Table 1 presents the differential diagnosis of acute low back pain. An episode of low back pain is called acute if it has arisen for the first time in a patients life, or after a pain free interval of at least six months, and lasts no longer than. Low back pain is a symptom affecting millions of adults annually. Pdf low back pain is among the major problems of daily clinical practice. Management guidelines endorse triage to identify the rare cases of low back pain that are caused by medically serious pathology, and so require diagnostic workup or specialist referral, or both. Low back pain that has been present for longer than three months is considered chronic, although there is still no consensus about the definition of clbp. Firm manual pressure applied to the muscle and elicited feedback from the patient appears to be the only means to establish the diagnosis.
The relief of unilateral painful thoracic radiculopathy. Spontaneous intracranial hypotension sih caused by spontaneous spinal cerebrospinal fluid csf leaks produces orthostatic headaches. With age, the normal back will exhibit visible morphological changes. Differential diagnosis of spondylolysis in a patient with. Chronic lbp clbp is a chronic pain syndrome in the lower back region, lasting for at least 12 weeks 2. Low back pain patient information jama jama network. The treatment of acute, subacute, and chronic low back pain are discussed separately. It also includes lower extremity pain that results from a low back disorder sciaticaradiating low back pain, whether there is trunk pain or not. Clinical diagnostic model for sciatica developed in primary.
Differential diagnosis of a patient referred to physical. Back pain is a common presentation to the emergency department. Particular emphasis is placed on the differential diagnosis of specific and nonspecific low back pain. The etiology of low back pain may be difficult to determine at times because of the number of diverse anatomic structures located. Last, md, mph, and karen hulbert, md, racine family medicine residency program, medical college of wisconsin, racine, wisconsin m ost primary care physicians can expect to see at least one patient with low back pain per week. Pdf low back pain is a symptom affecting millions of adults annually. This includes lumbosacral muscle strain, disk herniation. The etiology of low back pain may be difficult to determine at times because of the number of diverse anatomic structures located in or near the low back region. Chronic widespread pain is, however, not pathognomonic of fm, and other conditions may present similarly with cwp, requiring consideration of a differential diagnosis. Information gathered from the history and administration of special tests.
With spondylolysis or spondylolisthesis, the patient will usually complain of increased pain with hyperextension of the lower spine. Sciatica is radiating, lower extremity pain and may not be associated with back pain. In europe and the usa the lifetime prevalence is 60%, and 35% of the population suffer from back pain at least once a year. This discussion will focus on an approach to the initial evaluation, including diagnostic tests, of a patient presenting with low back pain in the primary care setting. The acute back pain is usually benign in nature in 90 % of cases. Many authors suggest defining chronic pain as pain that lasts beyond the expected period of healing, avoiding this close time criterion. Differential diagnosis and recovery of acute bilateral foot drop in a patient with a history of low back pain. Feb 15, 2012 diagnosis and treatment of acute low back pain. Differential diagnosis of low back pain n mechanical low back or leg pain 97% n lumbar strain, sprain 70% n degenerative processes of disks and facets, usually agerelated 10%. Your back is made up of bones the vertebrae,or spinal column, which protects your spinal cord and muscles. Specific causes of lbp are uncommon, and in approximately 90% of patients a specific generator cannot. Sep 05, 2018 osullivan pb, phyty gd, twomey lt, allison gt. Confirmation of pain originating from the pseudoarticulation can be made with steroid injections. Back pain can be caused by problems with the muscles, the bones, or the nerves in the back.
What is the source of chronic low back pain and does age play a role. Pain in the lower back area that can relate to problems with the lumbar spine, the discs between the vertebrae, the ligaments around the spine and discs, the spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, or the skin covering the lumbar area. The issue of low back pain lbp is as common as it is perplexing. Low back pain lbp is second only to upper respiratory problems for physician visits each year, with a lifetime prevalence of 70% to 85%. Liddle, md assistant professor of orthopedics assistant professor of internal medicine vanderbilt university medical center nashville, tn. Acute back pain has wide differential diagnoses, ranging from benign, selflimiting conditions to lifethreatening conditions. An accurate diagnosis is essential for both acute and chronic low back pain conditions. A 26yearold male sought physical therapy services via direct access secondary to a flareup of a chronic low back pain condition. The patient experiences acute back pain with functional limitations and. Differential diagnosis of low back pain sciencedirect.
There are three types of etiologies of the occurrence of low back pain. Assessment of back pain differential diagnosis of symptoms. The annual incidence in the adult population is 10% to 15% with a point prevalence of approximately 30% in developed countries. Generate differential diagnosis for the individual case.
Diagnosis and management of acute low back pain american. Low back pain lumbar back pain is defined as pain in the back from the level of the lowest rib down to the gluteal fold, with or without radiation into the legs. Mechanical low back pain american family physician. Chronic widespread pain cwp is the defining feature of fibromyalgia fm, a worldwide prevalent condition. Classification, diagnosis, and treatment of low back pain. Mechanical low back pain refers to back pain that arises intrinsically from the spine, intervertebral disks, or surrounding soft tissues. Fig 2 illustrates the differential diagnoses for lbp as defined in this study. Once the possibility of serious spinal pathology red flags or other nonspinal reasons for the leg pain are ruled out, the differential diagnosis is between leg pain due to nerve root involvement sciatica or nonspecific referred pain from other structures in the low back. Preventive back exercises, techniques of manual medicine, and. Low back pain is not a disease in itself, but rather a symptom with many. Back pain is the primary cause of disability in people of age. Acute back pain clinical features and differential diagnosis. Low back pain is the commonest cause for years lived with disability.
Bertolottis syndrome is a frequent anomaly which can be related to lower back pain. Respond to patient questions and discuss challenging presentations with other. Back pain is the primary cause of disability in people pdf only article. Most patients with back pain can be treated at the primary care setting, provided that the gp has the proper knowledge to elaborate the differential diagnosis of this. Jan 14, 2016 cardinal presentations this post is part of a series called cardinal presentations, based on rosens emergency medicine 8th edition. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. This case highlights the physical therapy examination, intervention, and outcomes of a 32yearold, 26 weeks gestation, complaining of low back pain. Acute episodes of back pain are usually selflimited. Cross sectional data from the yamaguchi low back pain study conducted.
Some occupations, such as heavy lifters, miners and truck drivers, have an increased prevalence of back pain due to repetitive mechanical strain to the back. When caring for a patient and developing a back pain differential diagnosis, remember to consider age, the history, physical exam findings, laboratory results, and imaging if needed. Despite the availability of modern diagnostic tools, the cause of the pain generator is often unidentifiable. Pdf on dec 1, 2002, hazel jenkins and others published classification of low back pain find, read. Osteitis condensans ilii in differential diagnosis of. They will link back to this article, and round out the discussion of.
Feverweaknesssyncopealtered mental statusseizuredizziness and vertigoheadachesore throatdyspneachest painabdominal painnausea and vomitinggastrointestinal bleedingacute pelvic painback pain causes of back pain key historical findings onset acute onset. Our personal files were used for additional references. Low back pain lbp is the fifth most common reason for physician visits, which affects nearly 6080% of people throughout their lifetime. Low back pain is the leading cause of long term disability worldwide. Patient strained lower back unloading a truck, which required lifting heavy boxes, twisting and placing boxes on flats three years ago. Low back pain lbp is the most common musculoskeletal condition affecting the adult population, with a prevalence of up to 84% 1.
Lower back pain persists on a daily basis and increases with bending and twisting. Pain in the lower back area that can relate to problems with the lumbar spine, the discs between the vertebrae, the ligaments around the spine and discs, the spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, or the skin covering the lumbar area low back pain. Low back pain lbp is a heterogeneous disorder including patients with dominant. Lbp is thought to be a chronic issue in approximately 10% of the u. Plo must be kept in mind in the differential diagnosis in patients presenting with low back pain during or after pregnancy. Differential diagnosis of spondylolysis in a patient with chronic low back pain jill theinnissenbaum, mpt, scs, atc1 william g. It can be seen at any period of life, from childhood to elderly. Osteitis condensans ilii in differential diagnosis of patients with chronic low back pain. To present a contemporary view of the epidemiology, classification, and differential diagnosis of low back pain. Low back pain caused by fragility fractures in osteoporosis patients has been found to have the most signi. Next, the differential diagnosis between predominant nociceptive and central.
It should be considered as a differential diagnosis when confronting a patient with compatible radiographic findings and persistent back pain. Examples of nociceptive pain include pain after surgery, arthritis pain, mechanical low back pain, and pain associated with sports injuries. Although upper arm pain or paresthesia is reportedly associated with sih from spontaneous spinal csf leak in the presence of orthostatic headache, low thoracic radicular pain due to spontaneous spinal csf leak unassociated with postural headache is extremely. Thus, idiopathic low back pain cannot be directly related to the morphological picture, but is influenced by many factors related to ligaments, discs, muscles and nerves. The current management of lumbar spondylolisthesis. Several layers of muscle cover the back, and ligaments and tendons support the vertebrae, supporting posture and giving the body flexibility. Pdf differential diagnosis of low back pain researchgate. Owing to the scarcity of pathologic evidence, there exists much perplexity as to the origin of the pain accompanying disorders in the lower part of the back, and one wonders whether the old conceptions of the sacrolumbar and sacroiliac entities are any longer adequate. Nov, 2014 the issue of low back pain lbp is as common as it is perplexing.
Some society journals require you to create a personal profile, then activate your society account. Nov 01, 2010 therefore with bilateral spondylolysis or bilateral fractures the vertebral pedicle slips anteriorly. Differential diagnosis of a patient referred to physical therapy for dizziness. The patients must be evaluated for the risk factors of plo, and an appropriate therapy must be initiated. Differential diagnosis of endometriosis in a young adult.
Plo is a rare clinical condition causing significant disability. Differential diagnosis and physical therapy management of. Adult with low back pain or back related leg symptoms for pain radiating. It is concluded that low back pain, a disease of the. Diagnosis and characters of nonspecific low back pain in japan. The icd diagnosis of low back pain low back strainlumbago and the associated icf diagnosis of acute or subacute low back pain with related cognitive or affective tendencies are made with a reasonable level of certainty when the patient presents with the following clinical findings 112, 124, 6, 183, 318. Differential diagnosis refers to the methods by which we consider the possible causes of patients clinical findings before making final diagnoses. Medications do not relieve the constant dull ache or the intermittent sharp. Nonspecific low back pain affects people of all ages and is a leading contributor to disease burden worldwide. Thus, in the differential diagnosis of low back pain, we must consider. Diagnosis and treatment of acute low back pain american. Learning point the differential diagnosis of back pain in children includes. Differential diagnosis arthritis anemia spinal stenosis narrowing of the spinal canal causing leg or lower back pain thrombophlebitis blood clots in the deep veins of the legs peripheral neuropathy nerve damage in the legs and feet, usually in people with diabetes. It is associated with disability, health care expenses, and a loss of wages and productivity.
Fewer than 2 percent of patients have disc herniation. These structures may be causing direct or referred pain patterns. It analyzes in detail the efficiency of various treatment modalities for chronic low back pain in the context of evidencebased medicine and the efficacy of nonsteroidal antiinflammatory drugs. Approximately two thirds of patients with low back pain lbp also report leg pain 1,2. Low back pain lbp is posterior trunk pain between the ribcage and the gluteal folds. Japanese orthopaedic association assessment criteria guidelines manual.
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