The goals of treatment for acute low back pain are to relieve pain, improve function, reduce time away from work, and develop coping strategies through education. Optimizing treatment may minimize the development of chronic pain, which accounts for most of the health care costs related to low back pain. 7 History and Physical Examination
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How is the clinical success of the treatment of low back pain?
The most commonly used functional outcomes were the Oswestry Disability Index, Roland Morris Disability Index, and range of motion. For pain, the Numeric Pain Rating Scale, Brief Pain Inventory, Pain Disability Index, McGill Pain Questionnaire, and visual analog scale were most commonly cited.
When should you seek medical care for low back pain?
The revised Oswestry Low Back Pain Questionnaire (ROLBPQ) and Roland-Morris Activity Scale (RMAS) were compared in a randomized controlled trial of chiropractic manipulation, stroking massage, corset and transcutaneous muscular stimulation (TMS). ... Functional outcomes of low back pain: comparison of four treatment groups in a randomized ...
Which medications are used in the treatment of acute low back pain?
Aug 01, 2005 · 5Clinically important outcomes in low back pain. Clinically important outcomes in low back pain. Four important domains directly related to low back pain are: pain intensity, low-back-pain-specific disability, patient satisfaction with treatment outcome, and work disability. Within each of the domains, different questionnaires have been proposed.
When is imaging indicated in the treatment of acute low back pain?
Predicting Outcomes in Low Back Pain Patients. Low back pain is a common problem seen in clinical practice, and one that can be difficult to treat. One patient may have an acute case of back pain that resolves on its own in a few days, while the next may suffer for years with chronic pain. Being able to predict which patients are the best candidates for chiropractic would be useful …
What is the most effective treatment for low back pain?
Medications such as naproxen, ibuprofen, and acetaminophen are most effective in reducing pain and swelling associated with muscle-related lower back pain. However, OTC medication is less likely to alleviate symptoms that stem from nerve compression or disc problems.
Is pain an outcome measure?
Pain is a difficult outcome to measure due to its multifaceted and subjective nature.
What is the result of lower back pain?
Lower back pain is very common. It can result from a strain (injury) to muscles or tendons in the back. Other causes include arthritis, structural problems and disk injuries. Pain often gets better with rest, physical therapy and medication.Jan 18, 2021
What is the prognosis for low back pain?
Prognosis of most low back pain is good and a minority seek care. Among those presenting for care, most new episodes recover within a few weeks. However, recurrences are common and individuals with chronic, long-standing low back pain tend to show a more persistent course.
How do you assess pain scores?
The three most commonly utilized tools to quantify pain intensity include verbal rating scales, numeric rating scales, and visual analogue scales. Verbal Rating Scales (Verbal Descriptor Scales) utilize common words (eg, mild, severe) to grade pain intensity.Sep 27, 2018
How accurate are pain assessments?
Since pain is subjective, self-report is considered the Gold Standard and most accurate measure of pain. The PQRST method of assessing pain is a valuable tool to accurately describe, assess and document a patient's pain.
Is walking good for lower back pain?
If you have lower back pain, walking may be a particularly good form of exercise to relieve pain, since low-impact activity is less damaging to your joints and helps your body maintain bone density. Physiotherapists may recommend retro walking (walking backward) as well as an effective way to manage back pain.Oct 13, 2021
How do you tell if your lower back pain is muscular or skeletal?
Back Pain Symptom Checker: Typically, pain originating in your spine will look a little different than pain from a muscle. You may have a more burning or electric type pain, or your pain may be constant. With spinal-issue pain, you may also have pain that “shoots” down your leg or into your glutes.Jun 1, 2021
How do you tell if lower back pain is muscle or disc?
The lower back and neck are the most flexible parts of your spine, and they're also where most herniated discs occur. While pain in your mid-back may be related to a disc, it's more likely caused by muscle strain or other issues. Your symptoms feel worse when you bend or straighten up from a bent position.
What are the domains of low back pain?
Four important domains directly related to low back pain are: pain intensity, low-back-pain-specific disability, patient satisfaction with treatment outcome, and work disability. Within each of the domains, different questionnaires have been proposed. This chapter focuses on validated and widely used questionnaires. Details of the background and the measurement properties, and of the minimally clinically important change (MCIC) using these questionnaires, are described. The MCIC can be estimated using various methods and there is no consensus in the literature on what the most appropriate technique is. This chapter focuses primarily on two adequate and frequently used methods for estimating the MCIC. We argue that the MCIC should not be considered as a fixed value and that the MCIC values presented in this chapter are used as indications.
What is pain intensity?
Pain intensity can be defined as how much a patient is hurt by his or her low back pain. Pain intensity is a quantitative estimate of the severity or magnitude of perceived pain. Von Korff et al 13 provides a comprehensive review of the assessment of pain intensity using self-report. The two most commonly used methods to assess pain intensity are the visual analogue scale (VAS) and numerical rating scale (NRS). It is important to realize that, no matter how numeric the values provided by these measurement instruments appear to be, the measurement of pain intensity remains a subjective interpretation of the pain experience and the patient's assignment of the value to the measurement scale. There is growing evidence to suggest that pain intensity, in combination with its interference with activities, contributes to an underlying construct of global pain severity. 13 There is a large body of research on the assessment of back pain's interference with activities. Measures to assess how back pain interferes with activities will be discussed later; findings from methodological studies indicate that the recall of key parameters of chronic recurrent pain, which includes pain intensity, have acceptable levels of validity for at least a 3-month recall period. 13 This indicates that self-report pain intensity measures with an extended recall period can yield useful information on pain outcomes ( Table 2 ).
How is the RDQ 22 calculated?
Patients are asked whether the statements apply to them that day (i.e. the last 24 hours). The RDQ-24 score is calculated by adding up the number of items with a ‘yes’, which will range from 0 (no disability) to 24 (maximum disability). Several modifications have been suggested but these seem to provide only modest improvements over the original version and the original version has been recommended for use. 1
What is the importance of validity?
Validity is the essential issue in the quality of a measurement instrument. A measurement is valid if it measures what it is intended to measure. Although the terminology in validity testing can be rather confusing, in general, three ‘types’ of validity can be distinguished. 2 Content validity focuses on the question of whether the items of a scale adequately cover the domain intended to measure. The definition of criterion validity is the correlation of a scale with other measures intended to measure the domain of interest (e.g. functional disability): the so-called ‘gold standard’. For the measures that we focus on in this paper (and also in the field of low back pain in general), hardly any gold standards exist. Therefore, it is conventional to compare scores of a questionnaire with scores of established measures: this is called construct validity. It refers to the extent to which scores on a particular instrument relate to other measures in a manner that is consistent with theoretically derived hypotheses concerning the constructs that are being measured ( Table 1 ). 3
What is VAS score?
A VAS consists of a line, usually 100-mm long, with ends labelled as the extremes of pain (e.g. ‘no pain’ to ‘pain as bad as it could be’). Specific points along this line might be labelled with intensity-denoting adjectives or numbers. Patients are asked to indicate which point along the line best represents their pain intensity and the distance from the no-pain end to the mark made by the patient is the patient's pain intensity score.
What is disability in medical terms?
The World Health Organization 20 defines disability as ‘any restriction or lack of ability (resulting from an impairment) to perform an activity in the manner or within the range considered normal for a human being’ . In low back pain, this is often interpreted as pain interfering with activities such as mobility, dressing, sitting and standing. Patients can give this information by completing disability questionnaires. Questionnaires are more consistent and reliable than interviews (e.g. history taking) because they present the questions in exactly the same way to every patient, every time. 21 Many questionnaires are available but definite statements about the superiority of one back-specific measure over another cannot be made. However, an international expert panel recommends using one of the two widely used measures, the Roland–Morris Disability Questionnaire (RDQ) or the Oswestry Disability Index (ODI). 1 It is important to emphasize that the differences between these instruments are small: both cover about the same content, are widely used, have been extensively tested and are applicable in a wide variety of settings.
How to treat low back pain?
The BACPAC Research Program will develop an integrated model of chronic low back pain by: 1 Using deep phenotyping to characterize people with chronic low back pain to improve understanding of the complex mechanisms underlying the condition 2 Identifying novel pathways and targets for intervention for the development of new therapeutic options to reduce pain and improve function 3 Developing precise diagnostic and treatment algorithms and then testing and refining them in clinical trials using new interventions and/or combination therapies so health care providers can tailor therapies to patients 4 Combining data from translational research and Phase 2 clinical trials to deliver an integrated model of back pain 5 Collaborating with the Early Phase Pain Investigation Clinical Network (EPPIC-Net) to test novel chronic low back pain interventions during clinical trials
How many people have low back pain?
National Health Interview Survey data indicate that 20 percent of adults in the United States reported “frequent” back pain and 28 percent experienced low back pain that lasted one or more days during the previous three months. Current chronic low back pain treatment options are ineffective, which has led to an increased use of opioids.
What is the most common chronic pain?
Chronic low back pain is one of the most common forms of chronic pain among adults worldwide; according to the Global Burden of Disease Study 2010, it ranked highest in terms of years lived with disability among hundreds of conditions. National Health Interview Survey data indicate that 20 percent of adults in the United States reported “frequent” ...
Is opioid use high after surgery?
Most patients considering spine surgery have experienced many years of back pain and rates of pre-surgical opioid use are high. Pre-surgical opioid use is predict ive of worse functional outcomes, higher complication rates and greater costs after surgery. The idea behind this project is that surgical outcomes can be improved, and risk for post-surgery opioid use reduced through comprehensive, enriched pain management designed to enhance patients’ ability and confidence in self-managing pain. This project includes a one-year planning phase and a two-year clinical trial, and expands the scope of an ongoing clinical trial in the Military Health System, investigating similar interventions for patients pursuing non-surgical management for chronic back pain.
What is BACPAC research?
The Back Pain Consortium (BACPAC) Research Program is a translational, patient-centered effort to address the need for effective and personalized therapies for chronic low back pain. It will examine biomedical mechanisms within a biopsychosocial context by using interdisciplinary methods and exploring innovative technologies.
How many grants did the NIH give to the BACPAC program?
Through the Helping to End Addiction Long-term SM Initiative, or NIH HEAL Initiative SM, NIH awarded 13 grants, totaling approximately $150 million, to form the BACPAC Research Program. The collaborative research program is composed of mechanistic research centers and technology sites combining translational research and Phase 2 clinical trials to deliver an integrated model of chronic low back pain.
Where is the DAC located?
The DAC is located at the Collaborative Studies Coordinating Center (CSCC) at the University of North Carolina at Chapel Hill. The DAC guides and coordinates activities and communication among the other 12 BACPAC study sites and is responsible for developing and hosting a secure, cloud-based, scalable data management and analysis platform to facilitate data sharing and collaborative analysis of data collected by the Consortium. The DAC will collaborate with Consortium members to conduct system level analysis for BACPAC generated multidimensional datasets to refine the Consortium’s model of lower back pain (LBP) to develop patient-centered algorithms for prediction of optimized therapeutic interventions. In collaboration with the BACPAC Clinical Management Committee, the DAC Adaptive Design Expert Group will design one or more collaborative studies, to be conducted by the Consortium, for which the DAC will serve as the central data coordinating and analysis center.
How long does it take for a low back to heal?
Many cases are self-limited and resolve with little intervention. However, 31 percent of persons with low back pain will not fully recover within six months, 1 although most will improve.
When does low back pain start?
Most persons will experience acute low back pain during their lifetime. The first episode usually occurs between 20 and 40 years of age. For many, acute low back pain is the first reason to seek medical care as an adult.
What is the best way to diagnose low back pain?
An accurate history and physical examination are essential for evaluating acute low back pain. Often, patients awaken with morning pain or develop pain after minor forward bending, twisting, or lifting. It is also important to note whether it is a first episode or a recurrent episode.
Is tizanidine a muscle relaxer?
Moderate-quality evidence shows that non-benzodiazepine muscle relaxants (e.g., cyclobenzaprine [Flexeril], tizanidine [Zanaflex], metaxalone [Skelaxin]) are beneficial in the treatment of acute low back pain.
Does home exercise help with back pain?
According to moderate-quality evidence, physical therapist–directed home exercise programs for acute back pain can reduce the rate of recurrence, increase the time between episodes of back pain, and decrease the need for health care services.
Can steroids help with low back pain?
Oral Steroids. A short course of oral corticosteroids has questionable benefit for patients with acute radicular leg pain. 34 However, there are no studies to support the use of oral steroids for isolated acute low back pain.
Is physical therapy good for low back pain?
23, 24. Although regular exercises may not be beneficial in the treatment of nonspecific acute low back pain, physical therapy (McKenzie method and spine stabilization) may lessen the risk of recurrence and need for health care services.
What percentage of people have low back pain?
Low back pain is one of the most frequently encountered conditions in clinical practice. Up to 84 percent of adults have low back pain at some time in their lives, and over one quarter of U.S. adults report recent (in the last three months) low back pain. 1,2 Low back pain can have major adverse impacts on quality of life and function;
What are the comparative benefits and harms of different nonpharmacological, noninvasive therapies, or combinations thereof?
What are the comparative benefits and harms of different nonpharmacological, noninvasive therapies, or combinations thereof (combinations may include both pharmacological and nonpharmacological components) for acute, subacute, or chronic nonradicular low back pain, radicular low back pain, or spinal stenosis, including but not limited to exercise and related interventions, complementary and alternative therapies, psychological therapies, physical modalities, and interdisciplinary rehabilitation?
What is systematic evidence review?
A systematic evidence review that included recently published research may provide a better understanding of the comparative effectiveness of treatment options for acute and chronic low back pain and could be used to update existing clinical recommendations that could be out of date .
What is a key informant?
Key informants are the end users of research, including patients and caregivers, practicing clinicians, relevant professional and consumer organizations, purchasers of health care, and others with experience in making health care decisions.
How much must an EPC team disclose?
EPC core team members must disclose any financial conflicts of interest greater than $1,000 and any other relevant business or professional conflicts of interest. Related financial conflicts of interest that cumulatively total greater than $1,000 will usually disqualify EPC core team investigators.
What is technical expert?
Technical experts constitute a multi-disciplinary group of clinical, content, and methodological experts who provide input in defining populations, interventions, comparisons, or outcomes and identify particular studies or databases to search. They are selected to provide broad expertise and perspectives specific to the topic under development. Divergent and conflicting opinions are common and perceived as health scientific discourse that results in a thoughtful, relevant systematic review. Therefore study questions, design, and methodological approaches do not necessarily represent the views of individual technical and content experts. Technical experts provide information to the EPC to identify literature search strategies and recommend approaches to specific issues as requested by the EPC. Technical experts do not do analysis of any kind nor do they contribute to the writing of the report. They have not reviewed the report, except as given the opportunity to do so through the peer or public review mechanism.
What is peer review in EPC?
Peer reviewers are invited to provide written comments on the draft report based on their clinical, content, or methodological expertise. The EPC considers all peer review comments on the draft report in preparation of the final report. Peer reviewers do not participate in writing or editing of the final report or other products. The final report does not necessarily represent the views of individual reviewers. The EPC will complete a disposition of all peer review comments. The disposition of comments for systematic reviews and technical briefs will be published three months after the publication of the evidence report.
