Lower back Pain LBP
It is the most expensive benign condition in industrialized countries and the most common cause of disability in persons younger than 45 years. It is defined as pain that persists longer than 12 weeks and often is attributed to degenerative or traumatic conditions of the spine. Fibrositis, inflammatory spondyloarthropathy, and metabolic bone conditions also are cited as causes. Patients with mechanical LBP often prefer to lie still in bed, while those with a vascular or visceral cause are often found writhing in pain, unable to find a comfortable position. Unrelenting pain at rest should generate suspicion for a serious cause such as cancer or infection.
Diagnostic "Red flags"
Diagnostic "Red flags"
- Pain unrelieved by rest or any postural modification
- Pain unchanged despite treatment for 2-4 weeks
- "Writhing" pain behavior
- Colicky pain or pain associated with a visceral function
- Known or previous cancer
- Fever or immunosuppressed status
- High risk for fracture (e.g., older age, osteoporosis)
- Associated malaise, fatigue, or weight loss
- Progressive neurological impairment
- Bowel or bladder dysfunction
- Severe morning stiffness as primary complaint
- Unable to ambulate or care for self
