Clinical Efficacy Assessment Subcommittee of the American College of Physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society

Oregon Health & Science University, Portland, Oregon, USA.
Annals of internal medicine (Impact Factor: 17.81). 11/2007; 147(7):478-91.
Source: PubMed

ABSTRACT RECOMMENDATION 1: Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause. The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain (strong recommendation, moderate-quality evidence). RECOMMENDATION 2: Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence). RECOMMENDATION 3: Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence). RECOMMENDATION 4: Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy) (strong recommendation, moderate-quality evidence). RECOMMENDATION 5: Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options (strong recommendation, moderate-quality evidence). RECOMMENDATION 6: For patients with low back pain, clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care. Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy (strong recommendation, moderate-quality evidence). For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs. RECOMMENDATION 7: For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits-for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence).

33 Reads
  • Source
    • "Back pain is becoming a more common health problem in recent years [5] [6]. Since it is generally difficult to identify a single specific cause of back pain, diverse non-pharmacologic therapies including CAM therapies have been practiced to relieve chronic back pain [5] [7]. Yoga is one CAM therapy that appears to be promising for relieving chronic back pain [8] [9] [10]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Yoga is known to reduce stress and inflammation which are related to chronic low back pain (CLBP). However, very few studies investigated the effect of yoga on stress and inflammation in patients with CLBP. We aimed to evaluate effects of the 12-week yoga program on back-related function, stress, and inflammatory factors in patients with CLBP. Methods: We conducted a non-randomized controlled study. Premenopausal women with CLBP were recruited with a local flyer and allocated to Hatha yoga and untreated control groups. Before and after 12 weeks, CLBP by Roland-Morris Disability Questionnaire (RMDQ), back flexibility, stress by Symptoms of Stress Inventory (SOSI), and serum cortisol, tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) were evaluated. Effects of yoga were assessed with per-protocol and intention-to-treat analyses. Results: By the per-protocol analysis, RMDQ (p < 0.05) and back flexibility (p < 0.001) significantly improved in the yoga group (n = 14), whereas there were no significant differences in the control group (n = 11). Serum cortisol level and total SOSI score significantly decreased in the yoga group (both p < 0.05). TNF-α maintained in the yoga group whereas TNF-α significantly increased in the control group (p < 0.01). CRP did not changed significantly in both groups. The findings from the intention-to-treat analysis were consistent with those of the per-protocol analysis. Conclusions: The present results suggest that yoga may be an effective treatment for CLBP and stress although the results should be confirmed with a large-scale randomized controlled trial.
    European Journal of Integrative Medicine 04/2015; 7(2). DOI:10.1016/j.eujim.2014.10.008 · 0.78 Impact Factor
  • Source
    • "Eligible participants (n = 280) were recruited to the original cohort study from the secondary care spine centre specialized in multidisciplinary assessment and treatment of LBP, assessed at baseline and then treated with usual care. Usual care treatment consisted of interventions recommended by guidelines for LBP (Swinkels et al., 2005; Chou et al., 2007) including exercises and the use of spinal manual therapy techniques. In this current cohort study, data on perceived levels of social isolation at baseline were available for 204 (73.0%) of the 280 eligible participants because the Friendship Scale used to assess perceived social isolation of 76 participants had not been appropriately translated (Table 1). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Perceived social isolation is prevalent among patients with low back pain (LBP) and could be a potential prognostic factor for clinical outcomes following an episode of LBP.MethodsA secondary analysis of an original prospective cohort study, which investigated the validity of the Danish version of the STarT Back Screening Tool (STarT), investigated whether social isolation predicts the clinical outcomes of disability, anxiety, depression and pain catastrophizing in people with LBP. Patients with LBP of any duration (N = 204) from Middelfart, Denmark, were included. Social isolation was measured at baseline using the friendship scale (score ranges from 0 to 24, with lower values meaning higher perceived social isolation), and outcomes were measured at baseline and at 6-month follow-up. Regression models investigated whether social isolation at baseline predicted the outcomes at 6-month follow-up.ResultsSome level of social isolation was reported by 39.2% of the participants (n = 80) with 5.9% (n = 12) being very socially isolated. One-point difference on social isolation predicted one point on a 100-point disability scale (adjusted unstandardized coefficient: −0.91; 95% confidence interval (CI): −1.56 to −0.26). Social isolation predicted anxiety; however, a change of one point on the social isolation scale represents a difference of only 0.08 points on a 22-point scale in anxiety (95% CI: 0.01–0.15) and is unlikely to denote clinical importance. Social isolation did not predict pain catastrophizing or depression.Conclusions Patients' perceived social isolation predicts disability related to LBP. Further understanding of the role of social isolation in LBP is warranted.
    European journal of pain (London, England) 10/2014; 19(4). DOI:10.1002/ejp.578 · 2.93 Impact Factor
  • Source
    • "Although established practice guidelines recommend manual therapies for chronic or persistent LBP (Chou et al., 2007; National Institute for Health and Clinical Excellence, 2009), questions remain about the mechanisms by which they exert their effects. Previous mechanistic research has focused on biomechanical effects of high-velocity, low-amplitude techniques, or " thrusts " (Triano, 2001; Evans, 2002; Maigne and Vautravers, 2003; Evans and Breen, 2006). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to measure changes in biomechanical dysfunction following osteopathic manual treatment (OMT) and to assess how such changes predict subsequent low back pain (LBP) outcomes. Secondary analyses were performed with data collected during the OSTEOPATHIC Trial wherein a randomized, double-blind, sham-controlled, 2x2 factorial design was used to study OMT for chronic LBP. At baseline, prevalence rates of non-neutral lumbar dysfunction, pubic shear, innominate shear, restricted sacral nutation, and psoas syndrome were determined in 230 patients who received OMT. Five OMT sessions were provided at weeks 0, 1, 2, 4, and 6, and the prevalence of each biomechanical dysfunction was again measured at week 8 immediately before the final OMT session. Moderate pain improvement (≥30% reduction on a 100-mm visual analogue scale) at week 12 defined a successful LBP response to treatment. Prevalence rates at baseline were: non-neutral lumbar dysfunction, 124 (54%); pubic shear, 191 (83%); innominate shear, 69 (30%); restricted sacral nutation, 87 (38%), and psoas syndrome, 117 (51%). Significant improvements in each biomechanical dysfunction were observed with OMT; however, only psoas syndrome remission occurred more frequently in LBP responders than non-responders (P for interaction=0.002). Remission of psoas syndrome was the only change in biomechanical dysfunction that predicted subsequent LBP response after controlling for the other biomechanical dysfunctions and potential confounders (odds ratio, 5.11; 95% confidence interval, 1.54-16.96). These findings suggest that remission of psoas syndrome may be an important and previously unrecognized mechanism explaining clinical improvement in patients with chronic LBP following OMT.
    Manual therapy 08/2014; 19(4). DOI:10.1016/j.math.2014.03.004 · 1.71 Impact Factor
Show more


33 Reads
Available from