Approach to LBP
Adult with acute LBP (1m
Age > 50yo
Multiple risk factors XR / MRI
Vertebral infection Fever MRI ESR or CRP
IVDU
Recent infection
Cauda equina syndrome Urinary retention MRI -
Motor deficits
Faecal incontinence
Saddle anaesthesia
Vertebral compression # Osteoporosis MRI -
Corticosteroids
Elderly
Ankylosing spondylitis Morning stiffness XR pelvis AP ESR or CRP
Better with exercise HLA-B27
Alternating buttock pain
Back pain at night
Younger age
Neurological deficits Progressive motor weakness MRI EMG/ NCV
Herniated disc Back pain with sciatica L4, L5, S1 - -
SLR+ (+/- crossed)
Symptoms > 1m MRI EMG/ NCV
Spinal stenosis Radiating leg pain - -
Elderly
Symptoms >1m MRI EMC/NCV
References
1. Chou et al. (2007). Diagnosis and treatment of low back pain: a joint clinical practice guideline from the
American College of Physicians and the American Pain Society. Ann Intern Med, 147, 478-491.
2. Hagen et al. (2004). Bed rest for acute low-back pain and sciatica. Cochrane Database of Systematic
Reviews.
3. Chou et al. (2007). Nonpharmacological therapies for acute and chronic low back pain: a review of the
evidence for an American Pain Society/ American College of Physicians clinical practice guideline. Ann
Intern Med, 147(7), 492-505.
4. Davies et al. (2008). A systematic review of paracetamol for non-specific low back pain. Euro Spine J,
17(11), 1423-30.
5. Roelofs et al. (2009). Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of
Systematic Reviews, 1.
6. Godges et al. (2008). Effects of education and return-to-work status for people with fear-avoidance
beliefs and acute low back pain. Physical Therapy, 88(2), 231-8.
7. Chou et al. (2007). Medications for acute and chronic low back pain: a review of the evidence for an
American Pain Society/ American College of Physicians Clinical Practice Guideline. Ann Intern Med,
147(7), 505-14.