The natural history of acute low back pain is very simple favorable.With education, activity modification and-the-counter painkillers over, most people recover completely within two to four weeks. However, when symptoms persist without significant improvement, the evaluation is needed. A careful medical evaluation is crucial to identify previously unrecognized conditions, inadequate initial treatment and unrecognized complicating psychosocial problems.
Like most people with back pain improve within a few weeks, the evaluation is not comprehensive and appropriate and not usually performed in the initial evaluation. When symptoms persist, a history and physical examination focused on identifying the causes of serious but rare health, such as malignancy or infection should be performed. In many cases, historical red flags (eg, weight loss, inability to find a comfortable position) calls for a more aggressive evaluation. A careful medical evaluation for non-spinal “mimics” of spinal disorders, including abdominal aortic aneurysm, prostate disease or rheumatic disease, is adequate in many patients with persistent back pain.
The search for an anatomically precise cause of the patient’s pain is complicated by the poor correlation between abnormal imaging findings or symptoms CT and MRI. Determine whether to assign a specific conclusion symptomatic in a patient with chronic back pain is often the key issue for the clinician. The results of diagnostic injections such as facet blocks, discography selective or selective nerve blocks, should be carefully considered in the context of patient’s symptoms and the coexistence of psychosocial view. For example, recent studies have demonstrated the unreliability of discography in patients with no environmental problems.
Finally, pretreatment of people with chronic back pain should be carefully evaluated. Excessively passive treatment delays recovery acute low back pain and promotes the de-conditioning, sick role behavior and fear of reinjury. Ensure that patients have sufficient evidence of non-operative treatment that incorporates active and aggressive treatment with appropriate medication is important before pursuing more invasive surgical treatment in most patients.
