Neurosurgery notes/Spine/Spinal Degenerative Diseases/Lumbar degenerative disease/Acute low back pain

Acute low back pain

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Parent item
Lumbar degenerative disease

General

  • 80% of people experience an episode of back pain in their lifetime.
  • Acute low back pain
    • Pain of < 6 weeks
  • The majority experience non- specific back pain (NSBP) and will have some degenerative changes on imaging.
    • NSBP is a diagnosis of exclusion and lacks features suggestive of radicular compression or serious underlying pathology.
    • Pain is usually diffuse and may radiate to the thigh.
    • NSBP is a benign, self- limiting condition.

Causes of specific back pain that should be excluded include

  • Neoplasia
  • Inflammatory disorders
  • Infection
  • Trauma
  • Degenerative disease
  • Deformity

Management involves

  • Exclusion of serious pathology
  • Holistic approach addressing the patient’s
    • Health beliefs
    • Expectations
    • Avoidance behaviour
    • Employment issues
    • Potential secondary gains
  • Reassurance is paramount: by 12 weeks, 90% of individuals will be pain- free.
  • Treatment
    • Optimisation of analgesia
      • Muscle relaxants
        • Limited role.
        • If there is a acute LBP in the setting of a chronic LBP they can be used.
        • Side effects
          • Sedating
          • Cause dependence
          • Little evidence supporting that they can relax tight muscles.
        • Options:
          • Cyclobenzaprine is similar to amitriptyline and is useful for sleep disturbance.
          • Baclofen is effective for painful muscle spasm and acts centrally.
          • Orphenadrine, methocarbamol, and tizanidine are also useful.
          • Diazepam is too sedating
          • Lorazepam is effective occasionally for spasm.
    • Referral to a pain specialist
    • Regular exercise
    • Physiotherapy
    • Work conditioning programmes
    • Psychological evaluation if appropriate