Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment

Abstract

Purpose of Review
Low back pain encompasses three distinct sources: axial lumbosacral, radicular, and referred pain. Annually, the prevalence of low back pain in the general US adult population is 10–30%, and the lifetime prevalence of US adults is as high as 65–80%.

Recent Findings
Patient history, physical exam, and diagnostic testing are important components to accurate diagnosis and identification of patient pathophysiology. Etiologies of low back pain include myofascial pain, facet joint pain, sacroiliac joint pain, discogenic pain, spinal stenosis, and failed back surgery. In chronic back pain patients, a multidisciplinary, logical approach to treatment is most effective and can include multimodal medical, psychological, physical, and interventional approaches.

Summary
Low back pain is a difficult condition to effectively treat and continues to affect millions of Americans every year. In the current investigation, we present a comprehensive review of low back pain and discuss associated pathophysiology, diagnosis, and treatment.

Full text

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Low Back Pain, a Comprehensive Review:
Pathophysiology, Diagnosis, and Treatment
(poster)
Ivan Urits
Harvard Medical School
Aaron Burshtein
Hofstra-Northwell Health System
Medha Sharma
Harvard Medical School
See next page for additional authors
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Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis,
and Treatment (poster)
Authors
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Keywords
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RESEARCH POSTER PRESENTATION DESIGN © 2015
www.PosterPresentations.com
Low back pain encompasses three distinct sources: axial
lumbosacral, radicular, and referred pain. Annually, the
prevalence of low back pain in the general U.S. adult
population is 10-30%, and the lifetime prevalence
among U.S. adults is as high as 65-80%.
Recent Findings: Patient history, physical exam, and
diagnostic testing are important components to accurate
diagnosis and identification of patient pathophysiology.
Etiologies of low back pain include myofascial pain, facet
joint pain, sacroiliac joint pain, discogenic pain, spinal
stenosis, and failed back surgery. In chronic back pain
patients, a multidisciplinary, logical approach to
treatment is most effective and can include multimodal
medical, psychological, physical, and interventional
approaches.
Summary: Low back pain is a difficult condition to
effectively treat and continues to affect millions of
Americans every year. In the current investigation, we
present a comprehensive review of low back pain and
discuss associated pathophysiology, diagnosis, and
treatment.
Purpose of Review
Low back pain encompasses three distinct sources: axial
lumbosacral, radicular, and referred pain
•Axial lumbosacral back pain refers to pain in the
lumbar, or L1-5 vertebral region, and sacral spine, or
S1 to sacrococcygeal junction region.
•Radicular leg pain travels into an extremity along a
dermatomal distribution secondary to nerve or dorsal
root ganglion irritation.
•Referred pain spreads to a region remote from its
source but along a non-dermatomal trajectory.
Chronicity: acute (<6 weeks), subacute (6-12 weeks),
and chronic (>12 weeks) low back pain
Overview of Low Back Pain
Diagnostic and Therapeutic Approach to the Patient with Low Back Pain Conclusions
Multidisciplinary approach to treatment:
•Lower back pain management varies from person to
person, as not all patients respond to the same
treatment approach, and no single intervention is
generally completely effective for all patients.
•Consequently, limited trials of one or more
interventions guided by evidence and effectiveness
are utilized to manage the pain, while aiming to
decrease overall costs.
•Pertinent courses of care include pharmacological
treatments, psychological treatments, physical and
rehabilitation treatments, complementary and
alternative medicine approaches, and minimally
invasive percutaneous approaches.
References
•Atlas SJ, Deyo RA. Evaluating and managing acute
low back pain in the primary care setting. J Gen
Intern Med 2001;16:120–131.
•Bogduk N. On the definitions and physiology of back
pain, referred pain, and radicular pain. Pain 2009;
147:17–19.
•Chou R, Qaseem A, Snow V, Casey D, Cross JT,
Shekelle P, et al. 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 2007;147:478.
•Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et
al. The global burden of low back pain: estimates
from the Global Burden of Disease 2010 study. Ann
Rheum Dis;2014;73:968–74.
•Samanta J, Kendall J, Samanta A. 10-minute
consultation: chronic low back pain. BMJ 2003;
326:535.
Acknowledgements
Thank you to the University of Massachusetts Medical School
Senior Scholars Program for the opportunity to research and
present my work.
Ivan Urits, MD1; Aaron Burshtein2; Medha Sharma1; Lauren Testa16; Peter A. Gold, MD2; Vwaire Orhurhu, MD MPH1; Omar Viswanath, MD3; Mark R. Jones, MD1; Moises A. Sidransky, MD4; Alan
D. Kaye, MD PhD5
1 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215.
2Department of Orthopedic Surgery, Hofstra-Northwell Health System, Great Neck, NY 11021.
3Valley Anesthesiology and Pain Consultants, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Omaha, NE
4 UT Health East Texas Physicians, Department of Anesthesiology, Tyler, TX, USA.
5Louisiana State University Health Science Center, Department of Anesthesiology, New Orleans, LA, USA. 70112.
6 University of Massachusetts Medical School, Worcester, MA. 01604
Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment
Patient with low back pain
Perform a history and
physical evaluating:
•Duration
•Red Flags
•Yellow Flags
Are there any serious
conditions suspected?
Perform diagnostic studies
to find cause
Discuss conservative
treatment options:
•Pharmacologic
•Non Pharmacologic
Assess response to
treatment
Back pain resolved or
improved?
Continue conservative
treatment and follow up in
1 month
Reassess symptoms and
risk factors and re-
evaluate diagnosis.
Consider imaging studies.
Consider alternative
pharmacologic and non-
pharmacologic
interventions
Yes
Yes