The Rational Clinical Examination
David L. Simel, Drummond Rennie
Low Back Pain, Disabling
Roger Chou, Paul Shekelle
Sections:
Patient Scenario, Methods, Results, Scenario Resolution, Bottom Line, References
Topics Discussed:
back pain, low back pain, pain
Excerpt:
"A 48-year-old woman is evaluated in clinic with a 3-day history
of low back pain without leg pain. She has no previous history of
cancer and no weight loss, anorexia, or night sweats. Her physical
examination reveals mild paralumbar tenderness with normal strength,
sensation, and lower extremity reflexes. She has not worked for
3 days due to the back pain. She does not recall any specific work-related
injury. She rates the pain as 8 out of 10 and reports little improvement with
over-the-counter acetaminophen.Low back pain is extremely common and costly. It is the fifth
most frequent reason for office visits in the United States, accounting
for approximately 2% of all visits.1,2 Among
patients who see a health care professional, studies show that pain
and function typically improve substantially in the first month.3 Indeed,
most patients with acute low back pain do not go on to develop chronic
disabling symptoms. Common imaging changes (eg, degenerative disk
disease or bulging disks) are only weakly correlated with presence
of symptoms,4,5 so most primary care patients with
low back pain (approximately 85%) have pain that is termed nonspecific.4,6 Patients
who develop chronic disabling low back pain account for a markedly
disproportionate share of the costs associated with low back pain.7,8..."
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