Common back suffering is one of the most widespread ailments facing primary cares practitioners today.
In fact, it has been estimated that about 80% of the population have experienced back pains at some point of their lives.
Fortunately, over 90% recover without the need to see a specialist.
Back pains therefore represents a major proportion of cases seen by GP's and can be the cause of significantly decreased quality of life for patients.
GP's are responsible for the treatment and management of the enormous majority of back sufferings patients, making it a significant problem to undertake in primary health care.
Diagnosis Lower back pain is defined as pain in the lumbar spine, sometimes sliding to the buttocks.
It can be derived in three classes: acute back sufferings, lasting less than a month; sub-acute pain, lasting between one to three months; chronic back pain, which pain lasting for more than three months.
Diagnosis of patients with lower back sufferings can be determined in two simple steps-history taking and physical examination, with the latter including neurological testing, strength testing and ROM testing.
A thorough history provides important information necessary for an accurate diagnosis.
A history of trauma, for instance, can alert the physician for a possible fracture.
Red Flags Red flags are signs and symptoms that suggest the problem is not simply a muscle strain, that includes; pain radiating down the legs, suggesting nerve involvement; unexplained fever, indicating of an infection going down the spine; unexplained weight loss, suggesting cancer of the spine; and the history or trauma, indicative of fracture.
A hint should be raised if one of these signs is present.
Imaging or referral to a doctor is the following step to do.
Treatment When complete history and physical examination have been completed, only those cases of the red flags must generally require referral to a specialist.
The remaining patients can be managed with simple rest, back care and medications.
If no specific back pains is diagnosed, the treatment should be focusing on the pain management and rehabilitation of the patients to a full functionality.
Bed rest is not recommended, unless the red flag has been raised.
Patients are advised to be active, although care should be taken to avoid activities which can cause pain to the patient.
There are two types of treatment used; the pharmacological treatment; and the none -pharmacological treatment.
Thus, patients' knowledge about back pains can also be helpful.
Example; physician may advice the patient about the posture, sleeping position and even the ergonomic issues.
It is worth stressing out to the patient that staying active can help for a speedy recovery.
Back Pain Management If there is no red flag raised requiring imaging or referral, then the back pain is more of a musculoskeletal that can be resolved with the pain medications.
With this case, the excellent course of management is to reassure and encourage the patient that will get better while continuing to monitor the progress.
Patients with constant or progressive symptoms must be followed up and may require further studies.