Interní Med. 2008; 10(3): 142-145

Diferrential diagnosis and treatment of low back pain

MUDr. Ivan Vrba

Anesteziologicko-resuscitační oddělení, Nemocnice Na Homolce, Praha

Low back pain (LBP) is defined as pain, muscle tension or stiffness localized below the costal margin and above the gluteal folds, with or without leg pain. There is a lot of LBP classification. The basic classification is a division to the acute and chronic LBP, the other is division to specific cause (only 10 % cases) and non-specific one (without clear cause – up to 90 % cases). It is a very important to distinguish between low back pain and referred pain from non-low back pain sources. But now, it seems, the most important is a division in to a diagnostic triage (very serious illness, radicular pain, simply LBP). LBP is currently a tremendous medical and socioeconomic problem. Numerous randomized controlled trials and systematic reviews have been published on the effectiveness of treatment for LBP. These trials show strong evidence that advice to stay active. Non-steroidal anti-inflammatory drugs and muscle relaxants are effective treatments for acute LBP. Exercise therapy, behavioral therapy and multidisciplinary pain treatment programs are effective for treatment of chronic LBP. International guidelines on the management of acute LBP are consistent. Clinical guidelines on chronic LBP are urgently needed and the implementation is a important challenge.

Keywords: acute low back pain, chronic low back pain, diagnosis, treatment, guidelines

Published: May 1, 2008  Show citation