Back pain made simple: An approach based on principles and evidence

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Low back pain is a common and costly medical condition with only a weak correlation between symptoms and pathologic changes, resulting in a lack of objective clinical findings on which a definitive diagnosis can be based.22 Most back pain has no recognizable cause and is usually regional and musculoskeletal. Back pain as a result of an underlying systemic disease is rare and needs to be excluded by a good history and physical examination. Diagnostic studies are best reserved for specific indications.

Referral to a specialist is warranted when the patient is not responding to conservative treatment, when a progressive neurologic deficit or cauda equina syndrome is noted or suspected, or when the patient has an underlying malignancy, infection, fracture, or spinal instability.

Bed rest is best avoided, and activity within the limits of pain is encouraged. NSAIDs and acetaminophen are usually the drugs of choice for controlling acute low back pain.

Ultimately, the goal for clinicians is to identify serious conditions and to prevent the back pain from becoming chronic pain by promptly identifying the various risk factors.

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