Presentation on theme: "Low Back Pain: Case Based Evaluation and Management"— Presentation transcript:
1 Low Back Pain: Case Based Evaluation and Management Patrick Kortebein, M.D.Departments of PM&R and GeriatricsUniversity of Arkansas for Medical Sciences5/31/09Slides:
2 ObjectivesUnderstand the evaluation and management of common sources of low back and related painUnderstand the significance of abnormal findings on lumbar spine MRI in individuals with low back and related pain.Understand the evaluation and management of chronic low back pain.
3 Low Back Pain Common; 2nd primary care visits Acute episodes 5-15% per year60-80% lifetimeAcute episodes75-90% recover w/in 3 months25-75% will have recurrence w/in 6 months
7 Case #1 28 yo M presents with CC: LBP Started 4 days ago while bending over to pick up his 14 mo old childPMHX: L knee arthroscopyMeds: AcetaminophenNKDASocial Hx: Married, insurance salesmanWhat other information is important?
42 Case # 351 yo M truck driver injured at work 2 years ago lifting a 30# box, and applying for disabilityContinued axial LBP and “numb” R LENo “Red Flags”Treatments to date:Medications: NSAIDs, Tramadol, HydrocodonePhysical Therapy: 24 sessionsWork restrictions; not workingInjections: Epidural / Facet / Sacroiliac
46 Chronic LBP Strong Association Depression Anxiety Poor Coping Skills “My back hurts, but I’m here because I can’t cope with this episode, as well as the turmoil at home (or work)”- N Hadler “Last Well Person”
51 Recommended ReadingKinkade S. Evaluation and treatment of acute low back pain. Am Fam Physician 2007; 75:1181-8,Deyo et al. Overtreating chronic back pain: time to back off? J Am Board Fam Med 2009; 22:62-8.LBP Handbook 2003Cole & Herring