Introduction
1. Next to common cold, low back pain ( LBP) is the most frequent complaint among those who seek medical advice.
2. Back pain is experienced by as many as 80% of Americans.
3. LBP problems affect visually everyone at some time during their life and the problems are the most common cause of disability. ( The agency for Health Care Policy and Research, 1994).
4. The lower lumbar area Is most of our body weight and is the most common site of low back pain.
5. Although most of practitioners believe that acute LBP episodes resolve within 1 month, there is a wide variation in the reported time course.
Origin of Back Pain
• Muscular 90% of acute cases
• Discogenic Pain 45%
• Spinal Stenosis 25%
• Facet Arthropathy 30%
• Sacroiliac Joint arthropathy 25%
• Vertebrogenic causing Endplate edema
* 70% of patients have at least 2 causes.
Factors affecting low back pain
• Age: greatest incidence between ages 30 and 50
• Height: more than 6 feet tall
• Weight: obesity and the highest 1/4 of weight range
• Gender: females have more generalized back pain, Males radiculopathy
• Tobacco use: slight increase in risk 1.5%
• Fitness: 9 times are more likely in those less fit
• Occupation: wrist with repetitive temporal poor movement, vibration, heavy lifting
• Psychological: increased risk with job dissatisfaction
When to Refer to a Pain Management Center?
• Earlier than later
• When no specific diagnosis is made
• When no progressive relief after 3-6 weeks
Basic Principles
• After 6 months of continued pain refer to a pain management specialist
• Determine a proper diagnosis or at least determine the type of pain
• Provide the necessary resources and don’t expect “a quick fix.” Expect stabilization or reduction of healthcare dollars.
• Resources should include adeptness at prescribing combination pharmacotherapy as well as interventional techniques.