A Pain in the Back 80% of the population will present to primary care with low back pain. Most of the time low back pain isn’t a signal of a worrisome underlying condition/ dangerous, though it can affect quality of life and become chronic. Definitions: Acute back pain: new back pain that has been present less than 4 weeks Subacute back pain: back pain present for more than 4 and less than 12 weeks Chronic back pain: back pain present for more than 12 weeks Most of the time it will improve. Symptoms: Pain across the low back, may shoot down the leg or to other locations Muscle spasm with stiffness Difficulty urinating or moving bowels* Weakness, foot drop* Numbness, tingling Tenderness over the spine *More concerning symptoms Causes: Nonspecific - a definitive diagnosis is not obtained or needed Injury/twisting/pulling Osteoarthritis / degenerative disc disease “Slipped disc” or disc herniation Compression fractures Radiculopathy (inflammation of the nerves) Spinal stenosis (narrowing around the spinal cord) Ankylosing spondylitis (auto-immune condition) Scoliosis Depression can increase pain sensations Foot issues - flat feet, poor arch support can contribute Kidney stones Shingles Intra-abdominal conditions (pancreatitis, gall bladder disease) Less common, more worrisome causes: cauda equina syndrome, spinal infection, malignancy Evaluation: Office visit for history and exam, usually no X-rays or other imaging at the first appointment unless trauma occurred. Clinician can rule out worrisome symptoms Management: Physical therapy Heat, ice Acetaminophen, NSAIDs (ibuprofen, naproxen, etc) if approved by your clinician, muscle relaxants Stretching, massage, rest Exercise, strengthening supporting muscles - needs to be ongoing Weight loss when indicated Injections from pain clinic or spine clinic Topical products (Biofreeze), lidocaine patches Narcotic pain medications are not usually indicated. If they are, it would be for 3 days or less. Narcotics have no role in management of chronic pain. Medications to help with nerve pain: duloxetine, gabapentin, pregabalin Health pearl: book recommendation - Mayo Clinic Guide to Stress Free Living by Amit Sood. Follow us on Facebook and Twitter: www.facebook.com/everythingdoc www.twitter.com/everythingdoc1