Treatment of acute low back pain
- Christopher L Knight, MD
Christopher L Knight, MD
- Assistant Professor
- University of Washington
- Richard A Deyo, MD, MPH
Richard A Deyo, MD, MPH
- Kaiser Professor of Evidence-Based Family Medicine
- Oregon Health & Science University
- Thomas O Staiger, MD
Thomas O Staiger, MD
- Associate Professor
- University of Washington School of Medicine
- Joyce E Wipf, MD
Joyce E Wipf, MD
- Professor of Medicine
- University of Washington
It is estimated that up to 84 percent of adults have low back pain at some time in their lives [1,2]. The vast majority of patients seen in primary care (>85 percent) will have nonspecific low back pain, meaning that the patient has back pain in the absence of a specific underlying condition that can be reliably identified [3-5]. For most of these individuals, episodes of back pain are self-limited. Patients who continue to have back pain beyond the acute period (four weeks) have subacute back pain (lasting between 4 and 12 weeks), and some may go on to develop chronic back pain (lasting >12 weeks) .
This discussion focuses on the initial treatment of nonspecific acute back pain. The treatment of acute low back pain from specific conditions is discussed in the appropriate topics. As examples:
●Treatment for vertebral compression fracture (see "Osteoporotic thoracolumbar vertebral compression fractures: Clinical manifestations and treatment")
●Treatment for lumbosacral radiculopathy (see "Acute lumbosacral radiculopathy: Treatment and prognosis")
●Treatment for lumbar spinal stenosis (see "Lumbar spinal stenosis: Treatment and prognosis")
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- GENERAL APPROACH TO CARE
- NONPHARMACOLOGIC THERAPIES
- Spinal manipulation
- Exercise and physical therapy
- Initial therapy
- - Nonsteroidal antiinflammatory drugs
- - Limited benefit of acetaminophen
- Second-line therapy
- - Combination with muscle relaxants
- Refractory or severe pain
- - Opioids
- - Tramadol
- Other medications
- PATIENT EDUCATION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS