Clinical-state-of-the-artTreatment strategy for chronic low back pain
Section snippets
Epidemiology
LBP is a highly prevalent health problem that most individuals experience at some point in their lives. LBP is among the leading causes of activity limitation and absence from work. The epidemiological data on LBP are widely conflicting. A 2012 systematic review found a point prevalence of 18.3% ± 11.7%, a 1-month prevalence of 30.8% ± 12.7%, a 1-year prevalence of 38% ± 19.4%, and a lifetime prevalence of 38.9% ± 24.3% [3]. Prevalence was higher in women (35.3% versus 29.4% in men) and was highest in
Risk factors for chronic low back pain
Investigations of prognostic factors are of the utmost importance to the identification of factors associated with unfavorable outcomes. Numerous studies have been conducted, often with conflicting results. However, a number of factors were consistently found [5]:
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factors related to the LBP episode:
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severe functional impairment,
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concomitant sciatica;
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individual factors:
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older age,
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poor general health;
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psychological factors:
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high level of psychological or psychosocial stress,
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negative thoughts about the
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Flags
Flags are risk factors for chronicity that can be easily identified by asking simple questions. Recommendations for LBP management include an evaluation of flags (Table 1). First, red and orange flags should be assessed to identify patients who require specific treatment. Red flags are signs and symptoms that suggest a specific underlying disease (tumor, infection, or inflammatory disease) and should be looked for in every patient with acute LBP. Orange flags identify psychopathological issues
Medications [18,19]
According to European recommendations for the management of chronic LBP, step 1 or 2 analgesics should be used [18]. Nonsteroidal anti-inflammatory drugs (NSAIDs) and weak opioids can be given for short periods to relieve pain flares. Antidepressants and muscle relaxants may deserve consideration for helping to relieve the pain. Anticonvulsant medications are not recommended, and systemic glucocorticoid therapy is not indicated. Epidural glucocorticoid injections have not been proven effective
Strategies for managing the patient with chronic low back pain
In every case, listening and informing are crucial components of the management strategy [27]:
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the patient must be taken seriously: the physician must listen to, and believe, what the patient says;
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easy-to-understand information on the problem must be provided;
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communication must be centered on the patient (expectations, perspectives, and preferences);
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the patient should be reassured and, if possible, informed that a favorable outcome can be achieved;
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the patient should be informed about what he/she
Disclosure of interest
The authors declare that they have no conflicts of interest concerning this article.
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2015, European Journal of Integrative MedicineCitation Excerpt :Low back pain may refer to pain, muscle tension or stiffness occurring between the costal margin and gluteal folds [6]. Rozenberg et al. [7] indicated that more than 90% of patients are categorized into nonspecific LBP cases. One of the main characteristics of nonspecific low back pain is its recurrent nature, which is an essential factor for predisposing the individuals to chronic illness [2,8].
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2014, Joint Bone SpineCitation Excerpt :This finding suggests a need for a routine screening for catastrophizing in order to determine the appropriateness of cognitive behavioral therapy targeting this additional source of distress. This approach that extends beyond the management of physical factors has been proven successful in patients with chronic low back pain [11]. The authors declare that they have no conflicts of interest concerning this article.