering a serious pathology.
For medications, NSAID's or acetaminophen can often relieve low back pain. They all have shown to be squally effective and can be changed at will. Opioiods are commonly prescribed but have shown little evidence of benefit. Epidural spinal injections have recently come under fire do to the fungal meningitis outbreak due to contaminated product. They don't really have any long term benefit although it may provide some temporary pain relief of radiating pain(if you don't mind the meningitis).
     So if you have a patient who wants to get well and isn't just going to pout until you give him/her a percocet script, you can tell him/her this: stay active. Avoid twisting and turning while bending forward. Try to get back to your normal level of activity as soon as possible. Heat packs can help.
     Some things that don't really work err... I mean haven't been shown to be effective are back braces, acupuncture  massage, traction,  or oral steroids. Just think bed rest = Bad rest!