Low+Back+Pain

=Low Back Pain - Acute;=

In the **absence of red flags** (wt loss, Hx Cancer, fever, Hx infections/surgeries, neuro deficets - especially motor, GI or GU), most back pain is self limiting (under 2 weeks of symptoms) and requires little more than anti-inflamatories, anti-spasmodics (Benzo's, Soma, Flexeril) and gentle return to function.

Some **people may benefit from** PT, Chiropractors, Osteopathic Manipulation, accupuncture, cupping, etc (basically whatever has worked before - or they think may work that isn't invasive)


 * Imaging (xrays, CT or MRI) in the absence of red flags are rarely helpful**, and may be "abnormal" in up to 50% of asymptomatic patients (high false (+) rate), and lead patients towards surgery - which is increasingly been found to be less than helpful in the 5 year prognosis plan. (ref below)


 * See the MAP** for another way to look at the material.

Chronic LBP:
Again, review for red flags, and include, **chronic pain review** (below), **addiction potential,** (DIRE Score) **and a depression screen (below)**. The MAP (above) may still apply for acute on top of chronic "flares" though the differential should be broadened

Many patients - particularly those over 40 may have **real pain from DJD** and benefit from Narcotic/NSAID combos, but this is usually 2-6 Norco/T#3 day - not dilaudid, percocet or other strong combinations.

Spine Clinic Referral

More Corsets - Less Opiates
(and in many instances are causing more harm than good.) and simple mechanical supports underused Dr. Loosli recommends: The Bird & Cronen corset "very sturdy with 4 metal stays & works well" Available from Ortho Tech in Martinez (3rd floor) and the Pittsburg Ortho Techs (or with a prescription from Kelley & Associates Lennon Ln. Walnut Ceek (925) 256-9999) see his **Handout** on exercises for Back Pain
 * Al Loosli's PBL highlights** Evidence (references below) that Surgeries, Epidurals, MRI's and Opioids are overused,

References -
NEJM 2010; 363:1981-85 A Flood of Opioids, a Rising Tide of Deaths JABFM 2009 Vol 22 62-68 Overtreating Chronic Back Pain: Time to Back Off

Also: Pain Introduction
(with a DDx for Fibromyalgia, Depression, etc) in a pdf format. Chronic pain and addiction are also separate topics.



if you found this helpful - please let me know (theairdoctor@gmail.com) and I'll post more MAP/summaries - thanks dpepper md

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