How to care for adults with low back pain in the primary care setting

Abstract

Low back pain (LBP) is one of the most frequent patient complaints in primary care. This article discusses the assessment and treatment of patients with LBP, including nonpharmacologic and pharmacologic approaches.

Care for the patient with low back pain

“…29 Routine imaging for LBP is not recommended unless there has been overt trauma with concern for fracture/dislocation or there are signs and symptoms of more serious diseases such as cancer, infection, or other conditions (see Imaging for serious pathology presenting as acute LBP). 5,29,30 Recent imaging updates suggest routine imaging is not warranted and may reveal abnormalities unrelated to presenting symptoms, further complicating the clinical picture. 29 In accordance with the ACR criteria, guidelines only recommend imaging if the results are likely to guide further intervention or with persistent and progressive symptoms following six weeks of conservative optimal medical management.…”

“…Treatment for LBP depends on the etiology and may require an interprofessional, collaborative, and multimodal patient-centered approach. 1,30,33 Clinical practice guidelines from the American College of Physicians, the Academy of Orthopaedic Physical Th erapy, and those for primary care providers guide clinicians on how to best manage both acute and chronic LBP. 1,5,10 Guideline-based recommendations for acute LBP include nonpharmacologic treatment.…”

“…1,5,10 Regardless of discipline, patient education emphasizing more active interventions, such as aerobic conditioning or muscle strengthening, over standalone passive treatments, such as pain relieving modalities, is recommended. 1,30,33 Guidelines strongly recommend referral to physical therapy as a conservative treatment option. 1,5,10 Physical therapy interventions for acute LBP include patient education on self-management techniques and favorable prognosis, muscle strengthening and endurance training, and joint mobilization.…”

“…The American College of Radiology (ACR) provides specific criteria to consider prior to ordering imaging to ensure patient appropriateness 29. Routine imaging for LBP is not recommended unless there has been overt trauma with concern for fracture/dislocation or there are signs and symptoms of more serious diseases such as cancer, infection, or other conditions (see Imaging for serious pathology presenting as acute LBP ) 5,29,30. Recent imaging updates suggest routine imaging is not warranted and may reveal abnormalities unrelated to presenting symptoms, further complicating the clinical picture 29.…”

“…Guideline-based recommendations for acute LBP include nonpharmacologic treatment 1,5,10. Regardless of discipline, patient education emphasizing more active interventions, such as aerobic conditioning or muscle strengthening, over standalone passive treatments, such as pain relieving modalities, is recommended 1,30,33. Guidelines strongly recommend referral to physical therapy as a conservative treatment option 1,5,10.…”