Presentation on theme: "Low Back Pain: Case Based Evaluation and Management"— Presentation transcript:
1Low Back Pain: Case Based Evaluation and Management Patrick Kortebein, M.D.Departments of PM&R and GeriatricsUniversity of Arkansas for Medical Sciences5/31/09Slides:
2ObjectivesUnderstand 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.
3Low 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
7Case #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?
42Case # 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
46Chronic 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”
51Recommended 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