Low Back Pain

Related Links

Find a patient education handout on this topic.

The AAFP concludes that the evidence is insufficient to recommend for or against routine use of interventions to prevent low back pain in adults in primary care settings. (2004)

(Grade: I recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#pre(www.uspreventiveservicestaskforce.org)
Clinical Consideration: http://www.uspreventiveservicestaskforce.org/3rduspstf/lowback/lowbackrs.htm#clinical(www.uspreventiveservicestaskforce.org)

Endorsement of Clinical Practice Guidelines on Diagnosis and Treatment

Pain Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline -- Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline -- American College of Physicians and American Pain Society (Endorsed May 2011)

Recommendation 1: Clinicians should conduct a focused history
and physical examination to help place patients with low back pain
into 1 of 3 broad categories: nonspecific low back pain, back pain
potentially associated with radiculopathy or spinal stenosis, or back
pain potentially associated with another specific spinal cause. The
history should include assessment of psychosocial risk factors, which
predict risk for chronic disabling back pain (strong recommendation,
moderate-quality evidence).

Recommendation 2: Clinicians should not routinely obtain imaging
or other diagnostic tests in patients with nonspecific low back pain
(strong recommendation, moderate-quality evidence).

Recommendation 3: Clinicians should perform diagnostic imaging
and testing for patients with low back pain when severe or pro-
gressive neurologic deficits are present or when serious underlying
conditions are suspected on the basis of history and physical ex-
amination (strong recommendation, moderate-quality evidence).

Recommendation 4: Clinicians should evaluate patients with per-
sistent low back pain and signs or symptoms of radiculopathy or
spinal stenosis with magnetic resonance imaging (preferred) or
computed tomography only if they are potential candidates for
surgery or epidural steroid injection (for suspected radiculopathy)
(strong recommendation, moderate-quality evidence).

Recommendation 5: Clinicians should provide patients with evi-
dence-based information on low back pain with regard to their
expected course, advise patients to remain active, and provide
information about effective self-care options (strong recommenda-
tion, moderate-quality evidence).

Recommendation 6: For patients with low back pain, clinicians
should consider the use of medications with proven benefits in
conjunction with back care information and self-care. Clinicians
should assess severity of baseline pain and functional deficits, po-
tential benefits, risks, and relative lack of long-term efficacy and
safety data before initiating therapy (strong recommendation, mod-
erate-quality evidence). For most patients, first-line medication op-
tions are acetaminophen or nonsteroidal anti-inflammatory drugs.

Recommendation 7: For patients who do not improve with self-
care options, clinicians should consider the addition of nonpharma-
cologic therapy with proven benefits—for acute low back pain,
spinal manipulation; for chronic or subacute low back pain, inten-
sive interdisciplinary rehabilitation, exercise therapy, acupuncture,
massage therapy, spinal manipulation, yoga, cognitive-behavioral
therapy, or progressive relaxation (weak recommendation, moder-
ate-quality evidence).