What is the treatment-based classification approach for back pain?
May 12, 2017 · Identifying diagnostic, prognostic and treatment orientated subgroups of patients with low back pain (LBP] has been on the research agenda for many years [1, 2]. Diagnostic reasoning with a structural/pathoanatomical focus is common among clinicians , and it is regarded as an essential component of the biopsychosocial model [4–6]. Within this model, …
What is the difference between low back pain and chronic pain?
Treatment-based classification (TBC) approach to low back pain describes the model whereby the clinician makes treatment decisions based on the patient's clinical presentation. The primary purpose of the TBC approach is to identify features at baseline that predict responsiveness to four different treatment strategies.
What is the pathophysiology of low back pain?
May 12, 2017 · Identifying diagnostic, prognostic and treatment orientated subgroups of patients with low back pain (LBP] has been on the research agenda for many years [1, 2]. Diagnostic reasoning with a structural/pathoanatomical focus is common among clinicians [ 3 ], and it is regarded as an essential component of the biopsychosocial model [ 4 , 5 , 6 ].
What is basic research on low back pain?
with low pain and disability status. This perspective article emphasizes that psychological and comorbid status should be assessed and addressed in each patient. This updated TBC is linked to the American Physical Therapy Association’s clinical practice guidelines for low back pain. M. Alrwaily, PT, MS, PhD, Depart-ment of Physical Therapy ...
Is back pain a pathology?
The pathophysiology of back pain depends on the etiology. Most often, it may be a part of an acute inflammatory process. Oncologic: This is caused by lytic lesions to the spine, cancers of the marrow, or compressive nerve phenomena from adjacent space-occupying lesions. Often presenting as a pathological fracture.Feb 22, 2022
How do you classify lower back pain?
Acute low back pain is an episode of low back pain for less than 6 weeks, sub-acute low back pain between 6 and 12 weeks and chronic low back pain for 12 weeks or more. Low back pain that has been present for longer than three months is considered chronic.
What is the pathophysiology of low back pain?
Pathophysiology of Low Back Pain It appears that alteration in biomechanical properties of the disk structure, sensitization of nerve endings by release of chemical mediators, and neurovascular ingrowth into the degenerated disks all may contribute to the development of pain.
What is the primary treatment intervention for low back pain?
In chronic low back without serious pathology, recommended primary conservative physical treatment preferences include exercise, yoga, biofeedback, progressive relaxation, massage, manual therapy, and interdisciplinary rehabilitation [17] (Table 2).Sep 18, 2018
What is low back pain definition?
Lower back pain (LBP) is defined as pain, muscular tension, or stiffness that is localized between the costal margins and the inferior gluteal folds, with or without leg pain (i.e., sciatica).
What is the major cause 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 differentiates acute low back pain from subacute back pain and chronic low back pain?
Acute back pain, which is the focus of this article, is classified as pain lasting 6 weeks or less, subacute back pain is pain that has been present between 6 and 12 weeks, and chronic back pain is pain that persists longer than 12 weeks [2].
What is non specific low back pain?
Definition. Non-specific low back pain is defined as low back pain not attributable to a recognizable, known specific pathology (eg, infection, tumour, osteoporosis, lumbar spine fracture, structural deformity, inflammatory disorder,radicular syndrome, or cauda equina syndrome).
Is low back pain a diagnosis?
Non-specific low back pain is defined as symptoms without a clear specific cause—that is, low back pain of unknown origin. About 90% of all patients with low back pain will have non-specific low back pain, which, in essence, is a diagnosis based on exclusion of specific pathology.
How is back pain diagnosed and treated?
AdvertisementX-ray. These images show the alignment of your bones and whether you have arthritis or broken bones. ... MRI or CT scans. These scans generate images that can reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.Blood tests. ... Bone scan. ... Nerve studies.Aug 21, 2020
What is a TBC in back pain?
Treatment-based classification (TBC) approach to low back pain describes the model whereby the clinician makes treatment decisions based on the patient's clinical presentation. The primary purpose of the TBC approach is to identify features at baseline that predict responsiveness to four different treatment strategies. This approach has been validated and is used widely in the USA.
When referring to evidence in academic writing, should you always try to reference the primary source?
When refering to evidence in academic writing, you should always try to reference the primary (original) source. That is usually the journal article where the information was first stated. In most cases Physiopedia articles are a secondary source and so should not be used as references.
What are the levels of TBC?
TBC was firstly developed in 1995 then updated twice in 2007 and 2015. The current TBC has two levels of triage: 1 the level of the first contact health care provider. 2 the level of the rehabilitation provider.
Is classification ongoing?
However, the process of classification is ongoing and it is anticipated that an individuals presentation will change with time and treatment. Ongoing reassessment is, therefore, necessary to determine the most appropriate intervention at any point in time [1].
What files are search strategies included in?
Search strategies for selection of studies are included as Additional files 8, 9 and 10. The datasets used and analysed during the current study are available from the corresponding author on reasonable request.
What is the significance of reference standards in index tests?
Studies using surgery means that results were obtained in a patient population with high prevalence of severe disc herniations, and thus results cannot be generalized to primary care populations where prevalence is much lower.
What is the cut off for a clinical finding?
In order to be clinically useful, we considered the cut-off for a clinical finding to rule in the disorder to be a positive likelihood ratio (LR) above 2.0 [ 28 ], meaning that a positive index test will at least double the ratio of having the disorder compared to not having the disorder. This means that if the pretest probability is 0.3, the pretest odds is 0.3/0.7 = 0.43 and if the LR is 2.0 the posttest odds is 2*0.43 = 0.86 and the posttest probability can then be estimated to 0.46. For a useful clinical finding to rule out the disorder, we considered the cut-off to be a negative LR below 0.5 [ 28 ], meaning that a negative index test will reduce the odds of having the disorder at least by half compared to not having the disorder. Overall, the change from pretest to posttest chance of having the disorder in question depends on the pretest probability.
Is the CDR weak?
The strength of our recommendation for the CDR is weak based on mediocre methodological quality in most of the studies. Studies revealed serious risk of bias in relation to differential verification, incorporation, or test review.
Is a double block procedure a CDR?
It was not possible to constitute a CDR for the identification of painful FJ. Double block procedure in joint space or at nerve supply was judged to be acceptable as reference standard when at least one of the following criteria were satisfied: a positive controlled block, i.e. the anesthetic block definitely reduced the pain from the injected joint, where as a block in a non-painful joint had no marked effect on pain, a positive confirmatory block, the anesthetic block definitely reduced the pain from the injected joint at two separate occasions 1 to 2 weeks apart, or a positive comparative dual block, i.e. a short- followed by a long lasting anesthetic significantly reduced pain in the predicted time periods [ 148 ].
Is SLR a peripheral nerve test?
While diagnostic value of the SLR and slump is demonstrated in patients with lumbar radiculopathy, the value in relation to painful peripheral nerve tissue is unknown. Our search did not identify any studies investigating the ability of these tests to discriminate patients with peripheral nerve pain from other competing disorders. The suggested criteria should be regarded as an attempt to define a common set of diagnostic criteria for selection of patients to be included in future validity studies.
What is the pathophysiology of back pain?
Pathophysiology of Back Pain or Backache: Radicular Pain: Chronic pain caused by pinched nerve or irritation of the nerve at nerve root close to spinal cord or at foramina before its exit from the spinal canal. 1 Radicular pain is associated with tingling, numbness or weakness.
What are the symptoms of back pain?
Pathophysiology of Back Pain or Backache: 1 Radicular Pain: Chronic pain caused by pinched nerve or irritation of the nerve at nerve root close to spinal cord or at foramina before its exit from the spinal canal. 1 Radicular pain is associated with tingling, numbness or weakness. Pain, tingling and numbness are symptoms of sensory nerve injury called as radiculopathy. Sensory symptoms are associated with weakness if motor nerve is irritated or squeezed. 2 Muscular Pain: Backache is also secondary to muscle spasm, muscle strains (pulled muscles) and tear in the back muscles. Backache is often observed in fibromyalgia and myofascial pain syndrome. 2 3 Facet (zygapophysial) Joint Pain: Facet joint pain is seen in older patients suffering with degenerative disk disease and in individuals following surgery or motor vehicle accident. 4 Ligamentum Flavum Hypertrophy: This is observed after trauma, whiplash injury and surgery. 5 Posterior Ramus Syndrome (PRS): Also recognized as Maigne syndrome or thoracolumbar junction syndrome. Cause of unexplained activation of the posterior ramus of thoracolumbar nerves is unknown. 6 Referred Pain – Visceral pain from stomach, pancreas and kidney disease is often referred to lower back and mid back 3:
What is spinal cord compression?
Spinal cord compression will result in symptoms of cauda equina syndrome. Foraminal Stenosis: Spinal foramen acts as a conduit to pass spinal nerves at each segment to distal organs. Foraminal are narrowed by protrusion of thick ligaments, facet joint hypertrophy, bony spurs and intervertebral disc herniation.
What is the term for a muscle spasm that causes numbness and pain?
Pain, tingling and numbness are symptoms of sensory nerve injury called as radiculopathy. Sensory symptoms are associated with weakness if motor nerve is irritated or squeezed. Muscular Pain: Backache is also secondary to muscle spasm, muscle strains (pulled muscles) and tear in the back muscles.
What is a bulged disc?
Disc Bulge and Herniation: Bulged disc is a result of protrusion of the jelly like central portion (nucleus pulposus) of the disc. Bulged disc pushes against a nerve root causing symptoms such as tingling, numbness and weakness in the dermatome of the injured nerve and group of muscles. Fracture of Vertebrae: Pain, ...
Can sciatica cause pain without disc rupture?
Minor trauma under these circumstances causes inflammation and nerve root impingement, which can produce classic sciatica like pain without disc rupture. Metastatic Cancer: Metastasis of primary cancer of breast, lung, prostate, or colon is very often detected in the vertebral column.
What is a subclassification of low back pain?
Low back pain subclassification is a strategy that can facilitate proper targeting of physical therapy treatment options because it takes functional aspects into account instead of focusing too sharply on symptoms, guiding towards the therapeutic option that can be used with greater potential for certain patients. Likewise, there is a need for a more in-depth study of signs and symptoms of cases in the management of low back pain, making use of tests and clinical evaluations that assess functional conditions more thoroughly.
What are the three types of low back pain?
Chronic low back pain is divided into three types of mechanisms: specific spinal pathology, irradiated pain, and nonspecific chronic pain, which is statistically the most common of the three types of low back pain. 3. 3.
What is method of treatment subgroup classification?
The method of treatment subgroup classification is a guide towards better semiological perspectives and the definition of the clinically preferred physiotherapeutic treatment for each case. Level of Evidence III; Diagnostic study.