Acute Low Back Pain
Definition
- Main article: Low Back Pain Definitions
Starting with the wrong definition of low back pain can lead to the wrong diagnosis, and so it is important to be clear here. The IASP taxonomy categorises low back pain into lumbar spinal pain and sacral spinal pain. There is also an overlapping definition called lumbosacral pain. These three categories constitute the colloquial term "low back pain."
Lumbar spinal pain is pain in a region bounded superiorly by an imaginary transverse line through the tip T12, inferiorly by an imaginary transverse line through the tip of S1, and laterally by vertical lines tangential to the lateral borders of the lumbar erectores spinae.
Sacral Spinal Pain is pain in a region bounded superiorly by an imaginary transverse line through the tip of S1, inferiorly by an imaginary transverse line through the posterior sacrococcygeal joints, and laterally by imaginary lines passing through the posterior superior and posterior inferior iliac spines."
Lumbosacral Pain is pain perceived as arising from a region encompassing or centred over the lower third of the lumbar region as described above and the upper third of the sacral region as described above.
Aetiology
Unlike with chronic low back pain there is little research on the aetiology of acute low back pain. No patho-anatomic diagnosis of low back pain can be made clinically without the use of special investigations. Such investigations are not appropriate for acute low back pain. The most important part of the assessment in acute low back pain is evaluating for red flag conditions. These include such conditions as fracture, discitis, osteomyelitis, abscess, primary malignancy, metastases, and enthesopathy. Therefore, in the acute setting in the absence of red flags, the diagnosis is simply "acute low back pain."[1]
Prognosis
- Main article: Prognosis of Low Back Pain
It is sometimes stated in guidelines that most patients with acute low back pain make an excellent recovery. The evidence is in fact quite conflicting, with markedly different findings across different studies. Overall the treating doctor can relay optimism, but be guarded about prognosis. The data on recurrence rates are also conflicting.
A systematic review of 11 studies performed in the US, Australia and Europe on patients with non-specific back pain found that recovery occurred in 33% of patients at 3 months, and by 1 year 65% still had pain. In studies that used total absence of pain as a criterion, 71% still had pain at 12 months. In studies that had a less stringent criteria, 57% still had pain at 12 months.[2]
Prognostic risk factors are broadly categorised into biological and psychosocial. Predictors of recurrence are often variable across studies, but generally include [3]
- Sociodemographic: female gender, obesity, poor educational level
- Current History: previous episodes, duration of episode, days to seek care, pain and disability levels, leg pain
- General Health: Smoking, habitual physical activity, perceived health, use of medications
- Psychosocial: Perceived risk of recurrence, depression, anxiety
- Work-related: Involvement in heavy lifting or awkward positions, job satisfaction, compensable case
- Others: MRI findings, qualification of practitioner.
References
- ↑ Bogduk et al. Medical Management of Acute and Chronic Low Back Pain. Chapter 3. Elsevier 2002.
- ↑ Itz CJ, Geurts JW, van Kleef M, Nelemans P. Clinical Course of Non-Specific Low Back Pain: A Systematic Review of Prospective Cohort Studies Set in Primary Care. Eur J Pain. 2013;17(1):5-15. doi: 10.1002/j.1532-2149.2012.00170.x.
- ↑ Machado GC, et al. Can Recurrence After an Acute Episode of Low Back Pain Be Predicted? Phys Ther. 2017 Sep 1;97(9):889-895. doi: 10.1093/ptj/pzx067. PMID: 28969347
