Monday, April 23, 2012

Diagnosis and Treatment

Reminder: If you have not done so, please read the Initial Post and  Blog Information.  At the upper left of this page above my picture click on the button, Initial Post and  Blog Information.

Since I am just learning how to manage a blog, I will start by posting interesting information about low back pain. This blog will very rarely, if ever, discuss neck pain.  The two are rarely related and they are treated differently, or should be, for optimal pain relief.

I will try to update the blog weekly.  As of today, that will happen on Mondays until I change my mind.

The first bit of interesting information is the abstract for an article published in American Family Physician, February 15, 2012; Volume 85, Number 4, by Brian A. Casazza, MD.  The article is filled with good information for physicians, although patients should not have too much difficulty working through it.  It's not flashy; it just reports the facts, as we know them to this point in time. Of course, all scientific theories are open to change as more information becomes available.

As the abstract points out, this article is important because it affirms a couple points I discuss in my book.  These are the following:  Taking x-rays, CTs, or MRIs of new onset back pain are usually worthless initially.  Unless the patient has a Red Flag problem, not much will be learned.  Second, surgery has only a limited place in the treatment of back pain.  Statistically, very few people benefit from surgery, and those are limited to patients with intractable pain, neurological deficits, and other severe back problems like bleeding into the spinal cord.  Lastly, the article points out some of the Red Flags, which indicate that back pain is a symptom of a very serious medical problem that needs to be addressed urgently.

Diagnosis and Treatment of Acute Low Back Pain
BRIAN A. CASAZZA, MD, University of North Carolina School of Medicine, Chapel Hill, North Carolina

Acute low back pain is one of the most common reasons for adults to see a family physician. Although most patients recover quickly with minimal treatment, proper evaluation is imperative to identify rare cases of serious underly­ing pathology. Certain red flags should prompt aggressive treatment or referral to a spine specialist, whereas others are less concerning. Serious red flags include significant trauma related to age (i.e., injury related to a fall from a height or motor vehicle crash in a young patient, or from a minor fall or heavy lifting in a patient with osteoporosis or possible osteoporosis), major or progressive motor or sensory deficit, new-onset bowel or bladder incontinence or urinary retention, loss of anal sphincter tone, saddle anesthesia, history of cancer metastatic to bone, and sus­pected spinal infection. Without clinical signs of serious pathology, diagnostic imaging and laboratory testing often are not required. Although there are numerous treatments for nonspecific acute low back pain, most have little evidence of benefit. Patient education and medications such as nonsteroidal anti-inflammatory drugs, acet­aminophen, and muscle relaxants are beneficial. Bed rest should be avoided if possible. Exercises directed by a physical therapist, such as the McKenzie method and spine stabilization exercises, may decrease recurrent pain and need for health care services. Spinal manipulation and chiropractic techniques are no more effective than established medical treatments, and adding them to established treatments does not improve outcomes. No substantial benefit has been shown with oral steroids, acupuncture, massage, traction, lumbar supports, or regular exercise programs. (Am Fam Physician. 2012;85(4):343-350. Copyright © 2012 American Academy of Family Physicians.)