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Red flags in low back pain

Nandini D Patel, Daniel F Broderick, Judah Burns, Tejaswini K Deshmukh, Ian Blair Fries, H Benjamin Harvey, Langston Holly, Christopher H Hunt, Bharathi D Jagadeesan, Tabassum A Kennedy, John E O'Toole, Joel S Perlmutter, Bruno Policeni, Joshua M Rosenow, Jason W Schroeder, Matthew T Whitehead, Rebecca S Cornelius, Amanda S Corey
Most patients presenting with uncomplicated acute low back pain (LBP) and/or radiculopathy do not require imaging. Imaging is considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. It is also considered for those patients presenting with red flags raising suspicion for serious underlying conditions, such as cauda equina syndrome, malignancy, fracture, and infection. Many imaging modalities are available to clinicians and radiologists for evaluating LBP...
September 2016: Journal of the American College of Radiology: JACR
Arianne P Verhagen, Aron Downie, Nahid Popal, Chris Maher, Bart W Koes
OBJECTIVE: The purpose of this study was to identify and descriptively compare the red flags endorsed in guidelines for the detection of serious pathology in patients presenting with low back pain to primary care. METHOD: We searched databases, the World Wide Web and contacted experts aiming to find the multidisciplinary clinical guideline in low back pain in primary care, and selected the most recent one per country. We extracted data on the number and type of red flags for identifying patients with higher likelihood of serious pathology...
September 2016: European Spine Journal
Lubdha M Shah, Jeffrey S Ross
UNLABELLED: : Imaging is important in the evaluation of patients with degenerative disease and infectious processes. There are numerous conditions that can manifest as low back pain (LBP) or neck pain in a patient, and in many cases, the cause may be multifactorial. Clinical history and physical examination are key components in the evaluation of such patients; however, physical examination has variable sensitivity and specificity. Although studies have demonstrated that uncomplicated acute LBP and/or radiculopathy are self-limited conditions that do not warrant any imaging, neuroimaging can provide clear anatomic delineation of potential causes of the patient's clinical presentation...
September 2016: Neurosurgery
Julie M Fritz, Minchul Kim, John S Magel, Carl V Asche
STUDY DESIGN: Economic evaluation of a randomized clinical trial. OBJECTIVE: Compare costs and cost-effectiveness of usual primary care management for patients with acute low back pain (LBP) with or without the addition of early physical therapy. SUMMARY OF BACKGROUND DATA: Low back pain is among the most common and costly conditions encountered in primary care. Early physical therapy following a new primary care consultation for acute LBP results in small clinical improvement but cost-effectiveness of a strategy of early physical therapy is unknown...
June 6, 2016: Spine
Ann Regina Lurati
Occupational acute lumbar injuries are a common injury. One intervention that is unique to occupational health is the determination of the amount of physical activity that an injured worker can perform without increasing the risk of further injury. Clinical recommendations suggest that workers continue to stay active; however, it is still the clinician's responsibility to determine the level of activity. The level of work activity is determined on a case-to-case basis and is done by evaluating the physical capacity of an injured worker and the job description...
May 2016: Orthopaedic Nursing
Andrei Fernandes Joaquim
Low back pain is in one of the most common reasons for seeking medical care in emergency care units, and also the second most common cause of work absenteeism. The recognition of red flags for serious diseases such as tumors and fractures, through proper history-taking and clinical examination, is essential for proper treatment and to rule out differential diagnoses. In the absence of suspected severe underlying disease, subsidiary radiological examinations are unnecessary. Analgesic and anti-inflammatory drugs are the treatment of choice and can be cautiously associated with muscle relaxants and opioids in more severe cases...
April 2016: Revista da Associação Médica Brasileira
Hans-Raimund Casser, Susann Seddigh, Michael Rauschmann
BACKGROUND: Back pain has many causes. In Germany, about 70% of adults have at least one episode of back pain per year. METHODS: This review is based on a selective literature search and on the German National Disease Management Guideline for Low Back Pain. RESULTS: The physician taking the history from a patient with back pain should ask about the nature, onset, course, localization, and radiation of the pain and its dependence on physical activity and/or emotional stress...
April 1, 2016: Deutsches Ärzteblatt International
M V Vygonskaya, E G Filatova
The paper is devoted to the most complicated aspects of low back pain. The differences between specific and nonspecific low back pain using the "red flags" system is highlighted. The authors consider the causes of pain chronification (the "yellow flags" system) and the necessity of using a biopsychosocial model. Main pathogenetic mechanisms of chronic muscle/skeletal pain are considered and the possible involvement of several mechanism in the pathogenesis of chronic pain as well as the use of complex therapy is discussed...
2016: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
Shala Cunningham
OBJECTIVE: The purpose of this study was to examine the validity and test-retest reliability of the ScreenAssist Lumbar Questionnaire (SALQ). If a high degree of reliability and validity could be determined, the questionnaire could provide physical therapists with a formal instrument to assist with the identification of patients with nonmusculoskeletal back pain or emergent musculoskeletal causes of back pain requiring referral to an alternate medical provider. METHODS: Participants were patients presenting to an internal medicine physician's office with the main complaint of low back pain over a 6 months period...
December 2015: Journal of Manual & Manipulative Therapy
Alessandro Rizzardo, Luca Miceli, Rym Bednarova, Giovanni Maria Guadagnin, Rodolfo Sbrojavacca, Giorgio Della Rocca
BACKGROUND: Low-back pain (LBP) affects about 40% of people at some point in their lives. In the presence of "red flags", further tests must be done to rule out underlying problems; however, biomedical imaging is currently overused. LBP involves large in-hospital and out-of-hospital economic costs, and it is also the most common musculoskeletal disorder seen in emergency departments (EDs). PATIENTS AND METHODS: This retrospective observational study enrolled 1,298 patients admitted to the ED, including all International Classification of Diseases 10 diagnosis codes for sciatica, lumbosciatica, and lumbago...
2016: Therapeutics and Clinical Risk Management
Maliha Shaikh, Andrew J K Östör
In the UK, low back pain is the most common cause of disability in young adults and every year 6-9% of adults consult their GP about back pain. A thorough history and examination is required to exclude an alternative diagnosis, such as pain arising from the hip or trochanteric bursa and to categorise patients as having: serious spinal pathology, nerve root/radicular pain or non-specific back pain. Inflammatory back pain is often missed, particularly in the early stages when examination may be normal. The primary features are pain arising in patients under 40, thoracolumbar or sacroiliac pain and alternating buttock pain...
December 2015: Practitioner
Risha Gidwani, Patricia Sinnott, Tigran Avoundjian, Jeanie Lo, Stevem M Asch, Paul G Barnett
OBJECTIVES: To analyze inappropriate use of magnetic resonance imaging (MRI) for patients with low back pain in a healthcare system with no financial incentives for overuse. STUDY DESIGN: We used administrative data to assess the appropriateness of lumbar spine (LS) MRI in the Veterans Health Administration. METHODS: All veterans who received LS MRI in the outpatient setting in fiscal year 2012 were included. We based our assessments of appropriateness on CMS criteria, which have been endorsed by the National Quality Forum...
February 2016: American Journal of Managed Care
Lindsey M Plass, Terrence G McGee, James M Elliott
A 58-year-old man was referred to physical therapy with a primary complaint of intermittent low back pain (LBP) 2 weeks after being in a motor vehicle collision. The absence of red flags justified the initiation of treatment, but when symptoms of unrelenting LBP emerged, he was referred to his primary care physician with a request for further medical workup. Before further imaging work-up was performed, the patient presented to the emergency room with a urinary complaint; this, in combination with unrelenting LBP, prompted further imaging follow-up...
February 2016: Journal of Orthopaedic and Sports Physical Therapy
Tara Potier, Emily Tims, Cherry Kilbride, Khadija Rantell
We conducted a five stage pilot study which initially consisted of a review of 75 case notes of people attending an emergency department (ED) in an inner London Teaching Hospital with musculoskeletal (MSK) low back pain (LBP). This review highlighted inconsistencies in how they were assessed and managed across and within different staff groups. We found patient documentation was often incomplete and that a biomedical model approach to the management of these patients was common. As a result, four further stages in the project were conducted...
2015: BMJ Quality Improvement Reports
Juan Luis Díaz-Cerrillo, Antonio Rondón-Ramos, Rita Pérez-González, Susana Clavero-Cano
OBJECTIVE: To assess the influence of an educational intervention in reducing «fear-avoidance» (FA) and «pain catastrophising» (CAT) in a population with unspecific chronic low back pain (UCLBP), attending physiotherapy in Primary Health Care. A pragmatic quasi-experimental study was conducted in Health Centres of a Costa del Sol Health District. DESIGN: Quasi-experimental study. SETTING: Primary Health Care physiotherapy Back Schools in Health Centres of a Costa del Sol Health District...
August 2016: Atencion Primaria
Evelien I T de Schepper, Bart W Koes, Erik F H Veldhuizen, Edwin H G Oei, Sita M A Bierma-Zeinstra, Pim A J Luijsterburg
BACKGROUND: The use of magnetic resonance imaging (MRI) as initial imaging for back pain has increased in general practice. However, few data are available on the characteristics of these referred patients. The objective of this study was to describe the baseline characteristics and MRI findings of patients presenting for a lumbar MRI examination as referred by their GP. METHODS: Patients presenting for a lumbar MRI examination as referred by their GP were recruited at the MRI Center...
February 2016: Family Practice
W Michael Hooten, Steven P Cohen
Low back pain (LBP) is a leading cause of disability worldwide. In the absence of a classification system for pain syndromes, classification of LBP on the basis of the distribution of pain as axial (pain generally localized to the low back) or radicular neuropathic (pain radiating to the lower extremities) is relevant to clinical practice because the distribution of pain is often a corollary of frequently occurring disease processes involving the lumbar spine. Common sources of axial LBP include the intervertebral disc, facet joint, sacroiliac joint, and paraspinal musculature, whereas common sources of radicular pain include a herniated intervertebral disc and spinal stenosis...
December 2015: Mayo Clinic Proceedings
Alan Rosenberg, Abiy Agiro, Marc Gottlieb, John Barron, Peter Brady, Ying Liu, Cindy Li, Andrea DeVries
IMPORTANCE: The Choosing Wisely campaign consists of more than 70 lists produced by specialty societies of medical practices or procedures of minimal clinical benefit to patients in most situations, with recommendations regarding judicious use. OBJECTIVE: To quantify the frequency and trends of some of the earliest Choosing Wisely recommendations using nationwide commercial health plan population-level data. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of claims data for members of Anthem-affiliated commercial health plans...
December 2015: JAMA Internal Medicine
Peter Vanbrabant, Lieven Moke, Wouter Meersseman, Geert Vanderschueren, Daniel Knockaert
BACKGROUND: Low back pain is extremely common and usually a minor self-limiting condition. Rarely, however, it is a harbinger of serious medical illness. Paraspinal compartment syndrome is a rare condition, but its timely recognition is important to allow adequate treatment. CASE REPORT: A 16-year-old boy presented to the Emergency Department (ED) with severe low back pain, necessitating intravenous opioids. Laboratory results showed severe rhabdomyolysis. Magnetic resonance imaging of the lumbar spine showed diffuse edema and swelling in the paraspinal muscles...
November 2015: Journal of Emergency Medicine
Wendy T M Enthoven, Judith Geuze, Jantine Scheele, Sita M A Bierma-Zeinstra, Herman J Bueving, Arthur M Bohnen, Wilco C Peul, Maurits W van Tulder, Marjolein Y Berger, Bart W Koes, Pim A J Luijsterburg
BACKGROUND: In a small proportion of patients experiencing unspecified back pain, a specified underlying pathology is present. OBJECTIVE: The purposes of this study were: (1) to identify the prevalence of physician-specified causes of back pain and (2) to assess associations between "red flags" and vertebral fractures, as diagnosed by the patients' general practitioner (GP), in older adults with back pain. METHODS: The Back Complaints in the Elders (BACE) study is a prospective cohort study...
March 2016: Physical Therapy
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