Question

Discuss the management of a patient who presents with lower back pain.

• Explain why this may be an emergent situation and how you would proceed in the management of this patient.
• Include any differential diagnoses, diagnostic studies, and other treatment measures for this patient.
• Include when you would refer this patient to another health care provider.

Answer 1

Management of patient with Lower back pain

Lower back pain : Pain in the lower back or lumbar area caused by strain in the lumbar area or conditions that affect lumbar spine, muscles and nerves of the back, ligaments and discs, pelvic organs. It is one of the commonest reason for Doctor visit by the population. One in Five patient present a symptom of Lower back pain. LBP make it difficult for a patient to stand up straight and move.

Differential diagnosis

* Lumbar strain

* Herniated disk

* Osteoporotic compression fracture

* Lumbar radiculopathy

* neural osseeous tumours( benign or malignant)

* Osteomyelitis

* Endometriosis

* Paget's disease

* Renal diseases( nephrolithiasis, pyelonephritis)

Diagnostic Evaluation studies

( History collection : regarding illness, onset, duration, aggravating and alleviating factors, associated symptoms and any injury or trauma and physical examination is essential to rule out the causes.)

- Blood studies ( to rule out infections)

- urine studies ( to rule out infections)

- X ray test

If the Lower back pain not reducing with the management for 2- 3 weeks then,

- CT scan and MRI and bone scanning

- Electromyograms.

Management of patient with Lower back pain

Check for the other symptoms like leg weekness, pain during urination or coughing, incontinence of urne or faeces, fever and numbness in the lower back or groin area. These conditions required to rule out the cause in addition to emergency management.

Pharmacological therapy

- Acetaminophen or NSAIDs ( Non steroidal Anti-inflammatory Drugs) such as naproxen or advil

- Muscle relaxants

- Provide adequate rest in the comfortable position( supine position)

- Hot applications( superficial heat: hydrocolloid pack) and deep heat by ultrasound)

- pain relieving creams for muscle aches

- cold applications and massages

- other management or preventive measures include:

Aerobic exercises, proper posture while working, maintain healthy weight, avoid lifting with the back.

we can refer this patient if he have a history of cancer, history of IV drug abuse, recent unintentional weight loss , steroid use for a long time.