Treatment of acute low

back pain

INTRODUCTION
Back pain a common problem and a
leading reason for all physician visits.
Most cases are attributed to
musculoligamentous injury or skeletal
degenerative changes.
although the differential diagnosis is
broad.

PROGNOSIS
The prognosis for acute low back
pain is excellent.
Only about a third of patients with
back pain seek medical care, so most
apparently improve on their own.

 Recurrences are common, however,

and may affect up to 40 percent of
patients within six months.
Nearly any treatment administered in
the acute phase may appear to be
effective

ACTIVITY MODIFICATION AND

BED REST
Bed rest was for decades considered
standard therapy for patients with
acute low back pain.
Randomized trials also suggest there
is no advantage to bed rest for
patients with sciatica.

PHARMACOTHERAPY
Nonsteroidal antiinflammatory drugs
- Global symptomatic improvement
after one week was greater for patients
treated with NSAIDs compared to
placebo
- There was moderate evidence that
NSAIDs were not significantly more
effective than acetaminophenfor
symptom relief of acute low back pain.

 In trials of newer NSAIDs, intramuscular

ketorolac(60 mg) was comparable to
intramuscular meperidine(1 mg/kg) for
acute pain relief in the emergency.
Recommendations from 2007 joint
practice guidelines of the American
College of Physicians (ACP) and the
American Pain Society (APS)
acetaminophenor NSAIDs as first line
therapy for acute pain

 Acetaminophen
a reasonable option for most patients
with acute low back pain
with perhaps less efficacy than NSAIDs
risk of hepatotoxicity with higher doses
dosing of 4 g per 24 hours
patients with a history of heavy alcohol
acetaminophen dose to 2 g per day or
less.

 Centrally-acting skeletal muscle

relaxants
collection of drugs with similar physiologic
effects (chiefly analgesia and sedation)
group of drugs : benzodiazepines,
cyclobenzaprine, methocarbamol,
carisoprodol, baclofen, chlorzoxazone,
metaxalone, orphenadrine, and tizanidine.
The primary adverse effects central
nervous system activity: sedation and
dizziness

 Opioids
widely acknowledged to be among the
therapeutic options for low back pain,
Most recent studies focus on chronic
back pain
Adverse effects of opiates include
sedation, confusion, nausea, and
constipation

 Glucocorticoids
A subsequent trial found only transient
pain reduction with bolus intravenous
methylprednisolonefor patients with
radicular findings
adverse effects, particularly insomnia,
mood lability, and poor glycemic control
in those with diabetes.

 Other medications
Several other medications, including
gabapentinand other anticonvulsants,
tricyclic antidepressants, and
lidocainepatches, have been used in
the setting of chronic back pain.

EXERCISE AND OTHER

PHYSICAL MODALITIES
Exercise
Patients should be encouraged to walk
and resume normal daily activities as
quickly as possible.
Once the acute phase has subsided,
exercise may help prevent recurrences

Spinal manipulation
Manipulative therapy
Massage and yoga
Acupuncture
Cold and heat

OTHER NON-DRUG
TREATMENTS
Traction, corsets and braces
Mattress recommendations
Patient education

PREVENTION
Ergonomic design of strenuous job
tasks in the workplace is an
intuitively attractive preventive
measure.

 THANKS