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Treatment for Low Back Pain Based on Timing

Who can benefit from treatment for back pain? And when should treatment be given? These are the questions discussed in this article.

There are about 15 million office visits to doctor's offices each year for back pain. Most get better without specific treatment. Money spent on health care could be saved if only those patients who need care get it. Some treatment can even make patients worse. Targeting those who really need intervention could also save some patients unnecessary suffering.

Doctors must triage or screen patients differently based on how long they've had the back pain. In the early or acute phase doctors look for red flags to indicate the need for urgent care. This would include patients who have fracture, infection, or tumors. Imaging isn't needed in this phase if there are no red flags.

For patients in the subacute phase pain has gone on more than four weeks. Studies show patients in this group are at risk for chronic pain and disability. An exam of psychologic and social factors is important during this phase. Patients who are improving slowly but steadily should be referred to physical therapy for a supervised exercise program.

Results of many studies show a strong link between chronic pain (lasts more than three months) and permanent disability. Only half the patients in this group are able to return to work. Treatment should involve many different members of the health care team. This is called a multidisciplinary approach.

The last group of patients to consider are those who have back pain that comes back two or more times during a 12-month period. This is called recurrent back pain. The doctor must look for both psychosocial factors and specific workplace hazards that could be causing repeated episodes of back pain.

Back pain of unknown cause remains a complex and poorly understood problem. Research has not given doctors all they need to make treatment decisions yet. The authors conclude by saying that triage is important but good judgment and experience are still the physician's best tools.

References: Sherri Weiser, PhD, and M. Rossignol, MD, MSc, FRCPC. Triage for Nonspecific Lower-Back Pain. In Clinical Orthopaedics and Related Research. February 2006. No. 443. Pp. 147-155.

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