Back pain: medical evaluation and therapy

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Most patients with acute low back pain or sciatica improve with appropriate conservative therapy, and most require no immediate diagnostic studies beyond a careful history and examination.

In patients with “red flags” for visceral, malignant, or infectious causes or possible cauda equina syndrome, a more aggressive evaluation is mandatory.

In patients whose pain does not respond to initial management or who have chronic symptoms, diagnostic reevaluation is appropriate.


In patients with acute symptoms involving the low back and leg, the duration of symptoms, the distribution of pain, and the age of the patient help focus the initial evaluation.

If a careful initial evaluation excludes serious visceral or noninflammatory disease, the favorable natural history of both back pain and radiculopathy mandates an aggressive medical approach to treatment.

Results of imaging studies are frequently abnormal in people without symptoms and must be interpreted with careful clinical correlation.

Identifying complicating psychosocial issues, particularly in patients with chronic symptoms, is critical for proper diagnosis and treatment.



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